Orange County public health officials say coronavirus outbreaks among restaurant employees rose sharply after indoor dining opened back in May, while dropping since the state shut down indoor dining again early this month.

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“We’ve seen outbreaks associated with many different kinds of work sites, but the largest number have been seen in restaurants. Restaurant clusters increased dramatically in number coincident with opening of in-room dining in the county, we’ve seen a decrease in these reports since in-room dining was discontinued,” said Dr. Matthew Zahn, medical director of the Health Care Agency’s communicable disease control division, on Wednesday in response to questions from Voice of OC.

“Clearly, since the closure of…indoor restaurants before July 4, we have seen a decreasing number of contacts from restaurants to ask for help when they have more than one or two employees that [were] infected,” added Dr. Clayton Chau, director of the Health Care Agency and the interim county health officer, at the county’s weekly coronavirus news conference on Thursday.

Coronavirus is believed to spread most through people being in close proximity to someone who is infected, with a higher chance of spreading in indoor spaces while not wearing masks.

“Outdoors you just get more ventilation, and you get breezes that carry the droplets away,” said Andrew Noymer, an epidemiologist and professor at UC Irvine.

And restaurant staff, in particular, spend many hours per day in close proximity to people, which increases their risk of exposure compared with customers who eat there for about an hour, he said.

“Dining at a restaurant you’re exposed to whoever’s there while you’re there. But working at a restaurant you’re exposed to everyone,” Noymer said.

Earlier in the pandemic, Orange County health inspectors enforced the first round of indoor dining closures through verbal warnings before escalating to a potential shut-down order. But the county later backed off enforcement after public calls from supervisors Michelle Steel and Don Wagner on May 4 and 5 to not enforce business closures in effect at the time, including the indoor dining restrictions.

Later in May, county officials announced they succeeded in getting state approval to re-open indoor dining.  But on July 1, Gov. Gavin Newsom closed indoor dining down again in OC and 18 other counties that were seeing sharp rises in coronavirus hospitalizations. He established state “strike teams” to enforce the latest closures, which close indoor dining while allowing take-out, delivery and outdoor dining if safety measures are met like spacing out tables and mask-wearing by employees.

The day after Newsom shut down indoor dining again, Steel criticized it as harming businesses and the economy.

“Because of this sudden order, these businesses will lose so much and this will likely have larger negative consequences on the California economy than we predicted,” Steel said at the county’s July 2 news conference.

A few minutes later, Orange County’s public health director said the reason for the dine-in closures was to help reduce the higher risk of infection in such spaces.

“When you are indoors and you linger around longer with people who do not live in the same household as you, you’re at higher risk of of getting [a coronavirus] infection,” Chau said.

At this week’s news conference, county CEO Frank Kim noted county supervisors this week approved a $10 million grant program for restaurants to incentivize them to comply with the state’s mandatory health guidelines, which the county no longer enforces but does report potential violations to state enforcement agencies.

“As we identify that there are violations of the [restaurant health] criteria, that we’re working with the state, as required, to identify situations that need their attention,” Kim said.

Chau said the county health department is working closely with the state’s Department of Alcoholic Beverage Control (ABC), which is among the state agencies doing restaurant enforcement. Over the weekend, ABC officials visited 217 business entities and did not issue citations, Chau said. Much of the enforcement during the pandemic has focused on verbal education and warnings before any potential citations or shutdowns are issued.

When a restaurant does have an outbreak, county health officials say they help educate the business on prevention and identify people who may have been exposed through close contact with an infected person.

“Our Environmental Health Division reaches out to every restaurant that has one or more cases reported in staff, and our Communicable Disease Control Division reaches out to educate every work site where a staff person is identified to have disease. We assist them with infection control guidance. We also help sites identify close contacts of cases that need to be excluded from work, and assess the need for broader staff testing,” Zahn, the Health Care Agency manager, said Wednesday in his written answer to questions.

Orange County public health officials said this week they’re having a tough time stopping coronavirus outbreaks because of a lag in testing results turnaround, coupled with not enough contact tracers in the county. A shortage of testing leading to wait times that can be a week or more in some cases to get tested, and another several days before results come back.

As local restaurants and other workplaces face outbreaks, OC officials have faced questions about why they don’t publicly disclose where outbreaks have occurred.

LA County publishes an online list of workplaces that have had clusters of coronavirus cases among staff, along with how many of their staff have tested positive. Many of the largest clusters have been at industrial settings like clothing manufacturers and meatpacking plants, as well as grocery stories and police stations.

This week, OC officials reiterated they have no current plans to publish such a list, citing concerns about fairness and cooperation.

“Because of the delay, it…truly isn’t fair to list [a business], because by the time we find out there is somebody who tested positive, the time has already passed. It doesn’t even make any sense to list them, or close them,” said Dr. Clayton Chau, director of the Orange County Health Care Agency and the county’s interim health officer, speaking at Tuesday’s meeting of the county Board of Supervisors.

“And then if you list them, you are discouraging business to come and work with us, right? Because who wants to be listed as, ‘I have an outbreak in my business’? So it’s a disincentive for them to work with us. We really want them to contact us, so we can help them to make sure that we mitigate any issue that they have.”

Asked about Chau’s concerns, LA County health officials said they believe disclosing all workplace outbreaks is the right thing to do and that they haven’t seen it get in the way of businesses working with them.

“We think it is appropriate to list all sites with outbreaks and haven’t noticed that this impedes cooperation,” Los Angeles County Department of Public Health officials said in a statement Thursday.

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