tag:theconversation.com,2011:/id/topics/hand-washing-11584/articlesHand washing – The Conversation2023-04-24T16:14:01Ztag:theconversation.com,2011:article/2039882023-04-24T16:14:01Z2023-04-24T16:14:01ZThe dirty truth about your phone – and why you need to stop scrolling in the bathroom<figure><img src="https://images.theconversation.com/files/522188/original/file-20230420-1700-nz53nk.png?ixlib=rb-1.1.0&rect=14%2C26%2C1970%2C1461&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Using your phone when you're on the toilet is a horrid habit. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-beautiful-young-woman-using-488716744">Canva/Shutterstock</a></span></figcaption></figure><p>We carry them everywhere, take them to bed, to the bathroom and for many people they’re the first thing they see in the morning – more than 90% of the world owns or uses a <a href="https://doi.org/10.3390/microorganisms11020523">mobile phone</a> and many of us couldn’t manage without one.</p>
<p>But while health concerns about phones use usually focus on the <a href="https://theconversation.com/why-using-a-mobile-phone-while-driving-is-so-dangerous-even-when-youre-hands-free-71833">distraction they can cause</a> while driving, the possible effects of <a href="https://theconversation.com/theres-no-evidence-5g-is-going-to-harm-our-health-so-lets-stop-worrying-about-it-120501">radiofrequency exposure</a>, or just how <a href="https://theconversation.com/seven-tips-for-a-healthier-relationship-with-your-phone-202215">addictive they can be</a>. The microbial infection risk of your phone is much less appreciated – <a href="https://www.nature.com/articles/s41598-021-93622-w">but it’s very real</a>.</p>
<p><a href="https://yougov.co.uk/topics/society/articles-reports/2019/02/28/most-britons-use-their-phone-toilet">A 2019 survey</a> found that most people in the UK use their phones on the toilet. So it’s not surprising to discover studies have found our mobile phones to be <a href="https://cals.arizona.edu/news/why-your-cellphone-has-more-germs-toilet">dirtier that toilet seats</a>. </p>
<p>We give our phones to children to play with (who aren’t exactly well known for their hygiene). We also eat while using our phones and put them down on all sorts of (dirty) surfaces. All of which can transfer microbes onto your phone along with food deposits for those microbes to eat. </p>
<p>It’s been estimated that people touch their phone <a href="https://www.dailymail.co.uk/news/article-2276752/Mobile-users-leave-phone-minutes-check-150-times-day.html">hundreds</a> if not <a href="https://dscout.com/people-nerds/mobile-touches">thousands</a> of times a day. And while many of us wash our hands regularly after say, going to the bathroom, cooking, cleaning, or gardening, we are much less likely to consider washing our hands after <a href="https://www2.deloitte.com/content/dam/insights/articles/us175371_tmt_connectivity-and-mobile-trends-interactive-landing-page/DI_Connectivity-mobile-trends-2022.pdf">touching our phones</a>. But given how disgusting and germ-infested phones can be, maybe it’s time to think more about <a href="https://pubmed.ncbi.nlm.nih.gov/19267892/">mobile phone hygiene</a>.</p>
<h2>Germs, bacteria, viruses</h2>
<p>Hands pick up bacteria and viruses all the time and are <a href="https://www.cdc.gov/handwashing/when-how-handwashing.html">recognised as a route</a> for <a href="https://www.ncbi.nlm.nih.gov/books/NBK144014/#parti_ch7.s3">acquiring infection</a>. So too are the phones we touch. <a href="https://www.nature.com/articles/s41598-022-14118-9">A number</a> of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196688/">studies</a> conducted on the microbiological colonisation of mobile phones show that they can be contaminated with many different kinds of potentially pathogenic bacteria.</p>
<p>These include the diarrhoea-inducing <em>E. coli</em> (which, by the way, comes from human poo) and the skin-infecting <em>Staphylococcus</em>, as well as <em>Actinobacteria</em>, which can cause tuberculosis and diphtheria, <em>Citrobacter</em>, which can lead to painful urinary tract infections, and <em>Enterococcus</em>, which is known to cause meningitis. <em>Klebsiella</em>, <em>Micrococcus</em>, <em>Proteus</em>, <em>Pseudomonas</em> and <em>Streptococcus</em> have also been found on phones and all can have equally nasty effects on humans.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130244/">Research</a> has found that many pathogens on phones are often antibiotic resistant, meaning they can’t be treated with conventional drugs. This is worrying as these bacteria can cause skin, gut and respiratory infections that can be life-threatening. </p>
<p>Research has also found that even if you clean your phone with antibacterial wipes or alcohol it can still be recolonised by microorganisms, indicating that <a href="https://www.mdpi.com/2076-2607/11/2/523">sanitisation</a> must be a <a href="https://www.nature.com/articles/s41598-022-14118-9">regular process</a>. </p>
<figure class="align-center ">
<img alt="Woman wearing yellow jumper cleaning phone screen with a wipe." src="https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/522184/original/file-20230420-23-ne9bdl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The importance of cleaning your phone and how to do it safely.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-global-epidemic-woman-disinfecting-phone-1677416521">Volurol/Shutterstock</a></span>
</figcaption>
</figure>
<p>Phones contain plastic which can harbour and <a href="https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)01034-4/fulltext">transmit viruses</a> some of which (the common cold virus) can live on hard plastic surfaces for up to a week. Other viruses such as COVID-19, rotavirus (a highly infectious stomach bug that typically affects babies and young children), influenza and norovirus – which can cause serious respiratory and gut infections – can persist in an infectable form for several days. </p>
<p>Indeed, since the beginning of the COVID pandemic, the US Centers for Disease Control and Prevention has introduced <a href="https://www.cdc.gov/hygiene/cleaning/cleaning-your-home.html">guidelines for cleaning and disinfecting mobile phones</a> – which, along with door handles, cash machines and <a href="https://theconversation.com/from-the-bed-sheets-to-the-tv-remote-a-microbiologist-reveals-the-shocking-truth-about-dirt-and-germs-in-hotel-rooms-202195">lift buttons</a>, are considered <a href="https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)01034-4/fulltext">reservoirs of infection</a>. </p>
<p>In particular, concern has been raised about the role mobile phones can play in the spread of infectious microbes in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196688/">hospital and healthcare settings</a>, as well as in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466825/">schools</a>. </p>
<h2>Clean your phone</h2>
<p>So it’s clear that you need to start cleaning your phone regularly. The US Federal Communications Commission actually recommends <a href="https://www.fcc.gov/consumers/guides/how-sanitize-your-phone-and-other-devices">daily sanitation</a> of your phone and other devices – not least because we are still within an active COVID-19 pandemic and the virus can survive for several days on hard plastic surfaces. </p>
<p>Use <a href="https://www.fcc.gov/consumers/guides/how-sanitize-your-phone-and-other-devices">alcohol-based wipes or sprays</a>. They need to contain at least 70% alcohol to disinfect phone casings and touch screens, and it needs to be done every day if possible. </p>
<p>Do not spray sanitisers directly onto the phone and keep liquids away from connection points or other phone openings. Absolutely avoid using bleach or abrasive cleaners. And wash your hands thoroughly after you’ve finished cleaning.</p>
<p>Thinking about how you handle your phone will also help to avoid it becoming colonised with germs. When not at home, keep your phone in your pocket, or bag and use a disposable paper list of to-do items, rather than constantly consulting your phone. Touch your phone with clean hands – washed with soap and water or disinfected with alcohol-based hand sanitiser. </p>
<p>There are other things you can do to avoid your phone becoming a source of viruses. Do not share your phone with others if you have any infection, or have not first sanitised it. If children are allowed to play with your phone, sanitise it as soon as possible afterwards. </p>
<p>And get in the habit of putting your phone away when not in use, then sanitising or washing your hands. You might also want to occasionally sanitise your phone charger when you are cleaning your phone.</p><img src="https://counter.theconversation.com/content/203988/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Primrose Freestone does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Your mobile phone is 10 times dirtier than a toilet seat. Here’s what to do about it.Primrose Freestone, Senior Lecturer in Clinical Microbiology, University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698922021-10-19T12:22:59Z2021-10-19T12:22:59ZYes, we should be keeping the healthier hand-washing habits we developed at the start of the pandemic<figure><img src="https://images.theconversation.com/files/427061/original/file-20211018-27-10mqkvf.jpg?ixlib=rb-1.1.0&rect=214%2C168%2C5782%2C3951&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Washing your hands is an easy and effective way to reduce the spread of illness.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hygiene-cleaning-hands-washing-hands-wash-hands-royalty-free-image/1216510830?adppopup=true"> Krisanapong Detraphiphat/Moment via Getty Images</a></span></figcaption></figure><p>People were washing their hands so much early in the pandemic that <a href="https://health.ucdavis.edu/health-news/newsroom/preventing-another-covid-19-problem-skin-irritation-from-hand-washing/2020/05">sensitive skin</a> and <a href="https://www.aarp.org/money/budgeting-saving/info-2020/8-scarce-supermarket-staples.html">soap shortages</a> were common problems in 2020. </p>
<p>All this focus on hand-washing was for good reason. The <a href="https://doi.org/10.2105/ajph.2007.124610">science uniformly demonstrates</a> that frequent hand-washing reduces the risk of a variety of illnesses. It is low-hanging fruit in terms of an easy, healthy habit to practice. </p>
<p>However, people today <a href="https://doi.org/10.1001/jamainternmed.2021.1429">aren’t washing their hands as often</a> as at the beginning of the pandemic, and many are wondering: Should I still be washing my hands more often because of the coronavirus? The short answer is yes. That is because you probably weren’t washing your hands nearly as often as you should have been before the pandemic.</p>
<p><a href="https://www.american.edu/cas/faculty/mhawkins.cfm">I am an epidemiologist</a> and mom of three boys, one girl, two cats and one dog. Between sports and a busy household, there are a lot of opportunities for germs to spread in our house, coronavirus or no coronavirus.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A green hand washing sign on a tile wall." src="https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=860&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=860&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=860&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1081&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1081&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427069/original/file-20211018-83508-1rfv3xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1081&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Before the pandemic, many people were not washing their hands as often as they should have.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/workplace-hand-wash-sign-royalty-free-image/497326561?adppopup=true">Peter Dazeley/The Image Bank via Getty Images</a></span>
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</figure>
<h2>Hand-washing: How often?</h2>
<p>You wash your hands after going to the bathroom, but when else should you be washing?</p>
<p>In general, germs can get on your hands in many ways – from dirty hands, droplets in the air released during a cough or sneeze, contaminated surfaces, or contact with a sick person’s body fluids. Your hands come into contact with thousands upon thousands of microorganisms each day – and that can be a problem considering that, on average, people touch their mouth, nose or eyes upward of <a href="https://doi.org/10.1016/j.ajic.2014.10.015">20 times per hour</a>.</p>
<p>In hospitals, health care professionals are required to wash their hands before and after seeing every patient. While you and I might not need to do it quite as often, it’s always a good idea to <a href="https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html">wash your hands</a> in warm or cold water with soap before eating, after using the bathroom, when coming inside from the outdoors and after any activity.</p>
<p>Before the pandemic, most people did not wash their hands enough. Men, in particular, were <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6940a2.htm#:%7E:text=Respondents%20frequently%20reported%20remembering%20to,94.8%25">less likely than women</a> to remember to wash their hands. In recent years prior to the pandemic, <a href="https://www.bradleycorp.com/handwashing">hand-washing hygiene had been slipping</a> generally, both in terms of frequency of washing and duration as people are more often doing a simple rinse-and-run. One survey found that only around <a href="https://www.bradleycorp.com/handwashing">40% of people reported washing their hands</a> six or more times a day.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A hand holding a railing on a bus or train." src="https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427070/original/file-20211018-57123-1g4grpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The risk of getting the coronavirus from touching a contaminated surface is low, but not zero.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/person-holding-onto-railing-on-bus-royalty-free-image/1291174449?adppopup=true">Alex Walker/Moment via Getty Images</a></span>
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</figure>
<h2>Coronavirus transmission from touch</h2>
<p>The SARS-CoV-2 virus is primarily spread through <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">inhalation of infectious particles in the air</a>. Catching the coronavirus from touching a surface – known as fomite transmission – is possible but is a <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html">low risk route of transmission</a>, according to the Centers for Disease Control (CDC). This indirect transmission could happen if a person touched a contaminated surface, the coronavirus transferred to the person’s hand and then from their hand to their mouth, nose or eyes.</p>
<p>It is difficult to directly measure the risk of fomite transmission. Laboratory studies have demonstrated that the <a href="https://doi.org/10.1056/NEJMc2004973">coronavirus can survive for hours and in some cases days on surfaces</a>. However, other studies testing surfaces in real–world conditions – like a grocery store – <a href="https://theconversation.com/testing-high-touch-surfaces-in-grocery-stores-for-covid-19-155648">did not detect the coronavirus</a>. A research team estimated that the <a href="https://dx.doi.org/10.1021%2Facs.estlett.0c00966">risk of infection from fomite transmission is less than 5 in 10,000</a> — significantly lower than risk estimates for infection through the airborne route and even lower than risk for influenza or norovirus. </p>
<p>But low risk is not no risk, and hand-washing has a direct, inverse association with illness. It has been shown to help prevent <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">respiratory illnesses</a> like colds, can reduce the spread of <a href="https://doi.org/10.1002/14651858.cd004265.pub2">diarrhea</a> and even helps to prevent children from <a href="https://doi.org/10.1016/j.ajic.2017.01.018">missing school</a> due to gastrointestinal illness. </p>
<p>The more you wash, the less likely you will have germs on your hands that can make you sick. This applies to the coronavirus as much as any other pathogen.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A hand under UV light glowing in many places." src="https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427075/original/file-20211018-57123-noxyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Washing your hands can prevent the spread of many illnesses, including the coronavirus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ultraviolet-light-on-a-hand-showing-bacteria-growth-royalty-free-image/1271510376?adppopup=true">Solarseven/iStock via Getty Images</a></span>
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<h2>When in doubt, wash</h2>
<p>The CDC and public health experts often repeat that the <a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">first line of defense</a> against the spread of the coronavirus is hand-washing with soap and water for at least 20 seconds. </p>
<p>In 2020, a survey by the CDC found that the chances a person washed their hands before doing certain things <a href="https://www.cnn.com/2020/10/08/health/people-remembering-to-wash-hands-wellness/index.html">nearly doubled compared to 2019</a>. But even so, people still weren’t washing their hands every time they should, pandemic or not. And despite this early increase, there is evidence that as coronavirus cases are dropping, <a href="https://doi.org/10.1001/jamainternmed.2021.1429">hand-washing hygiene is falling</a> too, even among health care professionals.</p>
<p>So how often should you wash your hands? The simple answer is every time you need to.</p>
<p>Use soap. Wash for 20 seconds at least – roughly one round of singing Happy Birthday. And remember to <a href="https://theconversation.com/coronavirus-and-handwashing-research-shows-proper-hand-drying-is-also-vital-132905">air dry or towel dry your hands</a> because wet hands are also a good vector for transferring germs. </p>
<p>The science is clear that the commonplace practice of hand-washing is one of the most important activities that a person can do to avoid getting sick or spreading germs to other people. You probably weren’t doing it enough pre-pandemic, and there has never been a better time to improve your hand-washing hygiene, especially as the holiday season approaches. </p>
<p>[<em>Over 110,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/169892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Hawkins receives funding from USDA and the Luce Foundation. </span></em></p>The risk of getting the coronavirus from a surface is low. But the frequent hand-washing from early in the pandemic is a good thing since most people weren’t washing their hands enough to begin with.Melissa Hawkins, Professor of Public Health, American UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574102021-03-29T02:20:05Z2021-03-29T02:20:05ZWe know hand dryers can circulate germs through the air. Why are they still used everywhere?<figure><img src="https://images.theconversation.com/files/392126/original/file-20210329-17-1jgdj3.jpg?ixlib=rb-1.1.0&rect=79%2C14%2C4713%2C3176&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Airborne contaminants, dirty toilet seats, mould and mildew: long before the coronavirus pandemic came around, the hygiene-focused among us knew public washrooms are grimy places.</p>
<p>Most adults visit the bathroom around <a href="https://www.sciencedirect.com/science/article/pii/S0002937802004246?via%3Dihub">8-10</a> times a day. With an average hand-drying time of 30 seconds, we can expect between 4-5 minutes of daily dryer use per person (and more for people with an <a href="https://www.nature.com/articles/s41598-020-60967-7">overactive</a> <a href="https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00619-0">bladder</a> or similar disorders).</p>
<p>In an attempt to facilitate the hand washing process, are hand dryers adding to the filth by blowing contaminants around? And if so, why are they still common?</p>
<h2>The need to dry</h2>
<p>Drying hands is an essential part of the hand washing process. Wet hands can further the spread of microbes, since moisture facilitates their transfer from the skin to other <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/residual-moisture-determines-the-level-of-touchcontactassociated-bacterial-transfer-following-hand-washing/096E367EA0A0363A4BD750AE8A174DE2">surfaces</a>. </p>
<p>Compared to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249283/">shaking your hands</a> dry after a wash, using an air dryer or paper towel greatly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538484/">reduces</a> the number of surface bacteria that <a href="https://pubmed.ncbi.nlm.nih.gov/12515399/">remain</a>.</p>
