Hygiene Theater Is Still a Huge Waste of Time

Six months ago, I wrote that Americans had embraced a backwards view of the coronavirus. Too many people imagined the fight against COVID-19 as a land war to be waged with sudsy hand-to-hand combat against grimy surfaces. Meanwhile, the science suggested we should be focused on an aerial strategy. The virus spreads most efficiently through the air via the spittle spray that we emit when we exhale—especially when we cough, talk loudly, sing, or exercise. I called this conceptual error, and the bonanza of pointless power-scrubbing that it had inspired, “hygiene theater.”

My chief inspiration was an essay in the medical journal The Lancet called “Exaggerated Risk of Transmission of COVID-19 by Fomites.” (Fomites is a medical term for objects and surfaces that can pass along an infectious pathogen.) Its author was Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School. At the time, Goldman was a lonely voice in the wilderness. Lysol wipes were flying off the shelves, and it was controversial to suggest that this behavior was anything less than saintly and salutary. Other journals had rejected Goldman’s short essay, and some were still publishing frightening research about the possible danger of our groceries and Amazon packages.

But half a year later, Goldman looks oracular. Since last spring, the CDC has expanded its guidance to clarify that the coronavirus “spreads less commonly through contact with contaminated surfaces.” In the past month, the leading scientific journal Nature published both a long analysis and a sharp editorial reiterating Goldman’s thesis. “A year into the pandemic, the evidence is now clear,” the editorial begins. “Catching the virus from surfaces—although plausible—seems to be rare.”

[Read: The mutated coronavirus is a ticking time bomb]

When I reached Goldman, he sounded triumphant, if a bit exhausted by the persistence of bad information and ongoing hygiene theater in American life. “There’s been no solid evidence to change my view about the minor, if any, role of surface transmission, and there’s been more evidence that I was right,” Goldman told me.

Still, scare-stories about surface transmission abound. In October, a paper by Australian researchers found that virus particles can survive almost a month on surfaces. That finding circumnavigated the globe, making headlines in The Guardian, Al Jazeera, the BBC, NBC, ABC. The opening paragraph in Reuters’s coverage was typical and quite terrifying:

The virus that causes COVID-19 can survive on banknotes, glass and stainless steel for up to 28 days, much longer than the flu virus, Australian researchers said on Monday, highlighting the need for frequent cleaning and handwashing.

The Australian paper was a greatest-hits compilation of research errors, Goldman told me. “It used so many unrealistic conditions to favor the virus’s survival,” he said. “They kept samples in the dark to spare it from light that kills the virus. They used optimal temperature and humidity.” Most important, their samples included a gargantuan amount of virus—“thousands and thousands of virus particles, when the research on influenza indicates that coughs or sneezes emit something in the range of 10 to 100 virus particles in a droplet.”

By contrast, real-world experiments that test for infectious SARS-CoV-2 from hospital surfaces have shown little infectious virus. In Italy, researchers swabbed a number of surfaces in a hospital following standard cleaning procedures and found no evidence of viable virus. Following standard precautions, “SARS-CoV-2 transmission is unlikely to occur in real-life conditions,” they concluded. Another study from Israel collected viral RNA samples from surfaces in several hospitals and quarantine hotels and found that none contained infectious levels of coronavirus.

[Derek Thompson: Mask up and shut up]

To be clear: The fact that the coronavirus is much less likely to spread through surfaces does not mean that it is impossible to get the coronavirus from touching things. If somebody with COVID-19 sneezes three times onto a little spot on a cold steel table, and you rub your hand around in the snot for a bit and immediately lick your fingers, that disgusting act may well result in you infecting yourself. But the threat of such unbelievably stupid behavior at a mass level shouldn’t warrant a multibillion-dollar war on fomites. “If surface transmission happened, it would have to require touching a newly contaminated surface, then very quickly touching your eyes, nose, or mouth without washing your hands first,” Goldman allows. That’s why he strongly advocates for hand-washing with soap and warm water, but otherwise not treating surfaces during this pandemic too differently than you otherwise would.

Why does this form of hygienic sensationalism even matter? If people want to wash their hands nine times a day, I guess they should go right ahead.  

But the costs of hygiene theater are greater than dry hands for paranoid people. First, it’s absorbing precious resources. Urban-transit authorities have spent hundreds of millions of dollars blasting their subways and buses with antimicrobial weaponry, even as they discuss the need to cut essential service. Money that should be spent on rides is being directed toward soap. Second, it builds a false sense of security: If you believe that the coronavirus is spread from surfaces rather than the air, you might be more likely to hang out in a restaurant that cleans its tables—increasing the odds that you get sick from an airborne disease floating your way from strangers seated nearby.

[Read: Don’t eat inside a restaurant]

Disinfectant mania also poses a health risk. As hotels, gyms, and offices engage in an arms race for the most germ-smashing disinfectants, health experts are starting to warn that these measures might accidentally make patrons and employees sick. Poison Control calls in the U.S. spiked by nearly 40 percent in 2020, largely because of the increase in exposures to disinfectants and cleaning supplies. Former President Donald Trump may shoulder some blame here: Last year, he wondered aloud if injections of cleaning fluid might combat the coronavirus. But widespread dissemination of bad information is a likelier culprit. In one case, a woman who heard from news reports that vegetables could convey the virus “soaked her produce in bleach, vinegar, and hot water,” according to the CDC. After this toxic sous-vide experiment, she went to the hospital coughing and wheezing, where she required additional oxygen and bronchodilator medication.

Hygiene theater is part of a bigger problem with America’s relationship to science. The cliché is that people should “follow the science” and do whatever “science says.” But the truth is that science says many things at once. Science says that the coronavirus can last one month on surfaces; it also says it’s vanishingly rare to get the coronavirus from surfaces. Bad studies, good studies, and mediocre studies are all part of the cacophonous hydra of “science” that is constantly “saying” stuff. In the telephone game between scientific research, media reports, and public understanding, dubious studies get simplified, exaggerated, and concretized as gospel. The solution isn’t to expect Americans to develop perfect scientific literacy; we can’t expect busy people to carve out time for an epidemiology degree in the middle of a pandemic. The only solution is clear expert guidance, an area where the U.S. government has consistently failed.

If hygiene theater were actual theater, it would exist in the genre of catastrophic improv. Hundreds of millions of people are ad-libbing their way through a crisis in the absence of a clear script. That script could begin something like this: The best defenses against an airborne virus are masks, social distancing, and ventilation—at least until you can get a vaccine—not gloves and bleach. “Some people still don’t get it,” Goldman said. “They’re distracting the public from the measures that can really protect them.”