CDC: Close Contact, Dining Out (Not Clubs) Linked to COVID-19

Data on exactly how COVID-19 is transmitted, and which places of public accommodation present the highest risk for transmitting COVID-19, are still emerging. The Centers for Disease Control and Prevention (CDC) published a new study examining which places people testing positive and negative for COVID-19 most likely visited.

The study found that people who tested positive for COVID-19 were more likely to have dined at a restaurant and to have a close contact who was positive for COVID-19 compared to people who tested negative. The authors note that situations in which adhering to mask-wearing and social distancing are difficult appear to create higher risk environments for COVID-19 transmission. Fitness centers providing ample social distancing and implementing (and enforcing) mask policies would not create such an environment. The study found no statistically significant association between COVID-19 test results and community activities, including:

• visiting a gym,
• shopping, and
• social gatherings, among others.

However, this study has been cited in media outlets to assert that fitness centers, alongside bars and restaurants, are among the highest risk locations for community spread of COVID-19. While data are still emerging, this particular study does not support the assertion that fitness centers are a high risk location for COVID-19 spread. In fact, this study found no statistically significant relationship between a COVID-19 test result and reported visits to a fitness center.

Study Methods & Findings

In a case control study, case patients (in this case those who were positive for COVID-19) and matched controls (people demographically similar to case patients but who tested negative for COVID-19) were identified and compared. Adults with a positive COVID-19 test result were randomly selected as case-patients. For each case-patient, two adults with a negative COVID-19 test result were randomly selected as control participants, and were matched by age, sex, and study location. The study started with 615 potential “case patients”—or people who had tested positive for COVID-19, and identified and contacted 1,212 people who could serve as matched controls 14-23 days following their test result.

After eliminating participants to satisfy the study criteria, the study included 306 people who received a COVID-19 test and were experiencing symptoms of COVID-19 at the time of their test. All participants—154 of whom tested positive and 160 of whom tested negative for COVID-19—took part in a structured interview conducted by CDC personnel. During the interview, evaluators asked participants about:

• demographic characteristics,
• underlying medical conditions,
• symptoms,
• self-reported physical and mental health,
• close contacts with a COVID-19 positive person,
• mask-wearing habits,
• potential workplace exposures, and
• their community activities 14 days prior to the onset of symptoms—including visits to restaurants, bars, salons, coffee shops, gyms, and social gatherings.

Participants also reported the degree to which others adhered to mask-wearing and social distancing during each reported activity.

According to the results, people who tested negative for COVID-19 were more likely to be white, have attained a college degree or higher, and report an underlying medical condition. People who tested positive were much more likely to report close contact with a COVID-19 positive person—42% compared to 14% for those testing negative. Half of the close contacts reported were family members.

Community Activities Linked to COVID-19

People who tested positive for COVID-19 were more than twice as likely to report dining out at a restaurant than those testing negative. When considering only those who did not report a COVID-positive close contact, people who tested positive for COVID-19 were more likely to report dining at a restaurant and visiting a coffee shop or bar.

The researchers found no statistically significant association between having a positive test result and having visited the gym.

There was also no statistically significant link between COVID-19 test results and any of the following community activities:

• Social gatherings of any
• Shopping at a retail store
• Visiting a salon
• Going to an office setting
• Using public transportation
• Going to a bar or coffee shop
• Attending a religious gathering

According to the authors, the practical implications of this study are that “eating and drinking on-site at locations that offer such options might be important risk factors associated with SARS-CoV-2 infection. Efforts to reduce possible exposures where mask use and social distancing are difficult to maintain, such as when eating and drinking, should be considered to protect customers, employees, and communities.”

This Data Is a Good Start—But We Need More

These results align with what we have seen with contact tracing in several states. For example, Colorado has reported no cases of COVID-19 in health clubs since they opened in June compared to 80 for bars and restaurants. In Louisiana, six outbreaks, resulting in 34 cases, were associated with fitness centers compared to 42 outbreaks, resulting in 190 cases, for restaurants.

There are, of course, several limitations to this study. Case-control studies rely on participant recall, which is not always reliable. Additionally, while this study can determine a correlation between COVID-19 test results and the likelihood of having visited certain places and/or participated in certain activities in the community, it does not provide any definitive information as to where COVID-19 cases were acquired. This study also did not include asymptomatic individuals who can still spread COVID-19 in the community.

More studies are needed in order to make a definitive conclusion about the risk of COVID-19 transmission in fitness centers and other community activities. More information is needed regarding air quality in fitness centers and dispersion of respiratory droplets during exercise compared to at rest and coughing, and researchers should continue leveraging contact tracing to determine the number of COVID-19 cases linked to health clubs and fitness centers. Internal data analysis suggests a low “visit-to-virus” ratio, but third party analysis is needed to validate that data.