<p>Warm air dryers remove moisture from the hands through <a href="https://www.sciencedirect.com/science/article/abs/pii/S002561961200393X">evaporation</a>, while jet air dryers remove it by using <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2010.04838.x">sheer force</a> to disperse the droplets into the air.</p>
<figure class="align-center ">
<img alt="Bathroom wall with both paper towels and air dryer." src="https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390324/original/file-20210318-23-1foj9am.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some bathrooms offer both paper towels and air dryers. Should you prioritise one of them?</span>
<span class="attribution"><span class="source">Christian Moro</span></span>
</figcaption>
</figure>
<p>It’s worth remembering hand dryers don’t <em>create</em> microbes and there’s usually only minimal bacteria on their <a href="https://aem.asm.org/content/84/8/e00044-18.abstract">nozzles</a>, too. In many cases air dryers can even be fitted with filters that help clean and remove contaminants from the air. </p>
<h2>Put a lid on it!</h2>
<p>Nonetheless, while dryers themselves aren’t necessarily unclean, their forced air can help circulate bacteria around the space. This is why the main focus should be on preventing bacteria from surfaces ever becoming aerosolised (entering the air) in the first place.</p>
<p>If a toilet’s lid is left open when it’s flushed, a fine aerosolised mist of microbes <a href="https://www.tandfonline.com/doi/full/10.1080/02786826.2013.814911">enters the air</a>. And this cloud of faecal matter can spread over an area of up to six square metres. </p>
<p>Research has shown even after flushing many times, a toilet can <a href="https://pubmed.ncbi.nlm.nih.gov/16033465/">continue</a> to emit contaminants into the air. In other words, a person infected with a virus could be spreading these germs for several hours after visiting the <a href="https://pubmed.ncbi.nlm.nih.gov/29651169/">bathroom</a>. </p>
<p>Public washrooms can therefore act as reservoirs for especially nasty bacteria, such as those which are resistant to <a href="https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0500-z">antibiotics</a>.</p>
<p>So are paper towels the solution?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-and-handwashing-research-shows-proper-hand-drying-is-also-vital-132905">Coronavirus and handwashing: research shows proper hand drying is also vital</a>
</strong>
</em>
</p>
<hr>
<h2>Problems with paper</h2>
<p>Paper towels remove water by absorption and take contaminants with them when they’re binned. However, they can cause plumbing problems if flushed down the toilet, which require time and money to fix. </p>
<p>Additionally, paper towels need to be continuously purchased, restocked and disposed of as waste — all of which leads to increased costs. In a worst-case scenario towels may run out, prompting people to exit without drying their hands at all.</p>
<p>Granted, in a hospital setting a dryer’s forced air may move microbes onto items handled by health professionals and patients, such as phones or <a href="https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/from-the-hospital-toilet-to-the-ward-a-pilot-study-on-microbe-dispersal-to-multiple-hospital-surfaces-following-hand-drying-using-a-jet-air-dryer-versus-paper-towels/FA51D26C9C3DC261D35F122EF97593D5">stethoscopes</a>. So paper towels may be a more suitable option here.</p>
<p>But they still don’t provide an entirely sterile environment and can be <a href="https://www.journalofhospitalinfection.com/article/S0195-6701(18)30366-9/abstract">contaminated</a> by microbes circulating in the area.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Toilet paper stuck to shoe leaves bathroom" src="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391342/original/file-20210324-19-cvnhyv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If contaminated paper towels are discarded on the floor, people stepping on them can transfer germs via their shoes to outside areas.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Weighing the environmental impact</h2>
<p>Although hand dryers do produce carbon emissions, studies have <a href="https://www.abc.net.au/news/science/2018-11-07/paper-towels-warm-air-jet-hand-dryers-environment-hygiene/10468580">shown</a> warm air dryers (which rely on evaporation) generate up to <a href="https://dspace.mit.edu/handle/1721.1/103115">70% more emissions</a> than newer, fast jet dryers (which force out a rush of cold air). </p>
<p><a href="https://theconversation.com/the-great-bathroom-debate-paper-towel-or-hand-dryer-51197">Environmentally speaking</a>, warm air dryers and paper towels perform roughly the same, on average. </p>
<p>Using recycled paper towels doesn’t seem to help much, either. This is because they can’t be recycled further, due to chemicals added to increase their absorptive properties as well as the overall energy required to manufacture them.</p>
<p>In the US, around <a href="https://www.abc.net.au/news/science/2018-11-07/paper-towels-warm-air-jet-hand-dryers-environment-hygiene/10468580">six million tonnes</a> of paper towels end up in landfill each year.</p>
<h2>The dry debate continues</h2>
<p>Some <a href="https://theconversation.com/whats-the-most-hygienic-way-to-dry-your-hands-54196">research</a> has concluded paper towels make a more hygienic method for drying hands. Meanwhile, aggressive jet hand dryers seem to have shown the greatest potential for dispersing bacteria and particles <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/full/10.1111/jam.13014">over wider distances</a>. </p>
<p>But there isn’t a clear winner in practise. A recent critical review <a href="https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/jam.14796">concluded</a> there wasn’t enough research weighing up both options and that until more robust studies were conducted, evidence-based public policy recommendations couldn’t be made. </p>
<p>This echoes both the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters">World Health Organisation’s</a> and <a href="https://www.cdc.gov/handwashing/faqs.html">Centre for Disease Control’s</a> hesitance to offer recommendations for whether drying hands with air dryers is more or less effective than using paper towels.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-great-bathroom-debate-paper-towel-or-hand-dryer-51197">The great bathroom debate: paper towel or hand dryer?</a>
</strong>
</em>
</p>
<hr>
<h2>Tips for a healthy bathroom regimen</h2>
<p>While hand dryers can circulate contaminants around a space, the aim should be to stop germs from becoming aerolised in the first place. If the contaminants aren’t in the air to begin with, their dispersion from hand dryers is less of a worry.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="No standing on the toilet seat." src="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391343/original/file-20210324-19-8hahnz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Common sense goes a long way in bathroom hygiene.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://link.springer.com/chapter/10.1007%2F978-3-030-47483-6_1">Health</a> <a href="https://link.springer.com/referenceworkentry/10.1007%2F978-981-13-6106-7_118-1">education</a> on this front is important. Simple recommendations include:</p>
<ul>
<li><p>closing the toilet lid before flushing</p></li>
<li><p>wearing a mask where recommended or required, especially for those who have respiratory tract symptoms or a cough</p></li>
<li><p>coughing or clearing your throat directly into a tissue and immediately throwing it in the bin</p></li>
<li><p>washing your hands regularly with soap and water and not forgetting to dry them, as wet hands are more likely to spread bugs and diseases. </p></li>
</ul>
<p>In areas where infection control and prevention are paramount, such as hospitals or food production areas, measures such as increased airflow and air filters can also help.</p>
<h2>The bottom line</h2>
<p>Using paper towels comes with recurring costs, logistical problems and environmental considerations. Meanwhile, air dryers can further circulate vapourised bacteria.</p>
<p>Managers of public washrooms have much to consider when deciding which method of hand drying to provide. In some scenarios, hand dryers do present as a better option, which is why we continue to see them in public washrooms.</p>
<p>Regardless of what option you choose, don’t forget drying is an essential part of the hand-washing process. Both air dryers and paper towels are, by a long way, better than using nothing at all. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CMjdfhsjsCg","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p><img src="https://counter.theconversation.com/content/157410/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What side are you on, paper or dryer? In either case, here’s the bottom line on what to do after using the toilet.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, PhD Student, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1553552021-02-16T01:03:33Z2021-02-16T01:03:33ZGlobal weekly COVID cases are falling, WHO says — but ‘if we stop fighting it on any front, it will come roaring back’<p>The number of reported <a href="https://news.un.org/en/story/2021/02/1084742">global weekly COVID cases is falling</a> and has dropped nearly 50% this year, the World Health Organization (WHO) said overnight. This incredibly encouraging news shows the power of public health measures — but we must remain vigilant. Letting our guard down now, when new variants are emerging, could easily reverse the trend.</p>
<p>According to a WHO <a href="https://news.un.org/en/story/2021/02/1084742">press release</a>: </p>
<blockquote>
<p>“Last week saw the lowest number of reported weekly cases since October”, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) told journalists at a regular press briefing in Geneva. </p>
<p>Noting a nearly 50% drop this year, he stressed that “how we respond to this trend” is what matters now. </p>
<p>While acknowledging that there is more reason for hope of bringing the pandemic under control, the WHO chief warned, “the fire is not out, but we have reduced its size”. </p>
<p>“If we stop fighting it on any front, it will come roaring back”. </p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-vaccines-already-helping-contain-covid-early-signs-say-yes-but-mutations-will-be-challenging-154479">Are vaccines already helping contain COVID? Early signs say yes, but mutations will be challenging</a>
</strong>
</em>
</p>
<hr>
<p>This welcome news shows that when governments respond rapidly by putting in place public health measures, we reap the benefits even before widespread vaccine rollouts. That’s a really important message now, and for when the next pandemic hits (and another one eventually will).</p>
<p>As good as this news is, though, we are still seeing infections in fairly large numbers worldwide. And, as we have regrettably seen in the past, subsequent waves of infection can easily emerge.</p>
<p>We also now have a series of variants to contend with. Even as begin to understand how the variants now circulating will affect the effectiveness of current vaccines, it’s possible we could see yet another new variant emerge that would reverse the downward trend. This remains a real risk when there are still so many new infections worldwide and when so few countries have been able to start vaccinating.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org">Our World in Data</a></span>
</figcaption>
</figure>
<h2>It’s too early to see vaccine effect</h2>
<p>Some countries, such as Israel and the United Kingdom, have already vaccinated huge swathes of their population. That’s a tremendous achievement and we will start to see the benefits in the coming months. But fundamentally, it’s too early to see the effect of the vaccine rollout in widespread reduction of infection. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-vaccinations">Our World in Data</a></span>
</figcaption>
</figure>
<p>On the other hand, we have recently seen a much greater focus on public health measures in places such as Europe, the Middle East and the United States. These places have been significantly affected by COVID outbreaks and are dealing with <a href="https://time.com/5929246/uk-coronavirus-third-wave/">third waves</a>, as some are preparing for <a href="https://www.reuters.com/article/us-health-coronavirus-iran-idINKBN2AD0KQ">their fourth</a>.</p>
<p>It’s likely these public health measures — such as lockdowns, physical distancing, mask-wearing and increased hygiene measures — are what’s driving the global downward trend. That shows the benefit when leaders do engage and bring their populations with them.</p>
<p>To keep that trend going in the right direction, we need high levels of public compliance with those public health measures and more equitable access to vaccines globally.</p>
<h2>Unequal global access to vaccines is a major risk</h2>
<p>Very few low-income countries have started a widespread vaccine rollout, and many are struggling to secure doses. Having unequal access globally to vaccines is obviously <a href="https://www.ft.com/content/797e3d7b-0091-4bfd-8cae-c0b5be380772">morally wrong and dangerous</a> — but it also represents a great economic risk to high income countries like Australia. </p>
<p>Having high-income countries buying up all the stock of vaccines and leaving poorer nations with little recourse will <a href="https://www.foreignaffairs.com/articles/world/2020-12-29/vaccine-nationalism-will-prolong-pandemic">prolong the pandemic</a>. And that’s bad news for the global economy, with estimates suggesting the pandemic will cost <a href="https://jamanetwork.com/journals/jama/fullarticle/2771764">US$16 trillion dollars</a>.</p>
<p>Even if Australia were able to maintain its success so far, having the pandemic run out of control in other countries means no travel, will continue to make it hard for Australians to return home, and could lead to shortages of products and materials from other countries. As the global financial crisis showed, economic strife in other parts of the world can have profound impact locally, even when Australia is doing relatively OK.</p>
<p>The risk this poses to lives and to the global economy is one reason the WHO has <a href="https://news.un.org/en/story/2021/02/1084372">called for</a> vaccine rollouts to begin in all countries in the first 100 days of 2021, and for health-care workers in lower- and middle-income countries to be protected first. </p>
<p>The WHO has issued a <a href="https://www.who.int/campaigns/annual-theme/year-of-health-and-care-workers-2021/vaccine-equity-declaration">vaccine equity declaration</a> calling for, among other things, world leaders to increase contributions to the UN-led vaccine equity initiative, COVAX, and to share doses with COVAX even as they roll out their own national campaigns. </p>
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<p>We also clearly need to upscale <a href="https://cepi.net/news_cepi/preparing-for-the-next-disease-x/">vaccine research and manufacturing capacity</a> around the world, which would also help us respond to the next pandemic, too.</p>
<p>There’s still <a href="https://www.wsj.com/articles/will-we-be-ready-for-the-next-pandemic-11613145677">a lot of work</a> to be done.</p>
<h2>Relaxing too soon can undo our progress</h2>
<p>As the WHO’s Director-General said overnight, the fire is not out and “if we stop fighting it on any front, it will come roaring back”. </p>
<p>That’s why sticking to the fundamentals of infection control is so important. That means keeping up with the hand-washing and physical distancing. It means wearing a mask if you can’t physically distance and complying with lockdowns and other public health orders. Yes, it’s hard to maintain a high level of commitment, but the alternative is far worse.</p>
<p>When people start to hear that global case numbers are improving, there’s a tendency to relax — and that’s risky. Now is the time we need to work together to see this contained, and ideally suppressed. </p>
<p>We may never completely eradicate this virus. But if we stick with the public health measures, and vaccinate as many people as possible worldwide, we can keep the trend going in the right direction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/uk-south-african-brazilian-a-virologist-explains-each-covid-variant-and-what-they-mean-for-the-pandemic-154547">UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/155355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott is an Associate Professor in the Centre for International Security Studies, University of Sydney, and a Non-Resident Fellow of the United States Studies Centre. He receives funding from the Australian Research Council and the Canadian Institute for Health Research. Adam is also a director of the Global Health Security Network.</span></em></p>When people start to hear that global case numbers are improving, there’s a tendency to relax — and that’s risky.Adam Kamradt-Scott, Associate professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1481282020-10-20T14:52:02Z2020-10-20T14:52:02ZSouth Africans aren’t being protected from fake sanitisers: what needs to be done<figure><img src="https://images.theconversation.com/files/364241/original/file-20201019-19-1o3mzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The WHO recommends sanitisers with an alcohol content of at least 70%.</span> <span class="attribution"><span class="source">Phill Magakoe / AFP via Getty Images</span></span></figcaption></figure><p>A wave of panic buying struck many countries when national states of disaster were announced in response to the global COVID-19 pandemic. Overnight, toilet paper, cleaning products and hand sanitisers became the most sought-after products on the <a href="https://www.bbc.com/news/stories-52126847">market</a>. </p>
<p>This was true in South Africa too. Production facilities for raw materials of hand sanitisers experienced an increase of nearly 400% in bulk <a href="https://www.chemengonline.com/sasol-roquette-join-growing-list-of-manufacturers-adapting-plants-to-produce-hand-sanitizer/">orders</a>. Suppliers could not keep up with sudden mass orders for hundreds of thousands of <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">litres</a>. </p>
<p>In response to the shortage, governments across the world adopted temporary policies. These allowed for the production of hand sanitiser by entities that weren’t registered manufacturers and for alcohol <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">distillers</a> to shift their production to hand sanitisers. </p>
<p>In South Africa’s economic hub, Gauteng province, non-specialist companies were speedily registered to secure government contracts. The surge in demand also opened doors for exploitation and corruption. Some companies supplying government departments saw an opportunity to supply hand sanitisers at inflated prices – at an estimated R66 million ($398,532) above market <a href="https://www.dailymaverick.co.za/article/2020-08-30-gauteng-healths-deadly-r500m-ppe-rip-off/">prices</a>. </p>
<p>Concern has been growing about safety issues related to hand sanitisers – in South Africa as well as other countries. But South Africa has been behind the curve in putting in place measures to ensure products are safe.</p>
<h2>Filling a gap</h2>
<p>In the absence of a vaccine, hand hygiene has become a critical part of the response to COVID-19. Washing hands at regular intervals during the day is viewed as essential. If water and soap are unavailable, hand sanitisers have served as a useful alternative. </p>
<p>The purpose of a hand sanitiser is to disrupt the enveloping lipid membrane of SARS-CoV-2. This kills the <a href="https://wwwnc.cdc.gov/eid/article/26/7/20-0915_article">virus</a>. The World Health Organisation (WHO) has recommended that consumers use an alcohol-based sanitiser with an alcohol content of at least 70%, based on effective and fast anti-microbial <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">activity</a>. </p>
<p>The WHO further <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">recommends</a> that hand sanitisers comprise ethyl alcohol (ethanol) or isopropyl alcohol (2-propanol) as the active ingredient, in addition to inactive ingredients listed as follows:</p>
<ul>
<li><p>Water as a diluent;</p></li>
<li><p>Glycerol to prevent drying out users’ skin; and</p></li>
<li><p>Hydrogen peroxide to inactivate contaminating bacterial spores in the <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">solution</a>.</p></li>
</ul>
