Since the beginning of the coronavirus pandemic, Pennsylvanians have been encouraged to adjust their routines to help slow the spread of the virus in their communities and the state.
Targeted mitigation efforts and safety guidelines have been implemented throughout the pandemic to lower the risk of people spreading the virus.
One area often included in mitigation efforts is the retail food services industry.
"The restrictions are basically aimed at decreasing the number of opportunities for people to get into population dense buildings where there may not be the best ventilation and where the spread is actually easier," said Dr. Gerald Maloney, chief medical officer for Geisinger hospitals.
On Dec. 10, Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine put Pennsylvania "on pause" with additional, limited-time mitigation efforts to help slow the spread of the virus as daily new case numbers and hospitalizations continue rise, passing peak numbers in the spring.
Under these new efforts which are in effect until Jan. 4, indoor dining is prohibited at restaurants, bars and other similar establishments. Indoor events and gatherings of more than 10 people are also prohibited.
There has been pushback from residents and business owners throughout the pandemic about these mitigation efforts. Many feel small businesses and restaurants are being unfairly targeted as other businesses such as large box stores and grocery stores are not included in the restrictions.
Indoor dining is determined to be riskier than going to other larger businesses because of the way the virus spreads, Maloney said.
"The virus can actually change the way it spreads under certain circumstances," he said. "Normally the virus spreads by what we call droplets. When we get into enclosed spaces where there's not the best ventilation, the virus can actually stay suspended in the air for longer."
One of the best protections against the virus, outside of the vaccine, is wearing a mask.
Maloney explained that masks help limit the amount of droplets the wearer expels into the air and prevents the wearer from breathing in droplets expelled by others. Being physically farther apart from others also helps lessen the spread of these droplets.
In indoor dining areas, people are unable to wear their masks the same way they would in other environments.
"We do have to take our mask off when we're eating and drinking," Maloney said. "We have tended to let our guard down around people that we know, which are generally the people that we eat and drink with. The other thing that we know is a key factor in the spread is the density of people in a given space."
In addition to being in an enclosed space with strangers, people are more likely to go out to a restaurant with people they do not live with than to other types of businesses.
If people do go to other businesses with someone they do not live with, they are able to wear a mask the entire time unlike in a restaurant where a mask cannot be worn to eat or drink, he said.
The size difference between a dining area in a restaurant and larger businesses is also a factor, Maloney said.
In box stores, people are often not stationary the same way they are in the dining area of a restaurant. In other businesses, people move past other shoppers instead of remaining close to them for an extended period of time.
Businesses with larger spaces and high ceilings allow for social distancing and better ventilation, which lowers the risk of spreading COVID-19, Maloney said. A mask can also be worn the entire time the person is inside the business.
"The number of times that the ventilation system is able to turn over the air, the number of air exchanges per minute, actually has a lot to do with the ability of the virus to spread," Maloney said.
Maloney explained that having a group of people in a smaller, enclosed space creates a better environment for the virus to spread. He added that less ventilation and the inability to wear a mask in these spaces increases the risk.
The percent positivity rate has continued to increase in counties and throughout the state. That means more people are likely to have COVID-19, which increases the risk of an outbreak should a group of people spend time together in an enclosed space where they cannot socially distance or wear a mask, Maloney said. This is an environment that is common among restaurants and bars.
Health care workers and officials expected to see case numbers rise when temperatures began to drop as people were spending less time outside, which allowed for social distancing and better ventilation.
With people now spending more time indoors, the virus can more easily spread, and the risk of spread increases when people are in an enclosed space and are unable to wear a mask, Maloney said.
"Everybody moved indoors where people are closer together and the population density is greater and the ventilation is not as good as being outside," Maloney said. "And we know that by condensing (people) into a smaller space, the chance of spread is greater."
Maloney said he understands the struggle this creates for the retail food services industry, but everyone also needs to understand the environment inside these businesses increases the risk of spreading the virus.
If nothing else, he stressed the importance of everyone wearing a mask whenever they are in the company of people they do not live with, no matter the environment.