Corona Daily 060: Hygiene Theatre

Last year, the first time my family went to a restaurant, our temperatures were checked. When I asked the waiter for the menu, he said it would be on my smartphone. Please click on the QR code and you will see the menu.

The ice cream shops stopped serving cones. McDonalds ketchup pumps disappeared. In Bombay, a roadside vegetable vendor asked me to pay him through Google Pay.

Cleaning of handles and knobs, metal surfaces, Amazon parcels; washing of vegetables and fruits became an obsession. A friend of mine carries a special stick to press the lift knobs. For the first time in 116 years, New York City shut down its subway system in the night to disinfect seats, compartment walls, and poles with antiseptic weapons. “They are power washing the outside of cars as if New Yorkers were going around licking the exteriors of subway cars. It’s hygiene theatre, and it has no place in the public discussion about covid now.” Said someone.

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This obsession is similar to the safety theatre triggered by the terrorist attacks. Before entering Bombay’s shopping malls and luxury hotels, a guard checks under your car with a mirror. The same car can carry a rocket launcher or Kalashnikovs inside, not under. At the airport, toothpastes and perfume bottles get confiscated. In 2006, a British not-such-a-gentleman was planning to carry a powdered drink Tang, and with a set of batteries wished to detonate the drink on a flight. He was arrested before boarding. Not sure if anybody has checked whether 100ml+ Tang can cause an explosion. But that single speculative case has prevented millions of air passengers from carrying ordinary water bottles on flights. Would the “hygiene theatre” continue like the “security theatre”?

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Last July, Emanuel Goldman, a microbiology professor, published a paper in the Lancet called “Exaggerated Risk of Transmission of Covid-19 by Fomites”. In medical lingo, Fomites are objects and surfaces that can transmit an infectious pathogen.

It is believed that if you touch a surface that a sick person has touched, and then touch your eyes or mouth, you will infect yourself. Goldman says this is true of some diseases, particularly bacterial diseases. However, most respiratory viruses spread primarily through air. RSV (respiratory syncytial virus) is the only one where there is evidence fomite transmission can happen. Rhinovirus that causes the common cold, and flu overwhelmingly spread via aerosols.

Ventilation, therefore, is more important than surfaces. Open windows may be safer than the strongest disinfectants. Washing hands, though, is a good habit, before preparing food, and after going to the bathroom. This has nothing to do with the pandemic.

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A well known case study in Seoul, South Korea talks about cases in a skyscraper. On its eleventh floor was a call center. This is where people were talking loudly as part of their job. More than half the members of the call center became sick. More than 1000 employees and residents shared elevators in the same building, and touched the same buttons as the call center employees. However, less than one percent was infected in the rest of the building. This case is cited as an example that transmission happened mainly through aerosols and was airborne, rather than by touching the surfaces.

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Two months ago, America’s CDC finally acknowledged that the risk of getting infected through contact with contaminated surfaces or objects (fomites) was low. The CDC director said disinfection is recommended in indoor settings such as schools or homes only if there has been a suspected or confirmed case in the last 24 hours.

Aggressive cleaning of surfaces creates a false sense of security. It is also a waste of money and time. The current consensus is that outdoor activities are much safer. Indoors, ventilation is critical. Masks and handwashing are more useful than obsessive cleaning of surfaces.

One hopes the hygiene theatre doesn’t become a constant the way security theatre has.

Ravi