<p>The guide, as well as statements issued by the US Food and Drug Administration, recommends that perfumes or dyes not be added due to risk of allergic <a href="https://www.fda.gov/media/136289/download">reactions</a>. The Australian Department of <a href="https://www.legislation.gov.au/Details/F2020L00340#:%7E:text=Therapeutic%20Goods%20(Excluded%20Goods%E2%80%94Hand%20Sanitisers)%20Determination%202020,-%2D%20F2020L00340&text=This%20instrument%20excludes%20specified%20hand,to%20the%20COVID%2D19%20emergency.">Health</a> goes so far as to say that hand sanitisers may not contain any other active or inactive ingredients. These include colourants, fragrances or emollients.</p>
<p>But the policing of these conditions has been weak in countries like South Africa.</p>
<h2>Maintaining standards</h2>
<p>In the US, the Food and Drug Administration has played a leading role in identifying inferior products. By early October more than 200 products had been <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">recalled</a> that contained either methanol, 1-propanol or less than the required amount of alcohol. </p>
<p>Methanol is a cheaper alcohol, but repeated use of methanol-based hand sanitiser can cause it to be absorbed through the skin. This can cause chronic toxicity, hallucinations or even death in <a href="https://www.mdpi.com/1660-4601/15/7/1440">extreme cases</a>. As for 1-propanol, not to be confused with 2-propanol, the substance can be toxic and life-threatening when ingested and is therefore not an acceptable ingredient for <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">hand sanitisers</a>. </p>
<p>Countries across the globe have detected other toxic substances in hand sanitisers that can also pose acute or chronic toxicity. These include <a href="https://www.bbc.com/news/uk-england-birmingham-51979932?intlink_from_url=&link_location=live-reporting-story">glutaraldehyde</a>, <a href="https://chemycal.com/news/eca0070d-04ff-48fa-867e-81fb3d18913d/Danish_EPA__Hand_disinfection_products_are_recalled">polyhexamethylene biguanide</a> and <a href="https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/73385a-eng.php#:%7E:text=Ethyl%20acetate%3A%20Frequent%20use%20of,respiratory%20system%20irritation%20and%20headaches">ethyl acetate</a>. </p>
<p>Sub-potent levels of alcohol have been recorded in the <a href="https://nltimes.nl/2020/06/24/hand-sanitizers-public-spaces-always-scratch-report">Netherlands</a>, the <a href="https://english.alarabiya.net/en/News/gulf/2020/04/02/Coronavirus-Dubai-recalls-these-6-hand-sanitizers-for-containing-methanol">UAE</a>, <a href="https://thenewdaily.com.au/finance/consumer/2020/07/16/hand-sanitiser-ineffective/">Australia</a>, <a href="https://www.inewsguyana.com/food-and-drug-recalls-substandard-purcill-hand-sanitizers/#:%7E:text=The%20Government%20Analyst%20Food%20and,as%20stated%20on%20the%20labels.">Guyana</a>, <a href="https://businesstoday.co.ke/kebs-kenya-bureau-of-standards-quality-concerns-kebs-bans-hand-sanitizers/#:%7E:text=KEBS%20Bans%20More%20Sanitizer%20Brands%20Over%20Quality%20Concerns%20In%20July,brands%20over%20the%20same%20reason&text=The%20Kenya%20Bureau%20of%20Standards,failure%20to%20meet%20quality%20threshold.">Kenya</a>, <a href="https://www.nafdac.gov.ng/public-alert-no-003-2020-alert-on-illegal-distribution-and-sale-of-unregistered-hand-sanitizers/">Nigeria</a> and <a href="https://www.iol.co.za/news/africa/rwanda-food-and-drug-authority-recalls-locally-manufactured-hand-sanitiser-45986888">Rwanda</a>. Zambia <a href="https://www.themastonline.com/2020/06/20/zamra-recalls-unsafe-sanitisers-disinfectants/">recalled</a> products from a number of producers, including South Africa. </p>
<p>In South Africa, the Bureau of Standards recently issued a press release, raising concerns about substandard sanitisers produced by “unscrupulous” manufacturers who were falsely claiming that their products had been <a href="https://www.sabs.co.za/Media/SABS-comments-on-the-illegal-us-of-its-Mark-on-sanitizers.asp">certified</a>. Reference was made to low-quality versions that can trigger skin allergies and can damage the skin, often presenting as a form of eczema.</p>
<p>In May 2020, a <a href="https://www.timeslive.co.za/news/consumer-live/2020-07-08-investigation-your-hand-sanitiser-might-not-be-keeping-you-as-safe-as-you-think/">laboratory</a> found that two out of the 11 hand sanitisers bought from retailers in the city of Pietermaritzburg contained 1-propanol. Four contained only between 46% and 67% alcohol while claiming to contain 70%.</p>
<p>Yet no hand sanitiser products in South Africa have been recalled. The country also has no regulatory system in place to assess hand sanitisers intended for household use. Companies have been <a href="https://ipasa.co.za/wp-content/uploads/2020/04/Comm-to-Industry_Covid-19_Reg-Status-of-Equipment-to-prevent_09April2020_vF.pdf">required</a> to voluntarily comply with the national standard on disinfectant alcohol-based hand-rubs, but this is woefully inadequate. </p>
<p>Part of the <a href="https://www.gov.za/sites/default/files/gcis_document/201409/321864670.pdf">Consumer Protection Act</a> seeks to ensure that consumers are provided with adequate evidence-based information. This is critical, especially since consumers are inundated with all sorts of brands and types of sanitisers that are intended for frequent use. </p>
<h2>What needs to be done</h2>
<p>A number of urgent steps need to be considered.</p>
<p>Firstly, labelling requirements should be standardised and enforced. The following information should be indicated on every bottle of hand sanitiser: </p>
<ul>
<li><p>an alcohol content of at least 70%; </p></li>
<li><p>a list of the active and inactive ingredients and the adverse effects they may cause; </p></li>
<li><p>instructions for use;</p></li>
<li><p>mandatory warnings;</p></li>
<li><p>the batch code and expiry date; and</p></li>
<li><p>the full address of the manufacturer. </p></li>
</ul>
<p>Secondly, public awareness programmes about correct hand hygiene techniques and the safe use, storage and effectiveness of hand sanitisers should be launched. </p>
<p>Thirdly, products that don’t comply with specifications or are not properly labelled should not be sold or provided in public spaces. </p>
<p>Fourth, a national task team should be established to investigate the regulatory framework and current levels of compliance. </p>
<p>Fifth, imports of raw material used in manufacturing of hand sanitisers and ready-to-use formulated products should be regulated more effectively. Likewise, products that are exported from South Africa to neighbouring <a href="https://www.timeslive.co.za/politics/2020-05-29-sa-exporting-millions-of-facemasks-hand-sanitiser-patel/">countries</a> should be monitored better. </p>
<p>Finally, environmental health inspectors or the <a href="https://www.nrcs.org.za/">National Regulator for Compulsory Specifications</a> should mercilessly track down fake products and have them confiscated and destroyed.</p>
<p><em>Dr Tracy Muwanga, a trans-disciplinary postdoctoral fellow in the faculties of Law and Natural and Agricultural Sciences at the University of Pretoria, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/148128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Willeke de Bruin receives funding from the University of Pretoria's UNICEF One Health for Change project. </span></em></p><p class="fine-print"><em><span>Lise Korsten does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hand hygiene is a critical part of the response to COVID-19. Washing hands at regular intervals during the day is essential. If water and soap are unavailable, hand sanitisers are an alternative.Lise Korsten, Professor in the Department of Microbiology and Plant Pathology and Co-Director at the Centre of Excellence in Food Security, University of PretoriaWilleke de Bruin, Postdoctoral fellow - Faculty of Natural and Agricultural Sciences, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1436902020-08-07T04:42:11Z2020-08-07T04:42:11ZNo, the extra hygiene precautions we’re taking for COVID-19 won’t weaken our immune systems<figure><img src="https://images.theconversation.com/files/351202/original/file-20200805-118-1ioumlr.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5996%2C4002&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>During the COVID-19 pandemic we’re constantly being reminded to <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/good-hygiene-for-coronavirus-covid-19">practise good hygiene</a> by frequently washing our hands and regularly cleaning the spaces where we live and work.</p>
<p>These practices aim to remove or kill the coronavirus that causes COVID-19, and thereby minimise our risk of infection.</p>
<p>But there have been some suggestions using hand sanitiser and practising other hygiene measures too often could <a href="https://www.womenshealthmag.com/health/a32464311/does-hand-sanitizer-weaken-immune-system/">weaken our immune system</a>, by reducing our body’s exposure to germs and with it the chance to “train” our immune defences.</p>
<p>The good news is, there’s no evidence to suggest this will be the case.</p>
<h2>The ‘hygiene hypothesis’</h2>
<p>For healthy immune function, it’s important we’re exposed to a diverse range of bugs in the environment, known as microbes. Most of these don’t make us sick.</p>
<p>The belief that a high level of cleaning and personal hygiene weakens our immune system is a common interpretation of what’s called the “<a href="https://pubmed.ncbi.nlm.nih.gov/29034905/">hygiene hypothesis</a>”.</p>
<p>The <a href="https://www.pnas.org/content/114/7/1433">hygiene hypothesis</a> is a theory that suggests a young child’s environment can be “too clean”, and they won’t be exposed to enough of these microbes to effectively stimulate their immune system as it develops.</p>
<p>The argument is that this results in increased allergies, asthma and certain autoimmune disorders. But scientists have refuted this hypothesis <a href="https://search.proquest.com/openview/1c0bbcc234be0e229473dc1bdf9960b0/1?pq-origsite=gscholar&cbl=2043523">in recent years</a>, as research has shown there are multiple other reasons for the increased incidence of these conditions.</p>
<p>Importantly, <a href="https://theconversation.com/if-being-too-clean-makes-us-sick-why-isnt-getting-dirty-the-solution-50572">being too dirty</a> doesn’t help our immune system either. It generally makes inflammation worse. </p>
<figure class="align-center ">
<img alt="A young girl plays in the mud." src="https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351676/original/file-20200807-16-1r4q2k1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ‘hygiene hypothesis’ has been controversial.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What is the immune system?</h2>
<p>The <a href="https://www.livescience.com/38028-how-the-human-body-s-immune-system-works-infographic.html">immune system</a> works to protect our bodies against things that threaten to make us sick — from harmful chemicals, to bacteria and viruses, to cancer cells.</p>
<p>It’s made up of <a href="https://www.medicalnewstoday.com/articles/320101#white-blood-cells">two lines of defence</a>. The first is the “innate” immune system, which responds rapidly to a range of pathogens to fight infection and prevent tissue damage. </p>
<p>Next is the “adaptive” immune system, made up of immune cells that develop a more targeted or specific response to fight off harsher germs such as viruses. Adaptive immune cells work by recognising small parts of the virus on the outside of the infected cell (for example, lung cells), and destroying them. </p>
<p>These cells then become what we call “memory cells”. The next time they encounter the same virus, they can eliminate it straight away. </p>
<p>This development of the immune system starts after birth and <a href="https://medlineplus.gov/ency/article/004008.htm">declines</a> in old age. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-nutrition-could-help-your-immune-system-fight-off-the-coronavirus-133356">5 ways nutrition could help your immune system fight off the coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>What can weaken our immune system?</h2>
<p>Some aspects of our modern lifestyle can weaken our immune system. These include:</p>
<ul>
<li><p>a <a href="https://theconversation.com/sleep-wont-cure-the-coronavirus-but-it-can-help-our-bodies-fight-it-134674">lack of sleep</a></p></li>
<li><p>certain medications and the <a href="https://www.insider.com/do-antibiotics-weaken-the-immune-system#:%7E:text=If%20your%20doctor%20prescribes%20antibiotics,overuse%20leads%20to%20antibiotic%20resistance.">overuse of antibiotics</a> </p></li>
<li><p>low <a href="https://theconversation.com/does-vitamin-d-protect-against-coronavirus-138001">vitamin D levels</a></p></li>
<li><p>a Western diet rich in <a href="https://theconversation.com/while-we-wait-for-a-coronavirus-vaccine-eating-well-exercising-and-managing-stress-can-boost-your-immune-system-137255">processed foods</a>, and reduced consumption of <a href="https://theconversation.com/5-ways-nutrition-could-help-your-immune-system-fight-off-the-coronavirus-133356">fruits and vegetables</a></p></li>
<li><p>a lack of <a href="https://www.webmd.com/balance/ss/slideshow-healthy-actions-feel-better">physical activity</a></p></li>
<li><p><a href="https://theconversation.com/while-we-wait-for-a-coronavirus-vaccine-eating-well-exercising-and-managing-stress-can-boost-your-immune-system-137255">stress</a> and anxiety. </p></li>
</ul>
<figure class="align-center ">
<img alt="Woman holds healthy breakfast bowl with blueberries, guava and cereal." src="https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351689/original/file-20200807-20-n3mem1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A healthy diet is one way to support immune function.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But there’s no scientific evidence to support the notion that extra hygiene precautions will weaken our immune system or leave us more <a href="https://www.reuters.com/article/uk-factcheck-hand-sanitizer-bacteria/false-claim-overuse-of-hand-sanitizers-and-bacterial-infections-overuse-of-face-masks-weakens-the-immune-system-idUSKBN22R2MV">susceptible to infection</a> by bacteria or viruses.</p>
<p>Microbes are <a href="https://www.mayoclinic.org/diseases-conditions/infectious-diseases/in-depth/germs/art-20045289">everywhere</a>: in the air, on food, and in plants, animals, soil and water. They can be found on just about every surface, including inside and outside your body. </p>
<p>The hygiene measures recommended during COVID-19 will help curb the spread of the coronavirus and greatly reduce our risk of infection — but won’t eliminate all microbes from our lives.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-hospitals-to-households-we-can-all-be-better-at-remembering-to-wash-our-hands-141271">From hospitals to households, we can all be better at remembering to wash our hands</a>
</strong>
</em>
</p>
<hr>
<h2>Keep it clean</h2>
<p><a href="https://www.safeworkaustralia.gov.au/covid-19-information-workplaces/cleaning-prevent-spread-covid-19">Cleaning</a> refers to the removal of microbes, dirt and impurities from surfaces. It doesn’t kill microbes, but by removing them, it lowers their numbers and therefore reduces the risk of spreading infection.</p>
<p>In contrast, <a href="https://simplegreen.com/news-and-media/disinfecting-dwell-time/">disinfecting</a> refers to using chemicals, known as disinfectants, to kill microbes on surfaces. </p>
<p>A combination of cleaning and disinfecting is the most effective way to get rid of microbes such as coronavirus.</p>
<figure class="align-center ">
<img alt="A colourful bucket of cleaning products, with a woman mopping in the background." src="https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351691/original/file-20200807-24-3m9b77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cleaning removes microbes and lowers the risk an infection will spread.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Extra <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/good-hygiene-for-coronavirus-covid-19">hand hygiene</a> is of course one of the <a href="https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-control-guidelines/standard-additional-precautions">most important infection control</a> measures.</p>
<p>We’ve been advised to clean our hands with soap and water for at least 20 seconds. If this is not possible, use hand sanitiser with at least <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html">60% ethanol or 70% isopropanol</a>. </p>
<p>Frequent hand-washing, especially if a sanitiser is used, can disrupt the <a href="https://www.popsci.com/is-hand-sanitizer-bad-for-my-microbiome/">natural skin biome</a>, which can lead to increased skin infections. This can be managed with the use of moisturisers. </p>
<p>But the extra hygiene measures during COVID-19 won’t weaken our immune systems. On the contrary, they are vital in controlling the pandemic. </p>
<p>If you’re worried about your immune system, don’t stop washing your hands or keeping your house clean. Importantly, follow a healthy balanced diet, do regular exercise and look after your mental health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-clean-your-house-to-prevent-the-spread-of-coronavirus-and-other-infections-133912">How to clean your house to prevent the spread of coronavirus and other infections</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/143690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vasso Apostolopoulos has received funding and fellowships from NHMRC of Australia. </span></em></p><p class="fine-print"><em><span>Maximilian de Courten has received funding from the NHMRC of Australia in the past. </span></em></p><p class="fine-print"><em><span>Maja Husaric does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’re cleaning and washing our hands perhaps more than we ever have before. But suggestions that all this this extra hygiene could weaken our immune systems are unfounded.Vasso Apostolopoulos, Pro Vice-Chancellor, Research Partnerships, Victoria UniversityMaja Husaric, Lecturer; MD, Victoria UniversityMaximilian de Courten, Health Policy Lead and Professor in Global Public Health at the Mitchell Institute, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1413592020-06-24T17:38:49Z2020-06-24T17:38:49Z5 things you should do right now to fight the rising number of COVID-19 cases<figure><img src="https://images.theconversation.com/files/343790/original/file-20200624-132982-1abbt3e.jpg?ixlib=rb-1.1.0&rect=23%2C203%2C7940%2C5101&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wearing a mask and using hand sanitizers can protect you and your family at this critical time. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-mother-squeezing-hand-sanitizer-onto-little-royalty-free-image/1208508344?adppopup=true">d3sign/Getty Images</a></span></figcaption></figure><p>The <a href="https://www.wsj.com/articles/coronavirus-latest-news-06-23-2020-11592901807?mod=hp_lead_pos1">increase of COVID-19 cases</a> across the country calls for quick action. Sure, you and your family are exhausted from distancing, you miss your loved ones and you want to get back to your support groups or church. </p>
<p>But the coronavirus, which causes COVID-19, does not stop just because we are tired. In the absence of clear, consistent directions from the federal government, it is more important than ever that people pay attention to the medical and public health facts. </p>
<p>“The next couple of weeks are going to be critical in our ability to address those surges that we are seeing in Florida, in Texas, in Arizona and other states,” Dr. Anthony Fauci, the nation’s top infectious disease expert, <a href="https://www.nytimes.com/2020/06/23/us/politics/fauci-congress-coronavirus.html">told Congress June 23</a>. Fauci and other public health experts testified before the House Energy and Commerce Committee. Fauci told Congress that he sees a “disturbing surge” in many parts of the country. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/JC1HeZPkNXE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. Anthony Fauci describes the ‘disturbing surge’ in coronavirus cases.</span></figcaption>
</figure>
<p>As an infectious disease epidemiologist from Arizona, <a href="https://www.azcentral.com/story/news/local/arizona-health/2020/06/23/arizona-covid-19-record-number-new-cases-hospitalizations-before-trump-visit/3242113001/">one of the current U.S. hotspots</a>, here are five things I urge you to do right now:</p>
<ol>
<li><p>Wear a mask. The World Health Organization recommends that when wearing a mask, medical-grade masks should be worn by people age 60 and over or with health issues, and the general public should wear a triple-layer cloth covering. Children under 2 should not wear a mask. If you can’t find those triple-layer masks, you can use a <a href="https://doi.org/10.1021/acsnano.0c03252">simple cotton or silk cloth face covering</a> to reduce the number of viral particles you emit or are exposed to. Make sure it covers your mouth and your nose. I have seen too many people wearing masks on their chins. And watch your hand-face contact – you can infect yourself by adjusting the mask too much and repeatedly touching your face.</p></li>
