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Covid-19: To Clean or Not to Clean?

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Covid-19: To Clean or Not to Clean?

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As it becomes clear, at least to those of us in the US, that Covid-19 will be with us a lot longer than anyone wants to contemplate, the next question for those of us fortunate enough not to have contracted it is how to minimize risk. And since this now looks to be a long haul, with many reporting or even exhibiting symptoms of Covid compliance fatigue, defining what are bona fide risks versus ones that are low, becomes even more important, since trying to do too much is likely to result in not doing much of anything well enough.

A new article in The Atlantic (hat tip ChiGal) argues that many of us are engaged in cleaning theater, just as much of what the TSA does in airports is security theater:

As a covid-19 summer surge sweeps the country, deep cleans are all the rage.

National restaurants such as Applebee’s are deputizing sanitation czars to oversee the constant scrubbing of window ledges, menus, and high chairs. The gym chain Planet Fitness is boasting in ads that “there’s no surface we won’t sanitize, no machine we won’t scrub.” New York City is shutting down its subway system every night, for the first time in its 116-year history, to blast the seats, walls, and poles with a variety of antiseptic weaponry, including electrostatic disinfectant sprays. And in Wauchula, Florida, the local government gave one resident permission to spray the town with hydrogen peroxide as he saw fit. “I think every city in the damn United States needs to be doing it,” he said…

But what if this is all just a huge waste of time?

In May, the Centers for Disease Control and Prevention updated its guidelines to clarify that while COVID-19 spreads easily among speakers and sneezers in close encounters, touching a surface “isn’t thought to be the main way the virus spreads.” Other scientists have reached a more forceful conclusion. “Surface transmission of COVID-19 is not justified at all by the science,” Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School, told me. He also emphasized the primacy of airborne person-to-person transmission…

Surface transmission—from touching doorknobs, mail, food-delivery packages, and subways poles—seems quite rare. (Quite rare isn’t the same as impossible: The scientists I spoke with constantly repeated the phrase “people should still wash their hands.”) The difference may be a simple matter of time. In the hours that can elapse between, say, Person 1 coughing on her hand and using it to push open a door and Person 2 touching the same door and rubbing his eye, the virus particles from the initial cough may have sufficiently deteriorated.

Now on the one hand, I welcome this discussion if nothing else because I’ve relaxed a lot of my own cleaning discipline. I used to use my trusty alcohol bottle to spray and then wipe down the touched surfaces of the car after the aides had driven it and then I went out. I stopped that, concluding that wearing a mask when out resulted in my hands being off my face enough so that washing my hands when I returned from my errands would suffice. And that’s all for the best, since you need to let 60% to 70% alcohol sit a full 30 seconds in order to kill Covid-19, and a lot of the time I wasn’t doing that.1

And another reason this topic is important is that a lot of the cleaning is ineffective…not even for the stated reason, that the surfaces cleaned in the overwhelming majority of cases won’t have enough Covid-19 on it to pose a transmission risk. It’s that the sanitation is ineffective. My favorite example is the wipedowns of shopping carts. Have you bothered watching how they are done? First, the staff uses cleaners that are too weak to do anything to viruses (all sorts of cleaning products claim to kill germs when viruses are another kettle of fish).

Second, they don’t leave them on the surface long enough. You need to leave undiluted Clorox on a surface for five minutes to kill Covid-19. Fumes fumes fumes!!! None of the stuff these well-meaing store employees use is remotely as strong as bleach or alcohol….which are nasty to handle…so the only cleaning is happening via mechanical action, not chemical nuking of pathogens. And that would mean real scrubbing, with a garden variety soap or cleaning solution, and a proper rinse. Instead, I see the store staff using dirty rags over and over, which seems more likely to move germs around than kill them.

So if you are worried about carts, bring your own trusty alcohol bottle, or put on gloves and trash them when you return the cart, or just use a paper towel or some other barrier so you don’t touch the cart handle.

But having said that, who can’t like NYC having clean subways, as in really clean? People who are not city dwellers forget that drunks throw up in them and people spill drinks and food, so there’s all sorts of mess. People are afraid of taking the Metro North and the Path, and I understand the subways too, even though the real risk is unmasked fellow passengers, particularly if they cough or talk.

So perhaps the effort of visibly clean trains will encourage more mask compliance (which is pretty good in NYC but readers report that some on trains pull down their masks to converse, gah). More messaging about the inability to trace Covid-19 cases to the much more crowded Tokyo subways might also help.

More generally, the article takes an unduly black and white stance when there are plenty of grey areas and unknowns. There are still lots of unknowns, particularly about transmission. With our terrible testing in the US, it will be quite a while before we know much more. In the meantime, more evidence is piling up that even getting a mild infection is dangerous. For example, a fresh study out of Germany of Covid-19 victims, which included mild cases and people with no pre-existing conditions, found that 78 out of the 100 examined by MRI had heart abnormalities. This means the reasons for working to avoid getting Covid-19 are even stronger than some might believe. So taking steps that involve comparatively little effort that have potential protective value are worth it.

For instance, while I do understand the Atlantic author dissing the cleaning done at Planet Fitness (strictly limiting the number of users and getting people not on cardio machines to wear masks would do more good), and per above, I suspect what cleaning they do is virtually useless, that does not mean that being a virus-phobe at a gym is wrong-headed. My gym lets only a maximum of 10 people into its >2500 square foot gym area (excluding the bathrooms) which has 14 foot ceilings, meaning lots of cubic volume at any time and says it cleans between time slots (not really…it’s not even as good as the grocery store cart handle cleaning). My impression is they do a more through job overnight but I am also highly confident no one is bombing the gym with Clorox and leaving to let it do its work.

The point of this long-winded narrative is that dumbbell handles, handles on machines (such as the ones used to change weight levels) get touched a lot, when people in gyms wipe their noses and touch their mouths a lot. In other words, normal habits result in personal body fluids on surfaces people touch, and not just through droplets landing. And the gym has unintentionally induced a false sense of confidence via its claims of intra-day cleaning plus giving members mini-bottles of clearly-too-weak-to-do-anything solution and microfiber washcloths and asking them to wipe up after equipment use. I’m sure it’s better than nothing, since the mechanical action probably will remove some pathogens. But this isn’t adequate if you believe those surfaces can harbor contagious levels of Covid-19, which is the premise of this exercise. Hence I carry and use my trusty alcohol bottle!

The other reason I’m more of a cleaning freak than I used to be is that cleaning is the best proxy we have for the aides as to how careful they are likely to be with other Covid-19 precautions in their private life. So we keep the house tidier than usual and I wear a mask in the house to model behavior.

In addition to taking even more dietary supplements and meds (Vitamin D, zinc, progesterone, melatonin and now the juice of half a lime, based on an MD recommendation), we are also airing out the house daily.

In other words, a risk assessment based on the environments you encounter is very much in order, along with then taking suitable protective measures. And in the spirit of Taleb, with unknowns that have very bad outcomes associated with them, being overly cautious is worthwhile. You can always change course when you have better data.

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1 And if you inhale alcohol fumes (which is a given if you are fooling with a car), it irritates your trachea, which can then lead to Covid alarm.

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