<li><p>Physically distance. Avoid crowded spaces. If you want to visit friends or family, you must still wear a mask – and keep six feet apart. If at all possible, have these visits outdoors. <a href="https://wellcomeopenresearch.org/articles/5-83">Indoor activities</a> are most commonly associated with SARS-CoV-2 transmission clusters. Transmission outdoors is less likely, and if you are in places other than Arizona (where the temperature is 106F as I type this), it is probably ideal summer weather to be outdoors. </p></li>
<li><p>Wash your filthy hands. And, yes, they can be really dirty, even if they do not appear so. Bacteria and viruses can lurk on them, spreading infection from surface to surface and person to person. And then wash them again. Hand-washing is critically important. I wash every time I walk into the house. Immediately. The benefits of hand-washing regularly may seem obvious, but many forget them. According to studies, <a href="https://www.health.harvard.edu/newsletter_article/The_handiwork_of_good_health">washing for about 15 seconds reduces bacterial counts by about 90%</a> of the germs on your hands. Washing for an additional 15 lowers the count to about 99% percent. And yes, hand-washing is better than sanitizer because the <a href="https://www.nytimes.com/2020/03/13/health/soap-coronavirus-handwashing-germs.html">soap and water mechanically rid your hands of germs</a>. That said, I keep a small bottle of hand sanitizer in my car and wipes for after shopping.</p></li>
<li><p>Plan ahead in case you or someone in your household gets sick. The reality is that many more of us are going to get sick before this pandemic is over. Planning ahead can give you some peace of mind that you are prepared. This includes doing such things as identifying people or services to transport essential items to your home and developing an emergency contact list. Also, keep cleaning high-touch surfaces, such as light fixtures, faucets and countertops, regularly. Know the <a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html">symptoms and emergency warning signs</a> for COVID-19. Also, if you live alone, find a buddy who will check in on you regularly in case you get sick. Prepare a kit for yourself that you can keep by your bed. </p></li>
<li><p>Maintain awareness of the situation in your community. I know, the data is hard to sort out right now, but one thing to look for in your community is a decline in local cases. Local and state health departments are still providing updated numbers on cases. You can also follow an <a href="https://coronavirus.jhu.edu/">independent source</a> that is assessing local situations. </p></li>
</ol>
<p>This is a time of uncertainty and anxiety for all of us. We desperately want to get back to normal, but it just isn’t possible yet. So find time each day to take care of your mental health. Take a walk, talk to a friend, read a book, snuggle with a pet, meditate, reach out to others who may need your help, while still social distancing, and advocate for our most vulnerable populations. Your life and those of your loved ones depend upon following public health guidelines.</p>
<p>[_<a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">The Conversation’s most important coronavirus headlines, weekly in a new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/141359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kacey Ernst receives funding from NIH, NSF, CDC, NASA, Gates Foundation, Arizona Department of Health Services. She is a board member for the American Meteorological Society, Environment and Health Board. </span></em></p><p class="fine-print"><em><span>Paulina Columbo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With COVID-19 cases rising in more than half of the states, the next two weeks are critical for stopping a spike in cases. An epidemiologist reminds us to get back to the basics now.Kacey Ernst, Associate Professor of Epidemiology and Biostatistics, University of ArizonaPaulina Columbo, Graduate student, Public Health, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1407702020-06-16T03:39:00Z2020-06-16T03:39:00ZPlanning a snow holiday? How to reduce your coronavirus risk at Thredbo, Perisher or Mount Buller<figure><img src="https://images.theconversation.com/files/341817/original/file-20200615-65956-1h499gr.jpg?ixlib=rb-1.1.0&rect=12%2C62%2C4181%2C2728&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>If you’re lucky enough to be able to afford a winter holiday, some good news: ski fields are reopening across the country as coronavirus restrictions continue to ease.</p>
<p>This makes the slopes perhaps more attractive than they’ve ever been. Indeed, the website of one of New South Wales’ most popular venues, Thredbo, <a href="https://www.abc.net.au/news/2020-06-12/thredbo-website-crashes-as-thousands-scramble-to-get-passes/12347756">crashed last week</a> as 25,000 customers tried to buy a lift pass at once – the largest volume the resort had ever experienced on its online store.</p>
<p>What’s more, skiing is great exercise and also good for both the tourism industry and the economy. And it’s an outdoor activity (which makes it safer than indoor activities as far as COVID-19 risk is concerned).</p>
<p>But there are still risks. So how do you stay safe on the slopes?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-stay-safe-in-restaurants-and-cafes-139117">How to stay safe in restaurants and cafes</a>
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</em>
</p>
<hr>
<h2>When do they open?</h2>
<p>Ski resorts in <a href="https://www.abc.net.au/news/2020-06-15/one-week-countdown-to-the-start-of-the-nsw-2020-ski-season/12354840">NSW</a> and <a href="https://www.abc.net.au/news/2020-06-11/victorian-ski-season-to-operate-at-half-capacity-due-to-covid-19/12343714">Victoria</a> are allowed to open from June 22, which is just around the corner.</p>
<p>Both <a href="https://www.thredbo.com.au/about-thredbo/covid-19-update/">Thredbo</a> and <a href="https://www.mtbuller.com.au/Winter/resort-info/latest-news/details/green-light-for-season">Mount Buller</a> are scheduled to reopen on that date, while <a href="https://www.fallscreek.com.au/">Falls Creek</a>, <a href="https://www.mthotham.com.au/discover/connect-with-us/latest-news/covid-19-update">Mount Hotham</a> and <a href="https://www.perisher.com.au/plan-your-trip/new-to-perisher/covid19-update">Perisher</a> will launch two days later. <a href="https://charlottepass.com.au/">Charlotte Pass</a> opens on June 26.</p>
<p>Many of these holiday spots have COVID-19 advice on their websites, which is worth reading closely before you book.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341816/original/file-20200615-65961-1xcx67n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Good news: the coronavirus pandemic won’t prevent you from throwing snowballs at your friends.</span>
<span class="attribution"><span class="source">AAP/Perisher</span></span>
</figcaption>
</figure>
<h2>Caution required</h2>
<p>The risk of contracting COVID-19 in the community is much reduced thanks to all our efforts over the previous few months. But we still need to still be cautious and sensible as we navigate the next phase with our newly granted freedoms. </p>
<p>There is no doubt things will be different this year on the slopes, as ski companies <a href="https://www.mthotham.com.au/discover/connect-with-us/latest-news/covid-19-update">do what they can</a> to make sure you’re safe.</p>
<p>Some extra planning and care can reduce the coronavirus risks to you, your loved ones and the community. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heading-back-to-the-gym-heres-how-you-can-protect-yourself-and-others-from-coronavirus-infection-139681">Heading back to the gym? Here's how you can protect yourself and others from coronavirus infection</a>
</strong>
</em>
</p>
<hr>
<h2>Planning your holiday</h2>
<p>The first and most important rule: stay home if you are sick. This should go without saying but if you have any symptoms, such as a sore throat or fever, get tested. Consider cancelling your holiday until you know you’re COVID-19-free.</p>
<p>You could also consider downloading the <a href="https://www.health.gov.au/resources/apps-and-tools/covidsafe-app?gclid=EAIaIQobChMIrdnL-4CF6gIVWQ4rCh26KwYyEAAYASAAEgJNnvD_BwE">COVIDSafe app</a> before you set off and make sure you know how to use it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covidsafe-tracking-app-reviewed-the-government-delivers-on-data-security-but-other-issues-remain-137249">COVIDSafe tracking app reviewed: the government delivers on data security, but other issues remain</a>
</strong>
</em>
</p>
<hr>
<p>Remember, all ski slopes in Australia will limit numbers to ensure people can maintain social distancing.</p>
<p>Demand for ski holidays will be great, with overseas getaway options limited. But many ski resorts will operate at <a href="https://www.abc.net.au/news/2020-06-11/victorian-ski-season-to-operate-at-half-capacity-due-to-covid-19/12343714">about 50% capacity</a> to ensure social distancing, which means some people may miss out on accommodation and lift passes.</p>
<p>Furthermore, all resorts are asking people to book resort entry and lift passes well ahead of time, to help with planning. Same-day lift ticket sales will not be available at many resorts.</p>
<p>Besides the usual warm clothing, pack hand sanitiser and perhaps even a few face masks for times you’re not able to physically distance.</p>
<h2>What will the new normal look like?</h2>
<p>Ski resorts face a range of challenges in dealing with the pandemic, and you should expect things to feel very different.</p>
<p>Aside from limiting numbers to ensure patrons can physically distance, resorts will have to institute rigorous cleaning protocols.</p>
<p>And the usual international ski workers will not be available due to travel restrictions.</p>
<p>Resorts are placing limits on classes. Although some <a href="https://www.perisher.com.au/plan-your-trip/new-to-perisher/covid19-update">are running</a> lessons for adults, others are <a href="https://www.mtbuller.com.au/Winter/ski-snowboard-school/lessons">not running group lessons</a> at all. Thredbo and Mount Buller are offering private lessons only. Make sure to check your destination’s rules before leaving.</p>
<p>There will be strict enforcement of social distancing in queues and limitations in the numbers on ski lifts. Mt Hotham is restricting ski lifts to <a href="https://www.mthotham.com.au/discover/connect-with-us/latest-news/covid-19-update">two people per quad chair</a> and asks that you only ride with those you’re sharing accommodation with on the mountain. Like many resorts, it is also banning cash.</p>
<p>Indoor seating at cafes and restaurants will be strictly limited and some resorts <a href="https://www.perisher.com.au/plan-your-trip/new-to-perisher/covid19-update">advise</a> you to pack your own snacks and lunch.</p>
<p>Tobogganing and snow play is <a href="https://www.perisher.com.au/plan-your-trip/activities/snow-experience">prohibited</a> throughout Perisher this year, to reduce COVID-19 risk. </p>
<p>There will also be hand sanitiser stations and increased cleaning protocols, particularly of frequently touched surfaces such as lift guardrails. </p>
<h2>What about when you’re not skiing or snowboarding?</h2>
<p>What will be most obvious is the absence of events that bring large groups of people together at ski resorts. Restaurants and cafes will operate in line with their respective state guidelines, involving limits to the numbers of people allowed indoors.</p>
<p>And just like the rest of Australia currently, there will be no nightclubbing.</p>
<p>As with all our activities, it’s your own responsibility to stay safe by making sure you maintain hand hygiene and physical distancing wherever possible.</p>
<p>However, resorts will be adapting to the current situation to keep you safe. With a bit of planning and flexibility, it can be a great holiday for you and your family that also supports Australia’s tourism industry.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-coronavirus-restrictions-ease-heres-how-you-can-navigate-public-transport-as-safely-as-possible-138845">As coronavirus restrictions ease, here's how you can navigate public transport as safely as possible</a>
</strong>
</em>
</p>
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<p><em>This article is supported by the <a href="https://theconversation.com/au/partners/judith-neilson-institute">Judith Neilson Institute for Journalism and Ideas</a>.</em></p><img src="https://counter.theconversation.com/content/140770/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hassan Vally does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re lucky enough to be able to afford a ski trip, expect it to look different this year. Some extra planning, however, can lower the coronavirus risk to you, your loved ones and the community.Hassan Vally, Associate Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1364342020-05-12T12:35:50Z2020-05-12T12:35:50ZThe dirty history of soap<figure><img src="https://images.theconversation.com/files/333754/original/file-20200508-49546-dx6y3a.jpg?ixlib=rb-1.1.0&rect=126%2C364%2C4404%2C3169&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How many times a day do you use soap?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bar-soap-royalty-free-image/530859976">Paul Linse/The Image Bank via Getty Images</a></span></figcaption></figure><p>“<a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html">Wash your hands often with soap and water for at least 20 seconds</a>.” That’s what the CDC has advised all Americans to do to prevent the spread of COVID-19 during this pandemic.</p>
<p>It’s common-sense advice. The <a href="https://www.washingtonpost.com/news/speaking-of-science/wp/2017/03/20/dear-science-how-does-soap-make-things-clean/">surfactants found in soap lift germs from the skin</a>, and water then washes them away. Soap is inexpensive and ubiquitous; it’s a consumer product found in every household across the country.</p>
<p>Yet few people know the long and dirty history of making soap, the product we all rely on to clean our skin. <a href="https://scholar.google.com/citations?user=ZG3N6Cr_wT0C&hl=en&oi=ao">I’m a historian who focuses on material culture</a> in much of my research. As I started digging into what’s known about soap’s use in the past, I was surprised to discover its messy origins.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333755/original/file-20200508-49546-550d2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From animal fat to coal tar, what goes in tends to be pretty dirty.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/advertising-during-the-first-world-war-in-1915-wrights-coal-news-photo/1080227192">SeM/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>Gross ingredients to clean things up</h2>
<p><a href="https://doi.org/10.1021/bk-2015-1211.ch009">Ancient Mesopotamians were first to produce</a> a kind of soap by cooking fatty acids – like the fat rendered from a slaughtered cow, sheep or goat – together with water and an alkaline like <a href="https://www.britannica.com/science/lye">lye</a>, a caustic substance derived from wood ashes. The result was a greasy and smelly goop that lifted away dirt.</p>
<p>An early mention of soap comes in <a href="https://www.researchgate.net/publication/282650616_An_Ancient_Cleanser_Soap_Production_and_Use_in_Antiquity">Roman scholar Pliny the Elder’s</a> book “<a href="https://books.google.com/books?id=nvBDAQAAMAAJ&q=sapo#v=onepage&accltump;q=soap&f=false">Naturalis Historia</a>” from A.D. 77. He described soap as a pomade made of tallow – typically derived from beef fat – and ashes that the Gauls, particularly the men, applied to their hair to give it “a reddish tint.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1276&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1276&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1276&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333756/original/file-20200508-49550-1mcaftr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A strigil and flask.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/strigil-and-flask-roman-a-strigil-was-a-curved-blade-used-news-photo/464504797">Heritage Images/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<p>Ancient people used these early soaps to clean wool or cotton fibers before weaving them into cloth, rather than for human hygiene. Not even the Greeks and Romans, who pioneered running water and public baths, <a href="https://www.thoughtco.com/hygiene-in-ancient-rome-and-baths-119136">used soap to clean their bodies</a>. Instead, men and women immersed themselves in water baths and then smeared their bodies with scented olive oils. They used a <a href="https://doi.org/10.1098/rstb.1976.0080">metal or reed scraper called a strigil</a> to remove any remaining oil or grime.</p>
<p>By the Middle Ages, new vegetable-oil-based soaps, which were hailed for their mildness and purity and smelled good, had come into use as luxury items among Europe’s most privileged classes. The first of these, <a href="https://www.reuters.com/article/us-syria-soap/modern-threat-to-syrias-ancient-aleppo-soap-industry-idUSTRE69L1ID20101022">Aleppo soap, a green, olive-oil-based bar soap</a> infused with aromatic laurel oil, was produced in Syria and brought to Europe by Christian crusaders and traders.</p>
<p>French, Italian, Spanish and eventually English versions soon followed. Of these, <a href="https://www.pharmaceutical-journal.com/opinion/comment/a-short-history-of-soap/20066753.article?firstPass=false">Jabon de Castilla</a>, or Castile soap, named for the region of central Spain where it was produced, was the best known. The white, olive-oil-based bar soap was a wildly popular toiletry item among European royals. Castile soap became <a href="https://www.pharmaceutical-journal.com/opinion/comment/a-short-history-of-soap/20066753.article?firstPass=false">a generic term for any hard soap of this type</a>.</p>
<p>The settlement of the American colonies coincided with an age (1500s-1700s) when most Europeans, whether privileged or poor, had turned away from regular bathing out of <a href="https://yalebooks.yale.edu/book/9780300171556/foul-bodies">fear that water actually spread disease</a>. Colonists used soap primarily for domestic cleaning, and soap-making was part of the seasonal domestic routine overseen by women.</p>
<p><a href="http://www.gutenberg.org/files/22675/22675-h/22675-h.htm">As one Connecticut woman described it in 1775</a>, women stored fat from butchering, grease from cooking and wood ashes over the winter months. In the spring, they made lye from the ashes and then boiled it with fat and grease in a giant kettle. This produced a soft soap that women used to wash the <a href="https://yalebooks.yale.edu/book/9780300171556/foul-bodies">linen shifts that colonists wore as undergarments</a>.</p>
<p>In the new nation, the founding of soap manufactories like New York-based <a href="https://www.supplytime.com/Blogs/Blog/History-of-Colgate-Palmolive-Company_23.aspx">Colgate, founded in 1807</a>, or the Cincinnati-based <a href="https://www.pg.com/en_US/downloads/media/Fact_Sheets_CompanyHistory.pdf">Procter & Gamble, founded in 1837</a>, increased the scale of soap production but did little to alter its ingredients or use. Middle-class Americans <a href="https://doi.org/10.2307/1894408">had resumed water bathing, but still shunned soap</a>.</p>
<p><a href="https://doi.org/10.1111/j.1468-0289.2007.00388.x">Soap-making remained an extension of the tallow trade</a> that was closely allied with candle making. Soap itself was for laundry. At the first P&G factory, laborers used large cauldrons to <a href="https://oac.cdlib.org/ark:/28722/bk000401r2p/?brand=oac4">boil down fat collected from homes, hotels and butchers</a> to make the candles and soap they sold.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333757/original/file-20200508-49565-mm0nq7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Workers tended to soap in large tanks in a French factory circa 1870.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-manufacture-of-soap-in-large-tanks-in-the-19th-century-news-photo/929239368">Universal History Archive/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>From cleaning objects to cleaning bodies</h2>
<p><a href="https://doi.org/10.1021/ed079p1172">The Civil War was the watershed</a>. Thanks to reformers who touted regular washing with water and soap as a sanitary measure to aid the Union war effort, bathing for personal hygiene caught on. <a href="https://ohiohistorycentral.org/w/Procter_%26_Gamble">Demand for inexpensive toilet soaps increased</a> dramatically among the masses.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=862&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=862&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=862&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1083&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1083&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333758/original/file-20200508-49558-6zabpn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1083&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Palmolive ads, like this one from 1900, stressed the exotic ingredients in the green bar.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/pictures/item/2018696682/">Library of Congress Prints and Photographs Division</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Companies began to develop and market a variety of new products to consumers. In 1879, P&G introduced <a href="https://oac.cdlib.org/ark:/28722/bk000401r2p/?brand=oac4">Ivory soap</a>, one of the first perfumed toilet soaps in the U.S. B.J. Johnson Soap Company of Milwaukee followed with their own palm-and-olive-oil-based <a href="https://www.milwaukeemag.com/story-behind-this-bar-of-palmolive-soap/">Palmolive soap</a> in 1898. It was the <a href="https://www.supplytime.com/Blogs/Blog/History-of-Colgate-Palmolive-Company_23.aspx">world’s best-selling soap by the early 1900s</a>.</p>
<p>Soap chemistry also began to change, paving the way for the modern era. At P&G, <a href="https://oac.cdlib.org/ark:/28722/bk000401r2p/?brand=oac4">decades of laboratory experiments</a> with imported coconut and palm oil, and then with domestically produced cottonseed oil, led to the <a href="https://www.ars.usda.gov/research/publications/publication/?seqNo115=210614">discovery of hydrogenated fats in 1909</a>. These solid, vegetable-based fats revolutionized soap by making its manufacture less dependent on animal byproducts. <a href="https://www.cleaninginstitute.org/understanding-products/why-clean/soaps-detergents-history">Shortages of fats and oils for soap</a> during World Wars I and II also led to the discovery of synthetic detergents as a <a href="https://www.britannica.com/science/soap/Early-synthetic-detergents">“superior” substitute</a> for fat-based laundry soaps, household cleaners and shampoos.</p>
<p>Today’s commercially manufactured soaps are <a href="http://www.soaphistory.net/soap-facts/soap-types/">highly specialized</a>, lab-engineered products. Synthesized animal fats and plant-based oils and bases are combined with <a href="https://www.bare-soaps.com/blogs/your-impact/116431557-what-s-in-a-bar-of-soap">chemical additives</a>, including moisturizers, conditioners, lathering agents, colors and scents, to make soaps more appealing to the senses. But they cannot fully mask its mostly foul ingredients, including <a href="http://www.soaphistory.net/soap-history/history-of-liquid-soap-and-shower-gel/">shower gels’</a> petroleum-based contents.</p>
<p>As a 1947 history of P&G observed: “<a href="https://oac.cdlib.org/ark:/28722/bk000401r2p/?brand=oac4">Soap is a desperately ordinary substance to us</a>.” As unremarkable as it is during normal times, soap has risen to prominence during this pandemic.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/136434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Judith Ridner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With hand-washing top of mind, soap is an integral part of keeping clean. But people through the ages relied on earlier forms of soap more for cleaning objects than for personal hygiene.Judith Ridner, Professor of History, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1364572020-04-20T12:24:14Z2020-04-20T12:24:14ZHand-washing and distancing don’t have tangible benefits – so keeping up these protective behaviors for months will be tricky<figure><img src="https://images.theconversation.com/files/328740/original/file-20200417-152563-1h6zpvf.jpg?ixlib=rb-1.1.0&rect=132%2C539%2C7216%2C4363&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't forget to wash your hands.</span> <span class="attribution"><span class="source">Moyo Studio/Getty Images</span></span></figcaption></figure><p>In recent weeks, Americans in many states appear to have <a href="https://abcnews.go.com/Health/flattening-coronavirus-curve-happening/story?id=70119118">successfully begun to “flatten the curve”</a> by following prescribed behavior. </p>
<p>People have been <a href="https://www.washingtonpost.com/politics/poll-finds-universal-lifestyle-changes-rising-stress-and-growing-fears-about-catching-coronavirus/2020/03/26/11360bb2-6f5e-11ea-b148-e4ce3fbd85b5_story.html">washing their hands frequently</a>, <a href="https://www.bloomberg.com/news/articles/2020-04-14/stay-home-during-outbreak-americans-stick-to-social-distancing">maintaining physical distance from others</a>, <a href="https://nypost.com/2020/04/10/more-than-half-of-americans-now-wearing-face-masks-as-coronavirus-spreads/">wearing face masks</a> and <a href="https://theconversation.com/viruses-live-on-doorknobs-and-phones-and-can-get-you-sick-smart-cleaning-and-good-habits-can-help-protect-you-133054">even sanitizing door knobs</a> and disinfecting food and packages brought into the house.</p>
<p>This has led <a href="https://www.newsweek.com/california-lockdown-stay-home-order-lifted-governor-gavin-newsom-president-trump-1497765">governors to begin discussing plans to lift lockdowns</a> and <a href="https://www.latimes.com/california/story/2020-04-16/california-counties-relax-coronavirus-work-closure">allow closed businesses to reopen</a>. </p>
<p>But in order to continue to contain the spread of COVID-19, we’ll still need to sustain these behaviors for weeks and maybe months to come. Will people be able to maintain their vigilance over time?</p>
<p>As scholars who study <a href="https://scholar.google.com/citations?user=ZhIXluwAAAAJ&hl=en">health-related</a> <a href="https://scholar.google.com/citations?user=8nyQzDsAAAAJ&hl=en&authuser=1">behavior change</a>, we’re skeptical. While continuing to wash your hands and stay six feet away from others doesn’t seem so hard for an individual, the problem is that people are unable to “see” the benefits of their actions – and thus often don’t recognize just how important they are. </p>
<p>As a result, adherence to these protective behaviors could wane over time without policies designed to sustain them.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329133/original/file-20200420-152597-mji2wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A sign displays social distancing at Centennial Olympic Park in Atlanta, Georgia.</span>
<span class="attribution"><span class="source">Paras Griffin/Getty Images</span></span>
</figcaption>
</figure>
<h2>Intangible benefits</h2>
<p>It is, in fact, remarkable to us that efforts to promote hygiene measures have been as successful as they have been. That’s because they are almost the embodiment of the types of protective measures that <a href="https://www.doi.org/10.1177/0963721419854102">people are especially bad at taking</a>. </p>
<p>The most obvious reasons are that maintaining physical distances and constantly washing hands are inconvenient and require constant vigilance. The <a href="https://www.doi.org/10.1257/002205102320161311">costs of these behaviors are immediate</a>, but the benefits are delayed. </p>
<p>A more subtle and equally important reason, however, is that the benefits are <a href="https://www.doi.org/10.1098/rstb.2008.0150">intangible</a>: You can’t touch, taste, feel or see the benefits of, for example, wiping off your door knob. </p>
<p>One reason the benefits are intangible is that people tend to be <a href="https://www.bloomberg.com/opinion/articles/2020-02-28/coronavirus-panic-caused-by-probability-neglect">insensitive to even dramatic changes in probabilities</a> – such as from one-in-a-thousand chance to one-in-a-million chance – when it comes to small probability events such as the chance of contracting coronavirus. </p>
<p>This is true unless the change in probability leads to certainty that the event will not occur, which is why people are not eager to engage in preventive behaviors unless they completely eliminate the risk, as research by psychologists has shown. </p>
<p>For example, <a href="https://www.jstor.org/stable/2555636">one study</a> found that people were willing to pay much more to reduce a pesticide risk from 5 in 10,000 to 0 in 10,000 than from 15 in 10,000 to 10 in 10,000, even though the actual reduction in risk was identical. <a href="https://www.taylorfrancis.com/books/e/9781315661773/chapters/10.4324/9781315661773-19">A similar study</a> concluded that people were more attracted to a vaccine said to entirely eliminate a 10% risk for a disease than to one that reduced the risk from 20% to 10%. And a <a href="https://www.doi.org/10.3758/PBR.16.1.156">third one</a> found that a vaccine described as 100% effective in preventing 70% of known cases of a disease was more appealing than one that was 70% effective in preventing all cases even though both would have the same net effect.</p>
<p>Even if we follow all recommendations about sheltering in place, washing hands, wearing masks and disinfecting grocery deliveries, we can only reduce and not eliminate the chance of catching COVID-19. </p>
<p>Will people continue to feel that it’s really worth it to sanitize all those plastic bags from the supermarket if the only effect is to reduce the odds from, say, 1 in 2,000 to 1 in 3,000?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329134/original/file-20200420-152558-73g0gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Will Americans continue to wear face masks at restaurants?</span>
<span class="attribution"><span class="source">Cindy Ord/Getty Images</span></span>
</figcaption>
</figure>
<h2>Invisible impact</h2>
<p>Another reason the benefits of prevention seem intangible is that we don’t get useful feedback about the effects of our actions.</p>
<p>The microbes are invisible, so we have no idea whether we had them before we washed our hands or have gotten rid of them after we have done so.</p>
<p>In addition, we get no feedback about how a particular protective action has changed our probability of getting infected. If all of our actions work, the outcome is that we don’t get sick. But not being sick was the state we were in before we took those actions. Thus, it seems as if the preventive actions caused nothing to happen because we can’t see the negative outcome that might have happened if we hadn’t been so vigilant. </p>
<p>Documenting such a pattern, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181183/">studies of treatment for depression</a> have found that many patients skip or discontinue taking antidepressants as soon as their symptoms improve, leading to relapse. </p>
<p>The same is likely true at a societal level. If all the sacrifices people are making pay off in the form of lower infection rates, people will point to those low rates as evidence that the <a href="https://www.bbc.com/news/av/world-us-canada-52304832/coronavirus-michigan-protesters-defy-stay-at-home-order">sacrifices weren’t actually necessary</a>. Such a pattern has been documented among <a href="https://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/index1.html">anti-vaxxers</a>, who claim that low rates of diseases that are vaccinated against are evidence that the vaccine wasn’t needed in the first place. </p>
<p>When one is healthy, <a href="https://www.cmu.edu/dietrich/sds/docs/loewenstein/projectionbias.pdf">it is very difficult to imagine being sick</a> – even when one has been sick in the past. This probably has something to do with low rates of adherence to lifesaving medications.</p>
<p>For example, one year after hospitalization for a heart attack, nearly half of patients prescribed statins <a href="https://www.doi.org/10.1001/jama.288.4.462">stop taking them</a>. And <a href="https://www.doi.org/10.1185/03007995.2015.1053048?journalCode=icmo20">rates of medication adherence for acute diabetics are similarly dismal</a>. </p>
<p>In both cases, people who are healthy – or even those who are sick but not experiencing immediate symptoms – don’t appear to appreciate the risks of failing to protect themselves.</p>
<h2>Constant vigilance</h2>
<p>So how can we sustain vigilance in the face of pervasive intangibility?</p>
<p>We could remind ourselves that life rarely offers certainty, and behaviors that reduce risk significantly are worth continuing even if they don’t eliminate it altogether. Or we could try to keep in mind those who have been hospitalized or even killed by COVID-19 – a fate that could befall any of us.</p>
<p>Realistically, however, neither of these approaches is likely to have much traction due to the intangibility of the effects of preventive behaviors. And so the best policies are those that eliminate the need for individual decision-making altogether, such as when stores ensure grocery carts and public spaces are kept well sanitized.</p>
<p>As for policymakers, they could compel companies to maintain these measures as a condition of being open. And they could design regulations that require people to continue to wear face masks in public or don gloves when entering public buildings, while lightly punishing those who don’t comply. <a href="https://www.doi.org/10.1257/pol.20150261">Small penalties can have a huge impact on behavior</a>. </p>
<p>The longer these behaviors are maintained, the more likely it is that <a href="https://www.doi.org/10.1146/annurev-psych-122414-033417">they’ll become habitual</a>, overcoming the problem of their benefits being intangible. And society will be able to get back to some semblance of normal while keeping the lid on the coronavirus.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/136457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Policymakers need to figure out ways to sustain the behaviors that are helping flatten the curve as cities begin to end their lockdowns.Gretchen Chapman, Professor of Psychology, Carnegie Mellon UniversityGeorge Loewenstein, Professor of Economics and Psychology, Carnegie Mellon UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1355282020-04-14T12:20:29Z2020-04-14T12:20:29ZIgnaz Semmelweis, the doctor who discovered the disease-fighting power of hand-washing in 1847<figure><img src="https://images.theconversation.com/files/327549/original/file-20200413-177903-6l8e8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A simple, low-tech way to get rid of germs.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/medical-personnel-hand-washing-dressed-in-medical-royalty-free-image/1212821218"> FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>One of the front-line defenses individuals have against the spread of the coronavirus can feel decidedly low-tech: <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html">hand-washing</a>.</p>
<p>In fact, it was 19th-century Hungarian physician Ignaz Semmelweis who, after observational studies, first advanced the idea of “hand hygiene” in medical settings.</p>
<p>The <a href="https://www.cdc.gov/handwashing/index.html">simple act of hand-washing</a> is a critical way to prevent the spread of germs. Here’s how Semmelweis, working in an obstetrics ward in Vienna in the 19th century, made the connection between dirty hands and deadly infection.</p>
<h2>Benefits of cleanliness, symbolic and real</h2>
<p>The <a href="https://doi.org/10.4103/2008-7802.201923">history of hand-washing</a> extends back to ancient times, when it was largely a faith-based practice. The Old Testament, the Talmud and the Quran all mention hand-washing in the context of ritual cleanliness.</p>
<p>Ritual hand-washing appears to have come with public health implications. During the Black Death of the 14th century, for instance, the Jews of Europe had a distinctly lower rate of death than others. Researchers believe that hand-washing prescribed by their religion <a href="https://doi.org/10.1016/j.ijid.2004.05.005">probably served as protection during the epidemic</a>.</p>
<p>Hand-washing as a health care prerogative did not really surface until the mid-1800s, when a young Hungarian physician named Ignaz Semmelweis did an important observational study at Vienna General Hospital.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=837&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=837&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=837&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1052&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1052&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327551/original/file-20200413-177938-r4kf7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1052&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ignaz Philip Semmelweis (1818-1865)</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ignaz-philip-semmelweis-hungarian-obstetrician-discovered-news-photo/113444168">Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>After becoming disillusioned with the study of law, Semmelweis moved to the study of medicine, graduating with a medical degree from the University of Vienna in 1844. Having graduated from this prestigious institution, he believed he would be able to pursue a choice practice. He applied for positions in pathology and then medicine, but received rejections in both.</p>
<p>Semmelweis then turned to obstetrics, a relatively new area for physicians, previously dominated by midwifery, which was less prestigious and where it was easier to obtain a position. <a href="https://wwnorton.com/books/9780393326253">He began working in the obstetrics division</a> of the Vienna Hospital on July 1, 1846.</p>
<p>The leading cause of maternal mortality in Europe at that time was <a href="https://doi.org/10.1017/s0025727300000119">puerperal fever</a> – an infection, now known to be caused by the streptococcus bacterium, that killed postpartum women.</p>
<p>Prior to 1823, about 1 in 100 women died in childbirth at the Vienna Hospital. But after a policy change mandated that medical students and obstetricians perform autopsies in addition to their other duties, the mortality rate for new mothers suddenly jumped to 7.5%. What was going on?</p>
<p>Eventually, the Vienna Hospital opened a second obstetrics division, to be staffed entirely by midwives. The older, First Division, to which Semmelweis was assigned, was staffed only by physicians and medical students. Rather quickly it became apparent that the mortality rate in the first division was much higher than the second.</p>
<p>Semmelweis set out to investigate. He examined all the similarities and differences of the two divisions. The <a href="https://doi.org/10.1128/9781555817220">only significant difference</a> was that male doctors and medical students delivered in the first division and female midwives in the second.</p>
<h2>Washing away germs from the dead</h2>
<p>Remember that at this time, the general belief was that bad odors – miasma – transmitted disease. It would be two more decades at least before germ theory – the idea that microbes cause disease – gained traction.</p>
<p>Semmelweis cracked the puerperal fever mystery after the death of his friend and colleague, pathologist Jakob Kolletschka. Kolletschka died after receiving a scalpel wound while performing an autopsy on a woman who’d died of puerperal fever. His autopsy revealed massive infection from puerperal fever.</p>
<p>Contagiousness now established, Semmelweis concluded that if his friend’s</p>
<blockquote>
<p>“general sepsis arose from the inoculation of cadaver particles, <a href="https://wwnorton.com/books/9780393326253">then puerperal fever must originate from the same source</a>. … The fact of the matter is that the transmitting source of those cadaver particles was to be found in the hands of students and attending physicians.”</p>
</blockquote>
<p>No midwives ever participated in autopsies or dissections. Students and physicians regularly went between autopsies and deliveries, rarely washing their hands in between. <a href="https://doi.org/10.1080/08998280.2010.11928658">Gloves were not commonly used</a> in hospitals or surgeries until late in the 19th century.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=312&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=312&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=312&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=392&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=392&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327550/original/file-20200413-177903-5qhytd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=392&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ignaz Semmelweis washing his hands in chlorinated lime water before attending to patients.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ignaz-semmelweis-washing-his-hands-in-chlorinated-lime-news-photo/517403466">Bettmann via Getty Images</a></span>
</figcaption>
</figure>
<p>Realizing that chloride solution rid objects of their odors, Semmelweis mandated hand-washing across his department. Starting in May 1847, anyone entering the First Division had to wash their hands in a bowl of chloride solution. The incidence of puerperal fever and death <a href="https://doi.org/10.1128/9781555817220">subsequently dropped precipitously</a> by the end of the year.</p>
<p>Unfortunately, as in the case of his contemporary John Snow, who discovered that cholera was transmitted by water and not miasma, Semmelweis’ work <a href="https://doi.org/10.1017/S0025727300043738">was not readily accepted by all</a>. The obstetrical chief, perhaps feeling upstaged by the discovery, refused to reappoint Semmelweis to the obstetrics clinic.</p>
<p>Semmelweis’ refusal to publish his work may have also contributed to his downfall. With little recognition during his lifetime, he <a href="https://wwnorton.com/books/9780393326253">eventually died from injuries</a> sustained in a Viennese insane asylum.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327552/original/file-20200413-132830-9emais.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Coronavirus has launched hand-washing into the spotlight.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-walks-past-a-coronavirus-public-information-campaign-news-photo/1206349532">SOPA Images/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>Taking an old lesson to heart</h2>
<p>Although Semmelweis began the charge for hand hygiene in the 19th century, it has not always fallen on receptive ears.</p>
<p>The medical field now recognizes that soap and running water are the best way to <a href="https://doi.org/10.1097/00002727-200407000-00007">prevent, control and reduce infection</a>. But regular folks and <a href="https://doi.org/10.1016/j.ajic.2005.05.025">health care workers</a> still <a href="https://doi.org/10.7326/0003-4819-141-1-200407060-00008">don’t always follow</a> <a href="https://doi.org/10.1071/ah980238">best practice guidelines</a>.</p>
<p>Hand-washing appears to get a bump in compliance in the wake of disease outbreaks. Take the example of the first major outbreak of SARS, which occurred in the Prince of Wales Hospital in Hong Kong in March 2003. Health authorities advised the public that hand-washing would help prevent spread of the disease, caused by a coronavirus. After the SARS outbreak, medical students at the hospital were much more likely <a href="https://doi.org/10.1016/j.ajic.2005.05.025">to follow hand-washing guidelines</a>, according to one study.</p>
<p>I suspect the current pandemic of COVID-19 will change the way the <a href="https://globalhandwashing.org">public thinks about hand hygiene</a> going forward. In fact, White House coronavirus advisor and NIAID Director Anthony Fauci has said “<a href="https://thehill.com/homenews/administration/491917-fauci-i-dont-think-we-should-shake-hands-ever-again">absolute compulsive hand-washing</a>” for everyone must be part of any eventual return to pre-pandemic life.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/135528/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leslie S. Leighton does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A Hungarian obstetrician was the first to nail down the importance of handwashing to stop the spread of infectious disease.Leslie S. Leighton, Visiting Lecturer of History, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1335992020-03-18T12:09:04Z2020-03-18T12:09:04ZCoronavirus reminds Americans that pursuit of happiness is tied to the collective good<figure><img src="https://images.theconversation.com/files/321089/original/file-20200317-60894-n64oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People practice social distancing by standing apart during a news conference in Washington D.C.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Washington/f5763cdc2f77412b95ce1ec804c5b8c6/22/0">AP Photo/Jacquelyn Martin</a></span></figcaption></figure><p>At its core, the United States <a href="https://www.archives.gov/founding-docs/declaration-transcript">Declaration of Independence</a> argues that all human beings have “unalienable rights.” These include right to “Life, Liberty and the pursuit of Happiness.” </p>
<p>These rights apply to all human beings, and <a href="https://www.washingtonpost.com/news/answer-sheet/wp/2015/07/04/are-our-rights-inalienable-or-unalienable/">cannot be given away</a>. </p>
<p>What is more, the Declaration says that “to secure these rights, Governments are instituted among Men.” In other words, the primary objective of government is to afford citizens the opportunity to exercise these rights; the right to be left alone and to be free to pursue their own notion of happiness. </p>
<p>These ideas – that all people have the right to freely pursue their own self interest, and that government is concerned primarily with defending that right – show that the United States is, speaking philosophically, a very liberal society. </p>
<p>I have been researching questions about American political philosophy since I was a graduate student studying social ethics in the 1990s and those questions <a href="https://democracy.psu.edu/">still occupy my research</a>. With the advent of the coronavirus pandemic, one question in particular has emerged as front and center: </p>
<p>Is a society founded on liberal principles able to preserve itself when confronted with an existential threat, such as the coronavirus pandemic? </p>
<h2>Is liberalism insufficient?</h2>
<p>With the end of the Cold War, Soviet-style communism was banished to what President Ronald Reagan called “<a href="https://www.historyplace.com/speeches/reagan-parliament.htm">the ash heap of history</a>.” Several countries throughout the former Soviet bloc, and throughout the world, <a href="https://www.foreignaffairs.com/articles/1990-09-01/democracy-global-revolution">embraced the ideals of civil rights, free enterprise and democratic equality</a>. </p>
<p>This dominance of Western liberalism was also reflected in American political philosophy. In the 70s and 80s, political theorists like <a href="https://www.law.columbia.edu/faculty/joseph-raz">Joseph Raz</a>, <a href="https://plato.stanford.edu/entries/nozick-political/">Robert Nozik</a> and <a href="https://plato.stanford.edu/entries/rawls/">John Rawls</a> all sought to refine <a href="https://plato.stanford.edu/entries/liberalism/#NewLib">the features and implications of liberal thought</a>. </p>
<p>For example, John Rawls, in my opinion, the most important American political philosopher of this time, argued that liberal society required as much freedom and as much equal distribution of resources as possible. Any inequality or restriction of rights was only acceptable when it made society better off. </p>
<p>But neither Rawls nor any of these eminent theorists questioned the idea that liberalism was the best way to organize society. </p>
<p>In fact, political scientist <a href="https://fukuyama.stanford.edu/">Francis Fukuyama</a> famously argued for liberalism saying that <a href="https://www.foreignaffairs.com/reviews/capsule-review/1992-03-01/end-history-and-last-man">the question about how people should live together was effectively over</a>. </p>
<p>But at the time, there also emerged a group of scholars who did question the sufficiency of liberalism. Political philosophers <a href="https://scholar.harvard.edu/sandel/home">Michael Sandel</a> <a href="https://www.mcgill.ca/philosophy/people/emeritus-faculty/taylor">Charles Taylor</a> and sociologist <a href="https://sociology.columbian.gwu.edu/amitai-etzioni">Amitai Etzioni</a> all came to be identified as <a href="https://plato.stanford.edu/entries/communitarianism/">Communitarians</a>. </p>
<p>They shared the belief that individual rights were not a sufficient foundation on which to build and sustain a good society. Communitarians agreed with Aristotle’s famous phrase: Humans beings are “<a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:tlg,0086,035:1:1253a">political animals</a>.” In other words, society is more than just a collection of individuals. </p>
<h2>It’s not about individual rights</h2>
<p>This philosophical debate, in my view, is suddenly very relevant again.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/321086/original/file-20200317-60889-13igdp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People wait in line outside a grocery store in Spring, Texas.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Texas/6fa97d2263cb4b8a94b6bcac0d09fe1d/12/0">AP Photo/David J. Phillip</a></span>
</figcaption>
</figure>
<p>As the coronavirus spreads, appeals about social distancing, washing one’s hands and the like appear to be focused primarily on the individual’s self-interest of not falling ill. </p>
<p>Such appeals would seem to fit nicely with liberalism and its focus on individual rights. </p>
<p>But the pandemic is at the same time demonstrating that these kinds of appeal are not enough. Just a few days ago, for example, Today’s Parent magazine offered the <a href="https://www.todaysparent.com/kids/kids-health/hand-washing-kids/">following advice</a> about how to talk to children about the coronavirus and washing their hands: “Assure them that kids don’t tend to get seriously ill with it, but other people in society are more susceptible, and they can do this small thing to help others stay healthy.”</p>
<p>Data is still sketchy, but it appears that for young people, <a href="https://www.buzzfeednews.com/article/lamvo/coronavirus-death-rates-age-charts-us-china">the mortality rate from the coronavirus</a> is not much different from seasonal flu. But even so, they can still transmit the virus to those who are more vulnerable – especially older people and those with underlying health conditions. </p>
<p>Also, <a href="https://www.washingtonpost.com/health/2020/03/02/n95-face-mask-coronavirus/">people are being urged not to load up on hand sanitizer and surgical masks</a>. Neither of these are absolutely necessary to keep the average person from contracting the virus. </p>
<p>But they might be very helpful for someone else – health care professionals, for example, need their patients to wear masks so they don’t get infected. Because of their repeated interactions with those same sick people, they are in more frequent need of the hand sanitizer as well. </p>
<h2>Obligations to each other</h2>
<p>This crisis makes it all too clear that pursuing one’s own self-interest is not enough. While every one of us has the legal right to purchase as much hand sanitizer as we can find, if that is all we think about, the welfare of others and society itself are at risk. </p>
<p>Like the Communitarians from 30 years ago, Americans need to challenge the idea that everyone is just pursuing their own happiness as individuals. When we live together in society, we depend on each other. And therefore we have obligations to each other. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133599/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Beem does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As the coronavirus spreads far and wide, a political philosopher argues that it is a time to understand that the idea of individual happiness does not work without thinking of the larger good.Christopher Beem, Managing Director of the McCourtney Institute of Democracy, Co-host of Democracy Works Podcast, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1330542020-03-17T19:46:25Z2020-03-17T19:46:25ZViruses live on doorknobs and phones and can get you sick – smart cleaning and good habits can help protect you<figure><img src="https://images.theconversation.com/files/320286/original/file-20200312-111300-zgdow6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disinfecting an area takes time and effort. And there is only so much you can do. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-New-York/4af925c106ca40268d5db383657b355e/2/0">AP Photo/Seth Wenig</a></span></figcaption></figure><p>One vomiting episode from someone infected with norovirus <a href="https://dx.doi.org/10.3201/eid1410.080117">emits billions and billions of individual viruses</a>. That’s enough to fuel an outbreak – and is exactly what happened in an elementary school in <a href="https://www.usatoday.com/story/news/health/2019/12/13/norovirus-outbreak-stomach-flu-terrorizes-washington-public-schools/4417867002/">Seattle, Washington a few months ago</a>. Over 100 children got sick with the stomach-churning bug, and the school doors remained closed until workers could decontaminate the lockers, desks and hallways.</p>
<p>You might think of germs mostly passing directly from one person to another, but the outbreak in Seattle illustrates how they can survive on and be transmitted by inanimate objects in the world around us. <a href="https://sph.umich.edu/faculty-profiles/eisenberg-joseph.html">Epidemiologists like me</a> call these everyday objects – like doorknobs, elevator buttons and cellphones – fomites, and when contaminated, these fomites can make you sick. </p>
<p>Fomites can be an important pathway of disease transmission. They were the main culprits in that norovirus outbreak in Seattle last year and have been the cause of many other outbreaks. In 1908, <a href="https://dx.doi.org/10.1128%2FAEM.02051-06">smallpox outbreaks were traced to contaminated imported cotton</a>. More recently, <a href="https://doi.org/10.1093/oxfordjournals.aje.a113661">outbreak studies in day care centers</a> have identified viruses on <a href="https://www.ncbi.nlm.nih.gov/pubmed/8393172">toys, phones, toilet handles, sinks and water fountains</a>.</p>
<h2>The novel coronavirus</h2>
<p>The coronavirus is spreading quickly. As concern has increased, I’ve seen more people washing their hands and using hand sanitizer than ever before. While there is still a lot we don’t know about the new coronavirus, SARS-CoV-2, history would suggest that there is probably some transmission from fomites. Everyone should be washing their hands and using hand sanitzer, but taking efforts to clean the things around you is also important to fight the spread of the virus.</p>
<p>For instance, in the last major coronavirus pandemic, SARS in 2002, contaminated surfaces were a major contributor to over <a href="https://dx.doi.org/10.1258%2Fjrsm.96.8.374">300 cases in a Hong Kong apartment building</a>.</p>
<p>When thinking about how risky transmission via fomites is in an outbreak, the important question is how long can a particular bug survive on surfaces. And there is a lot of variation. Some pathogens can last outside the body for only minutes, while others are hardier and can hold on for days or even months. A new study suggests that the novel coronavirus <a href="https://doi.org/10.1101/2020.03.09.20033217">can survive on some surfaces up to three days</a>, but it varies depending on the material. The study found that the virus could survive for 24 hours on cardboard and up to three days on plastic and stainless steel.</p>
<p>This variation is caused in part by the <a href="https://doi.org/10.1186/1471-2334-6-130">properties of the surface a virus lands on</a>. Porous material like clothing may allow pathogens to survive longer but it can be harder for a virus to move <a href="https://doi.org/10.1128/AEM.01030-13">from your shirt to someone else’s fingers</a>. The matrix fibers in nonporous materials can trap germs making it hard for them to transfer. On the other hand, viruses can more readily transfer from nonporous materials like the glass screen on your phone to fingers, but the virus won’t always survive as long on a glass surface compared to a sweater.</p>
<p>Environmental conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC201876/">temperature and humidity also influence the viability of a pathogen in the environment</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320291/original/file-20200312-111268-3h808r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most viruses will eventually die on their own. But cleaning with alcohol, bleach and other chemicals can kill them more quickly.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Ukraine-Virus-Outbreak/6b99329a97094a578d3b689b6f5d9924/20/0">AP Photo/Efrem Lukatsky</a></span>
</figcaption>
</figure>
<h2>Persistent bugs and how to get rid of them</h2>
<p>It’s nearly impossible to keep anything in the real world virus-free, but during outbreaks like this one it’s a good idea to try to minimize the number of viruses on fomites around you. Some people are practically bathing in hand sanitizer and wiping down everything they touch with disinfectant. But whether this works depends on what virus you are hoping to kill.</p>
<p>Norovirus, for example, is notoriously hardy. After an outbreak on a cruise ship in 2002, the next group of passengers got sick <a href="https://dx.doi.org/10.3201%2Feid1101.040434">more than a week later after a thorough cleaning of the ship</a>. Many standard cleaners like alcohol or Lysol do not kill norovirus. It takes something as strong as chlorine bleach to get the job done. </p>
<p>In contrast to norovirus, <a href="https://dx.doi.org/10.1128%2FAEM.02051-06">influenza is much less persistent in the environment</a>. While influenza is often lurking in daycare centers during flu season, it typically lasts on surfaces only for hours or a few days. And if you wanted to clean off your phone or countertop, simply wiping it down with an alcohol-based product or ammonia is effective.</p>
<p>While virologists don’t know much about how tough the current coronavirus is, past coronaviruses have fallen somewhere between norovirus and the flu. Like influenza, Lysol will likely kill the coronavirus.</p>
<p>But you don’t necessarily need to kill the virus to make yourself safer. Removing the virus can be just as effective and simply <a href="https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html">washing often-used objects or your hands with soap can do that</a>.</p>
<p>If you have been in crowded areas or want to be extra careful, washing your hands with soap for 20 seconds will effectively remove germs, and disinfecting tabletops and gym equipment with ammonia will effectively kill most germs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320289/original/file-20200312-111237-38wj0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Viruses are on everything. How you behave around them matters.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-woman-with-protective-face-mask-using-royalty-free-image/1203348066?adppopup=true">d3sign/Moment via Getty Images</a></span>
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<h2>What can you do in a world with viruses everywhere?</h2>
<p>During the coronavirus pandemic, it is important to clean the objects you touch frequently, like keyboards, tabletops and gym equipment.</p>
<p>But while fomites are known to be the culprits in many outbreaks, an individual’s risk depends on a lot of factors. Someone who touches contaminated surfaces frequently, like a health care worker, <a href="https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html">is more likely to get sick than someone who doesn’t</a>. Risk also depends on personal habits, such as how often one touches their eyes, nose and mouth. And for most infectious diseases, whether someone gets sick and the severity of the illness depends on age and underlying health conditions.</p>
<p>Cleaning objects frequently with a disinfectant is the best way to mitigate the risk of transmission from everyday objects. Hand-washing is also important, especially if done reliably right after coming home from a public place.</p>
<p>Given that germs are ubiquitous, it’s easy to become germ-phobic and strive for a sterile environment. But keep in mind that while basic precautions are important, germs will always find a way to exploit our human environment. You can and should minimize risk, but germs are here to stay. </p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133054/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Eisenberg does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The coronavirus, like many infectious diseases, can live and spread on inanimate objects in the world around us. An epidemiologist explains how and gives some advice on how to minimize the risk.Joseph Eisenberg, Professor and Chair of Epidemiology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1332212020-03-16T12:18:14Z2020-03-16T12:18:14ZWhat Islamic hygienic practices can teach when coronavirus is spreading<figure><img src="https://images.theconversation.com/files/320483/original/file-20200313-115127-1aiuq2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Muslim man prepares for prayer by doing a ritual washing.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/muslim-man-taking-ablution-for-prayer-royalty-free-image/1165714884?adppopup=true">mustafagull/Getty Images</a></span></figcaption></figure><p>As outbreaks of the coronavirus spread throughout the world, people are reminded over and again to limit physical contact, <a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">wash hands</a> and avoid touching their face. The recent Netflix docuseries “<a href="https://www.netflix.com/Title/81026143">Pandemic: How to Prevent an Outbreak</a>” illustrates how the Islamic ritual washing, known as “wudu,” may help spread a good hygiene message.</p>
<p>The series focuses on Syra Madad, a Muslim public health specialist in a New York hospital, who takes a break to say her prayers at the Islamic Center of New York University. Before entering the prayer room, Madad stops to perform wudu, and washes her mouth and face as well as her feet. </p>
<p>Islamic law requires Muslims to ritually purify their body before praying. As a scholar of Islamic studies who <a href="https://scholar.google.com/citations?user=FvTDlCsAAAAJ&hl=en">researches</a> ritual practices among Muslims, I have found that these practices contain both spiritual and physical benefits. </p>
<h2>Ritual purity</h2>
<p>The Prophet Muhammad left detailed guidance for Muslims on how to live their lives, including how to pray, fast and stay ritually pure. This guidance is available in collections called the Hadith. </p>
<p>According to Islamic law, there are minor and major impurities. Minor impurities involve urinating, defecating and sleeping, among other practices. A person of Muslim faith is supposed to perform a <a href="http://www.oxfordislamicstudies.com/article/opr/t125/e2520">ritual washing</a> of their bodies before praying to get rid of these minor impurities. </p>
<p>Wudu is to be performed, as was done by the Prophet Muhammad, in <a href="https://www.youtube.com/watch?time_continue=3&v=8x-OHSYzPr8&feature=emb_title">a specific order</a> before praying, which takes place five times a day. Before each prayer, Muslims are expected to wash themselves in a certain order – first hands, then mouth, nose, face, hair and ears, and finally their ankles and feet. </p>
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<p>While washing with water is required when it is available, if a person has limited access to water, then a Muslim is permitted to <a href="https://www.youtube.com/watch?v=Oh0gxMmyPSk">symbolically “cleanse” their hands and face</a> with dust or sometimes sand or other natural materials. </p>
<p>A Quranic verse <a href="http://al-quran.info/#5:6">says</a>: “And if you are ill or on a journey or one of you comes from the place of relieving himself or you have contacted women and find no water, then seek clean earth and wipe over your faces and your hands [with it]. Indeed, God is ever Pardoning and Forgiving.” </p>
<p>A hadith from the prophet also <a href="https://ahadith.co.uk/permalink-hadith-1552">describes the Earth</a> as a purifying agent if there is a scarcity of water for washing. </p>
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<p>Major impurity is defined in Islamic texts as occurring after sexual activity or when a woman completes her menstrual cycle. A Muslim woman should not pray during her menstrual cycle. To purify oneself after such an impurity, a Muslim is required to take a shower, called “<a href="https://www.youtube.com/watch?v=PEgUbg9YuCA">ghusl</a>.” A person needs to wash their entire body, from head to toe, including their hair. </p>
<h2>Spiritual actions</h2>
<p>Preparing for prayer by washing one’s body using water can be a deeply spiritual act for Muslims. Islamic studies scholar <a href="https://college.lclark.edu/live/profiles/99-paul-powers">Paul Powers</a> <a href="https://academic.oup.com/jaar/jaar/article-abstract/72/2/425/688516">argues</a> it isn’t “empty ritualism,” but an embodied practice that helps the individual center on an inner religiosity. </p>
<p>Similarly, another Islamic studies scholar, <a href="https://as.nyu.edu/content/nyu-as/as/faculty/marion-h-katz.html">Marion Katz</a>, explains in her 2002 book “<a href="https://books.google.com/books?id=60YGB0kF3-cC&lpg=PP1&pg=PA75#v=onepage&q&f=false">Body of Text</a>” that the importance of wudu lies in its symbolic cleansing. It does not always cleanse the parts of the body that are “physically involved in the pollution act.” </p>
<p>Ritual purity is different from hygienic practices, although Islam also emphasizes good hygiene. Muslims take care to wash often, including using water <a href="https://www.salon.com/2012/07/10/secrets_of_the_muslim_bathroom/">after going to the bathroom</a>.</p>
<h2>Aligning with public health guidelines</h2>
<p>In view of the coronavirus risk, Muslim leaders <a href="https://sandala.org/congregations-and-covid-19/">around the world</a>, including <a href="https://shuracouncil.org/">in the U.S.</a>, have aligned their religious opinions with public health experts. </p>
<p>Muslim institutions have begun to <a href="https://www.adamscenter.org/coronavirus">recommend</a> that people make sure to wash their hands for 20 seconds with soap before doing wudu. Emphasizing that wudu alone cannot prevent the virus from spreading, other Islamic institutions <a href="https://www.aljazeera.com/news/2020/03/muslims-advised-stop-coronavirus-spread-200304160256140.html">recommend</a> that mosques supply extra soap and hand sanitizer near the washing area.</p>
<p>They have issued rulings to <a href="https://sandala.org/congregations-and-covid-19/">cancel Friday prayers</a>, urged Muslims to wash their hands with soap regularly, refrain from touching their face and practice social distancing. </p>
<p>While people have cleared local store shelves of hand sanitizers, wipes, cleaning supplies, gloves and masks, basic hygiene practices remain the best way to prevent the spread of the coronavirus and other viruses. </p>
<p>At this time, Islamic practices that emphasize purity of body could help reiterate the importance of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099567/">hygienic practices</a> along with the use of soap or hand sanitizer, to reduce one’s vulnerability to the virus.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rose S. Aslan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Islamic law requires Muslims to ritually clean their body before praying. This guidance has particular relevance at a time when hand-washing is important to contain the spread of the coronavirus.Rose S. Aslan, Assistant Professor of Religion, California Lutheran UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1335932020-03-13T17:15:41Z2020-03-13T17:15:41ZVodka won’t protect you from coronavirus, and 4 other things to know about hand sanitizer<figure><img src="https://images.theconversation.com/files/320436/original/file-20200313-115120-1375plm.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C2882%2C2309&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Soap and hot water is the best way to clean your hands, but sanitizer is a good second choice.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/AP-F-GA-USA-Hand-Sanitizers/22f9fdc206f848bb9ce4b9f1b0fa2826/5/0">AP Photo/Ric Feld</a></span></figcaption></figure><p><em>Editor’s note: As concern about coronavirus grows, hand sanitizer is in high demand. Biologist Jeffrey Gardner explains why alcohol is a key ingredient in hand sanitizer, and why he doesn’t recommend making your own supply at home.</em></p>
<h2>1. Why is alcohol the main ingredient in most hand sanitizers?</h2>
<p>Alcohol is effective at killing different types of microbes, including both viruses and bacteria, because it <a href="https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html">unfolds and inactivates their proteins</a>. This process, which is called <a href="https://www.britannica.com/science/denaturation">denaturation</a>, will cripple and often kill the microbe because its proteins will unfold and stick together. Heat can also denature some proteins – for example, when you cook an egg, the solidified egg whites are denatured proteins. </p>
<h2>2. Alcohol doesn’t kill some microbes very well - why not?</h2>
<p>There are different types of bacteria and viruses, and some types are more easily killed by alcohol. For example, <em>E. coli</em> bacteria, which can cause <a href="https://www.webmd.com/food-recipes/food-poisoning/what-is-e-coli#1">foodborne illness and other infections</a>, are very effectively <a href="https://aem.asm.org/content/aem/55/12/3113.full.pdf">killed by alcohol</a> at concentrations over 60%. Differences in the outside surface of various bacteria make alcohol sanitization more effective against some of them than others. </p>
<p>Similarly, some viruses have an <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/enveloped-virus">outer wrapping, which is called an envelope</a>, while others are non-enveloped. Alcohol is effective at killing enveloped viruses, including the <a href="https://doi.org/10.1186/s12985-019-1182-0">coronavirus</a>, but is less effective at killing non-enveloped viruses. </p>
<p>Whether you are trying to kill bacteria or viruses, many research studies have found that an alcohol concentration of <a href="https://cmr.asm.org/content/17/4/863.long">60% or greater is needed</a> to be effective. </p>
<h2>3. If 60% alcohol is good, is 100% better?</h2>
<p>Surprisingly, no. Protein denaturation actually works faster when a small amount of water is mixed with the alcohol. And pure alcohol would evaporate too quickly to effectively kill bacteria or viruses on your skin, especially during winter when the air is less humid. </p>
<p>Using 100% alcohol also would dry your skin out very quickly and cause it to become irritated. That might cause you to not sanitize your hands as frequently as needed. This is why most hand sanitizers contain <a href="https://doi.org/10.1016/S0195-6701(01)90004-0">emollients</a>, which are mixtures that help soften and moisturize your skin.</p>
<h2>4. Are homemade hand sanitizers a good idea?</h2>
<p>In my view, no. You may see do-it-yourself formulas online, including some that use vodka. However, vodka is typically 80 proof, which means it’s only 40% alcohol. That’s not high enough to effectively kill microbes. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1235627926525222912"}"></div></p>
<p>The rubbing alcohol you have in your bathroom for cuts and scrapes might seem like a good alternative, but if you are already near a sink, the best choice is to <a href="https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html">wash your hands</a> with soap and hot water.</p>
<h2>5. Does hand sanitizer expire?</h2>
<p>Most commercial hand sanitizers are effective for a couple of years when they are stored properly, and are marked with expiration dates. One thing to keep in mind is that alcohol is volatile, which means that over time the alcohol will slowly evaporate and the sanitizer will lose its ability to effectively kill viruses and bacteria. However, with hand sanitizer in such high demand now, you’re unlikely to buy one that is expired.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p><img src="https://counter.theconversation.com/content/133593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey Gardner receives funding from the U.S. Department of Energy and the Maryland Technology Development Corporation. He is also the Technical Director of Gardner Industries LLC, a biotechnology start-up company. </span></em></p>Most commercial hand sanitizers are mainly alcohol, but forget about hitting the liquor store and mixing your own.Jeffrey Gardner, Associate Professor of Biological Sciences, University of Maryland, Baltimore CountyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1332142020-03-13T12:03:36Z2020-03-13T12:03:36ZCoronavirus could hit homeless hard, and that could hit everyone hard<figure><img src="https://images.theconversation.com/files/319995/original/file-20200311-116236-13j08cg.jpg?ixlib=rb-1.1.0&rect=0%2C87%2C5272%2C3131&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Homeless people at the 42nd Street and Bryant Park subway station in New York City, March 9, 2020.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/homeless-people-sleep-in-the-42nd-st-bryant-park-subway-news-photo/1211830073?adppopup=true">Gary Hershorn/Corbis via Getty Images</a></span></figcaption></figure><p>As the number of cases of COVID-19, the illness caused by the coronavirus, continues to grow, the nation is on edge. Doctors and scientists do not know what percentage of the general population has been infected and what percentage of the infected develops symptoms.</p>
<p><a href="https://www.cnn.com/videos/politics/2020/03/12/andrew-cuomo-coronavirus-testing-intv-sot-cpt-vpx.cnn">State and local governments</a> and the federal public health system are deploying strategies to contain the spread of the virus and consider ways to mitigate the effects of the disease on vulnerable groups, the health care system and the economy. </p>
<p>But amid all the planning, and a growing sense of panic, the impact of the spread of COVID-19 among homeless people is not being widely discussed. It should, however, be of special concern to local officials.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=e8_mXHUAAAAJ&hl=en">professor of preventive medicine</a> and health policy at the Keck School of Medicine at the University of Southern California. USC is in Los Angeles, which has one of the largest homeless populations in the nation. I am concerned about how infectious disease could undermine our efforts to provide humane care to homeless people and assist them to get off the streets and into stable housing. </p>
<p>I am also deeply concerned about infection rates and mortality more generally among vulnerable populations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319990/original/file-20200311-116270-12qqmug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Biti Arelong, a man experiencing homelessness, rests before the start of tai chi, near the Salt Lake City Public Library, in Salt Lake City.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Homeless-Tai-Chi/ae413eabe48c4ed7b3fd4a0bd9301066/64/0">AP Photo/Rick Bowme</a></span>
</figcaption>
</figure>
<h2>A vulnerable group, even when the economy is humming</h2>
<p><a href="https://files.hudexchange.info/resources/documents/2019-AHAR-Part-1.pdf">Over half a million people are homeless</a> in the U.S. Their living conditions and poor health may place them at higher risk for contracting the disease and dying from it, although as of this writing, there have been no reported cases among homeless people. </p>
<p>High rates of infectious diseases among people experiencing homelessness is hardly new. Since those of us who work with the homeless have been keeping data, we know that homeless people have a <a href="https://doi.org/10.1353/hpu.2012.0047">higher risk of tuberculosis, hepatitis, HIV and pneumonia</a>. This should give government officials and health providers cause for concern that coronavirus may also spread among the homeless.</p>
<p>While it’s too early for specific studies, <a href="http://www.bhchp.org/health-care-homeless-persons">the conditions of homelessness</a> may <a href="https://nhchc.org/clinical-practice/homeless-services/emergency-preparedness/">increase the risk</a> of transmitting the coronavirus to homeless people and ultimately its spread to others in the community.</p>
<p>COVID-19 is a respiratory illness. People get it when an infected person sneezes or coughs, spreading droplets in the air that could be transmitted to others. <a href="https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html">The Centers for Disease Control and Prevention has recommended</a> staying away from others who are sick, avoiding crowds and proper hand-washing. The agency also suggests that since the virus lives on surfaces for at least several hours, people should avoid touching surfaces that others may have touched. </p>
<p>These practices, however, are nearly impossible for those living on the streets who have no way to bathe or wash hands. Few encampments have portable toilets or sinks. People eat, sleep and congregate close to each other.</p>
<p>Those in shelters may fare a little better, if the shelter does frequent cleaning or provides access to bathrooms and hot water and hand sanitizers, <a href="https://doi.org/10.1097/NHH.0b013e3181ed754f">which many do not</a>. Even so, in many shelters, people sleep, eat and participate in activities in groups, which increases the risk of an exposed person transmitting the virus to those nearby. </p>
<p>In addition, many shelters are large spaces with cots or beds placed in close proximity. In the winter months, homeless people are often <a href="https://www.lahsa.org/winter-shelter">transported by bus to winter shelters</a>. Both the buses and mass shelters are almost designed to spread airborne droplets putting guests and those whom work there at risk for transmission. </p>
<p>Those working in shelters may have limited training in prevention, or a way to identify and isolate an individual showing signs and symptoms of COVID-19. </p>
<p>Many homeless people who do not stay in shelters may sleep in train or bus stations, ride subways or buses or go the waiting room of a hospital emergency department for the evening. These are places where an exposed person could contaminate doors and bathroom fixtures, chairs or other objects, providing opportunities for spreading the infection to others.</p>
<p>Once exposed, homeless people may have mortality risk due to other health conditions they may already have, such as diabetes, hypertension, cardiovascular disease and increased age. <a href="https://nhchc.org/wp-content/uploads/2019/08/health-homelessness-and-racial-disparities.pdf">Many people living on the street</a> <a href="https://nhchc.org/wp-content/uploads/2019/08/homelessness-and-health.pdf">already have diminished health</a>, have higher rates of chronic illnesses or have compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those who suffer from mental illness may have difficulty recognizing and responding to the threat of infection.</p>
<p><a href="https://doi.org/10.2105/AJPH.2009.180109">Homeless people have less access</a> to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments.</p>
<p>Without access, ill homeless people may be living on the streets and virtually unknown to the health care system and possibly exposing others to the virus. Homeless persons showing symptoms of COVID-19 may go to a crowded hospital emergency department, which even before coronavirus, is where many homeless people go to for health care services. But if the epidemic continues to spread, these facilities will <a href="https://www.latimes.com/homeless-housing/story/2020-03-01/coronavirus-homeless-risk-outbreak-unsheltered-califiornia">become even more crowded</a>, and wait times will increase potentially exposing more people to an infected individual who has come seeking care. </p>
<h2>Too important to be ignored</h2>
<p>Prudent action to contain the virus that targets this population makes sense, given the <a href="https://abcnews.go.com/Health/wireStory/homeless-double-risk-spreading-coronavirus-69454275">risk that this population poses</a> for the spread of the virus and the impact on the health care system. </p>
<p>A few communities are just beginning to put in place efforts to help prevent the spread of the coronavirus among the homeless population. In <a href="https://www.seattletimes.com/seattle-news/homeless/seattles-aging-and-ill-homeless-population-in-shelters-is-particularly-vulnerable-to-coronavirus/">Seattle</a>, officials are distributing hygiene kits and provide tips and checklists on prevention to shelter operators. Many of these activities are core public health functions that any local and state government agencies should be doing routinely as a part of their core surveillance and health assurance efforts. </p>
<p>But most localities do not have the resources available for new and widespread screening among homeless people or ways to locate and respond to an outbreak unless patients present in the hospital emergency department. </p>
<p>Public health agencies at all levels of government have a role to play in mitigating the effects of coronavirus. If public health agencies from local governments to the CDC do not have capacity because of budget cuts or a lack of commitment, local jurisdictions will not have the tools necessary to reach out to those at risk that will be necessary to contain the virus and mitigate its effects on our most vulnerable groups.</p>
<p><em>Also contributing to this are Gary Blasi, Paul Gregerson, Michelle Levander and Fareed Dibazar.</em></p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133214/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cousineau receives funding from The California Endowment 1000 Alameda St Los Angeles CA 90012</span></em></p>Many homeless people already have compromised immune systems. They are targets – and conduits – for COVID-19.Michael Cousineau, Professor of Clinical Preventive Medicine, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329052020-03-05T16:40:45Z2020-03-05T16:40:45ZCoronavirus and handwashing: research shows proper hand drying is also vital<figure><img src="https://images.theconversation.com/files/318345/original/file-20200303-66074-17luy9t.jpg?ixlib=rb-1.1.0&rect=36%2C45%2C5970%2C3962&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-washing-hands-before-operating-hospital-633360866">shutterstock/santypan</a></span></figcaption></figure><p>With the number of people infected with coronavirus increasing around the world on a daily basis, the World Health Organization (WHO) has advised everyone to <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">regularly and thoroughly clean their hands</a>. This can be either with an alcohol-based hand rub or with soap and water. The hope is that good hand hygiene will limit the spread of the virus.</p>
<p>To wash your hands effectively, it needs to be done with clean water and soap. Hands should be rubbed together for at least 20 seconds, followed by rinsing. The use of soap is particularly important for handwashing to be effective as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037063/">research</a> has shown that washing with soap significantly reduces the presence of microbes (viruses and bacteria) on hands. But one often overlooked part of handwashing is hand drying – which is also integral to effective hand hygiene. </p>
<p>Hand drying not only removes moisture from the hands but it also involves friction, which further reduces the microbial load and the environmental transfer of microorganisms. And the transmission of microbes is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809004/">more likely to occur</a> from wet skin than dry skin. </p>
<h2>How you dry matters</h2>
<p>But it’s not just as simple as drying your hands off in any old way, because how you dry your hands also matters. And this is particularly the case in hospitals and doctors surgeries.</p>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/1757177418815549">Our research review</a> has examined the importance of hand drying and the implications of wet hands for patients and healthcare workers. The findings highlight that hot air hand dryers and cloth roller towels can be a problematic way of drying your hands – especially in a hospital.</p>
<p>Our review mainly looked at the impact of hand drying on bacteria, not viruses. But what we found is still relevant when looking at the possible transmission and spread of coronavirus in hospitals and GP surgeries – particularly given the advice from the WHO regarding frequent handwashing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318346/original/file-20200303-66060-hyv0k9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drying your hands properly removes a significant number of microorganisms after hand washing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drying-hands-after-cleaning-bubble-747331132">ALPA PROD/Shutterstock</a></span>
</figcaption>
</figure>
<p>Disposable paper towels offer the most hygienic method of hand drying. Indeed, warm air and jet air dryers are not recommended for use in <a href="https://europeantissue.com/pdfs/090402-2008%20WUS%20Westminster%20University%20hygiene%20study,%20nov2008.pdf">hospitals and clinics</a> for hygiene reasons. These types of hand dryers can increase the dispersion of particles and microorganisms into the air, contaminating the environment. </p>
<p>Cloth roller towels are also not recommended as they become a general use towel when the roll comes to an end – and can be a source of pathogen transfer to clean hands. </p>
<h2>Importance of hand drying</h2>
<p>Our review also found that the most appropriate methods for hand drying within a clinical environment – such as a hospital – differed to that recommended for public washrooms. This is because of the higher risk of contamination and cross-infection in hospitals. So while it is important to dry your hands properly wherever you are, paper towels are always the preferred option if you are in hospital as a patient or a visitor – or a member of staff.</p>
<p>As part of our review, we also looked at government policy on hand drying and found that disposable paper towels are recognised as being the quickest and most effective way of removing residual moisture that may allow for the transmission of microorganisms. This is good to know given the current concerns around the spread of the coronavirus. </p>
<p>In this sense, our research serves as a timely reminder that proper and effective hand drying is integral to hand hygiene whether you’re in a hospital, doctor’s surgery or just in the office.</p><img src="https://counter.theconversation.com/content/132905/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our findings also highlight that hot air hand dryers and cloth roller towels can be a problematic way of drying your hands.Julian Hunt, Research Officer Human and Health Sciences Central, Swansea UniversityJohn Gammon, Deputy Head of the College of Human and Health Sciences, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329152020-03-04T14:31:40Z2020-03-04T14:31:40ZYes, washing our hands really can help curb the spread of coronavirus<figure><img src="https://images.theconversation.com/files/318367/original/file-20200303-66064-lhrpi4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>Much of the media discussion about coronavirus revolves around diagnosis and management of suspected cases. But the first piece of advice that is essential for anyone worried about contracting the coronavirus is something your grandparents might have suggested: wash your hands. It’s at the top of the list of many of the players trying to prevent the spread of the disease. This includes the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">World Health Organisation</a> (WHO), the US Centers for Disease Control and Prevention and other health authorities around the world.</p>
<p>But, ask the cynics, could preventing the spread of disease really be as simple as washing my hands?</p>
<p>The answer is yes. Because the science says so.</p>
<p>Hand washing is a tried and true, <a href="https://www.cdc.gov/handwashing/why-handwashing.html">scientifically proven</a> preventive strategy that reduces the likelihood of transmitting both viral and bacterial borne diseases. It has been shown to decrease both respiratory and <a href="https://doi.org/10.1186/s12889-017-4746-1">diarrhoeal</a> diseases in countries across the world. One review <a href="https://doi.org/10.1002/14651858.CD004265.pub3">found</a> that hand washing reduced diarrhoea cases by 30%. This is because it prevented bacteria being transmitted from faeces to the mouth.</p>
<p>It may seem like a low-cost – and incredibly simple – intervention. But not emphasising it would be a huge missed opportunity.</p>
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Read more:
<a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">Why hand-washing really is as important as doctors say</a>
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<p>The American Centers for Disease Control and Prevention recommends the following five‑step approach:</p>
<p>1) Wet your hands and turn off the tap (to save water),</p>
<p>2) Lather,</p>
<p>3) Rub your hands together for at least 20 seconds (possibly while singing Happy Birthday twice),</p>
<p>4) Rinse, and</p>
<p>5) Dry.</p>
<p>Do this multiple times a day, especially before eating. Using hand sanitiser is another option, as long as it is composed of 60% or more alcohol.</p>
<p>The benefits of hand washing over other preventive measures are clear: soap is easy to access. Both soap and an alcohol-based products for cleaning hands are cost effective interventions.</p>
<p>But millions of us don’t wash our hands as often and as well as we should. A <a href="https://www.jpmph.org/journal/view.php?id=10.3961/jpmph.2007.40.3.197">study done</a> in South Korea indicated that 93.2% of 2,800 survey respondents did not wash their hands after coughing or sneezing.</p>
<h2>The history</h2>
<p>The current outbreak of the new coronavirus disease (COVID-19) was first reported on <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019">31 December 2019</a> in Wuhan, China. By <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200302-sitrep-42-covid-19.pdf?sfvrsn=edd4f123_2">early March</a> 2020 more than 90,000 people from 71 countries had been infected. More than 3,000 people have died so far. It is not clear what the fatality rate is and this may not be known until the outbreak is over – but it has been quoted as around 2.5% by the WHO.</p>
<p>Other diseases carry much higher fatalities. For example, tuberculosis claims the lives of <a href="http://www.stoptb.org/assets/documents/global/plan/plan2/General%20TB%20Factsheet%20-%20November%202015%20final.pdf">4,100</a> people worldwide every day. And the Ebola virus <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">fatality rate is 50%</a>.</p>
<p>Nevertheless, the spread of the new virus has set off alarm bells, with China famously building two hospitals in <a href="https://qz.com/1792705/coronavirus-the-engineering-behind-wuhans-rapidly-built-hospitals/">10 days</a>, cruise ships being quarantined and cities effectively being <a href="https://www.nytimes.com/2020/03/02/business/economy/china-coronavirus-economy.html">shut down</a>.</p>
<p>The reason for the panic is that Corona-19 (more correctly named SARS-CoV-2) is a newly discovered virus. We don’t know exactly how infectious it is or who is at risk and why. As the WHO director-general said: we are entering <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020">uncharted territory</a>.</p>
<p>Apart from hand washing it’s important to try not to touch one’s face and not shake hands. Face masks are really only useful for those who already have the virus or are caring with someone known to have the virus. Proper use of face masks is <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">explained</a> by the WHO.</p>
<p>Consideration should also be given to the fact that a run on medical masks could cause a shortage for public health-care workers who need them for <a href="https://bhekisisa.org/health-news-south-africa/2020-02-21-south-africa-could-face-tb-mask-shortage-because-of-coronavirus-outbreak/">protection against other diseases</a> such as drug-resistant TB. This is particularly true in South Africa.</p>
<h2>What the science says about hand washing</h2>
<p>Research shows that hand washing isn’t just effective in preventing transmission of coronavirus. MIT recently conducted <a href="http://news.mit.edu/2020/slow-epidemic-airport-handwashing-0206">a study</a> to identify the most effective mitigation strategy for hand hygiene that could contribute most to the reduction of global epidemic risk. Researchers used modelling and data‐driven simulations.</p>
<p>The study found that if 60% of travellers moving through airports worldwide had clean hands, global disease spread could be curbed by almost 70%. And if this rate could be maintained in only 10 of the busiest airports internationally, an astounding 37% of infections could be prevented.</p>
<p>Research has also shown that hand washing can prevent about 30% of diarrhoea-related sicknesses and about 20% of <a href="https://www.cdc.gov/handwashing/why-handwashing.html">respiratory infections</a>. Some scientists go as far as to <a href="https://asthma.ca/wp-content/uploads/2017/08/asthma_handwashing_eng.pdf">argue</a> that 80% of diseases can be prevented by proper hand washing.</p>
<p>Not everyone is convinced. Hand washing has been treated with scepticism as a significant disease prevention and eradication measure by some who favour “hard science interventions”.</p>
<p>This is not without precedent.</p>
<p>A Hungarian-born physician in the mid-19th century, <a href="https://www.vinehealthcare.com/2020/02/15/ten-amazing-medical-breakthroughs/">Ignaz Semmelweis</a>, was ostracised and shunned by his colleagues because he was so bold as to make a link between decreased maternal mortality and hand washing for doctors who went directly from the dissection halls to deliver babies.</p>
<h2>Huge gaps</h2>
<p>Despite the growing body of research showing its effectiveness, hand washing habits are inadequate.</p>
<p>The MIT study assumes that 30% of people do not wash their hands at all after using a bathroom, and that correct hand washing is practised at such low rates that only 20% of people in airports actually have clean hands.</p>
<p>In South Africa, a national hand hygiene behaviour strategy estimated that only <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5573-8">20%</a> of South Africans washed their hands with soap at critical times such as before, during and after preparing food, after going to the toilet, after sneezing or coughing, after touching animals, after changing nappies of babies, and after caring for an ill person.</p>
<p>Hand washing is simple and should already be part of everyone’s daily routine. If it became a habit for everyone in the world, it would not just prevent mortality and illness from coronavirus. It could be the start of a more viable strategy to prevent death from other bacterial and viral diseases.</p>
<p>While the full implications of this global pandemic are still unfolding, and a <a href="https://theconversation.com/heres-why-the-who-says-a-coronavirus-vaccine-is-18-months-away-131213">vaccine</a> has yet to be developed, we need to act without delay using the one tool we already have.</p><img src="https://counter.theconversation.com/content/132915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Hofman currently receives research funding from the IDRC (Canada), UK Wellcome Trust, UK National Institutes for Health Research, Bloomberg Philanthropies and the South African Medical Research Council. In the past, she has also received funding from the Bill and Melinda Gates Foundation, WHO and UNFPA.</span></em></p><p class="fine-print"><em><span>Susan Goldstein is Associate Professor at the SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), School of Public Health, University of the Witwatersrand.
</span></em></p>Hand washing is a tried and true, scientifically proven preventive strategy that reduces the likelihood of transmitting both viral and bacterial borne diseases.Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandSusan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253302019-10-15T15:20:17Z2019-10-15T15:20:17ZMost people don’t wash their hands properly – here’s how it should be done<figure><img src="https://images.theconversation.com/files/297177/original/file-20191015-98653-iqr2x7.jpg?ixlib=rb-1.1.0&rect=26%2C13%2C4426%2C2951&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-washing-his-hand-545014/">Pexels</a></span></figcaption></figure><p>It’s something most people do everyday, often without really thinking about it, but how you wash your hands can make a real difference to your health and the well-being of those around you.</p>
<p>Washing your hands is the one most <a href="https://www.ijidonline.com/article/S1201-9712(04)00172-9/fulltext">effective method</a> to prevent cross-contamination which can cause the spread of illness and infections. And many research studies have shown how improvements in hand hygiene have resulted in reductions in illness. </p>
<p><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004265.pub3/information">A look at research from around the world</a> on the promotion of washing hands with soap, found that such interventions resulted in a <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-3156.2006.01568.x">30% reduction</a> in diarrhoea episodes and respiratory illnesses such as colds. <a href="https://www.ajicjournal.org/article/S0196-6553(17)30041-X/fulltext">Hand hygiene interventions</a> at elementary schools in the US similarly helped to reduce sick days associated with acute gastrointestinal illness by 31%.</p>
<p>The impact of good hand hygiene is even greater among people that have an increased risk of infection. A <a href="https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.46867-0#tab2">study</a> from 2007, for example, found that patients with AIDS who washed their hands more frequently got ill less often.</p>
<p>But as <a href="https://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-378">our recent research shows</a>, despite awareness of the importance of washing your hands, people often fail to do it properly. In our study, we observed how adults over the age of 60 prepared food in a domestic kitchen set up with CCTV cameras, and found that only 30% of people properly washed and dried their hands before preparing food. </p>
<p>We found that 90% of people failed to wash and dry their hands properly immediately after handling raw chicken. And that 62% failed to rub hands, palms and between fingers when washing hands. We also discovered that 47% of people in our study failed to use soap during one or more hand washing attempt.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297144/original/file-20191015-98661-1p6wgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The model domestic kitchen.</span>
</figcaption>
</figure>
<p>We also swabbed the kitchen and found that those who adequately washed their hands, had significantly lower levels of microbiological contamination levels in the kitchen following food preparation sessions.
<a href="https://www.emerald.com/insight/content/doi/10.1108/00070700510606873/full/html">Other studies</a> have also determined that failing to wash hands adequately after handling raw poultry can transfer bacteria to domestic kitchen surfaces – such as the handles of taps and refrigerators. All of which highlights the importance of properly washing your hands.</p>
<h2>How to wash your hands</h2>
<p>The World Health Organisation <a href="https://www.who.int/foodsafety/publications/consumer/manual_keys.pdf">recommends</a> that to wash your hands effectively, it needs to be done with clean water and soap. Hands should be rubbed together for at least 20 seconds, followed by rinsing. Hands must also be dried using either disposable kitchen paper or a clean hand towel.</p>
<p>The use of soap is particularly important for hand washing to be effective. Indeed, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037063/">research</a> has shown that washing with soap significantly reduced the presence of bacteria on hands. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1XVhNEoxtN8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The soap doesn’t have to be antibacterial to be effective – though antibacterial soap works on reducing the number of bacteria not just removing them. And research has <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2007.124610">shown</a> that the use of non-antibacterial soap is successful for preventing both gastrointestinal and respiratory illnesses.</p>
<p>You should spend 20 seconds washing and drying your hands. Here’s how to do it properly: wet your hands with clean water, use soap, rub palm to palm, rub back of hands, rub between fingers, rub fingernails, rinse your hands. Then dry them using a clean towel or kitchen paper.</p>
<h2>Dry them properly too</h2>
<p>Hand drying is also very important to prevent contamination from hands to food, surfaces and equipment as the transmission of bacteria is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809004/">more likely</a> to occur from wet skin than from dry skin. So the proper drying of hands after washing should be an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538484/">integral part</a> of hand hygiene. </p>
<p>Drying your hands properly also removes a significant number of bacteria following hand washing – drying with a towel removes pathogens by means of friction, on top of the removal of moisture. Though this means that a hand towel can become a site for cross-contamination. Indeed, in <a href="https://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-378">our study</a> we found that 37% of people used the same towel for drying hands and equipment.</p>
<p>It is essential to wash hands on occasions when they may be contaminated such as before, during, and after preparing food – particularly after handing raw meat and poultry – after using the toilet, after blowing your nose, coughing, or sneezing and after touching an animal.</p>
<p>This is important, because washing our hands properly can mean the difference between sickness and health. And for people with compromised immune systems it can even mean the difference between life and death – so make sure you do it properly. If in doubt follow the tips above and sing “<a href="https://tools.cdc.gov/medialibrary/index.aspx#/media/id/302345">Happy Birthday</a>” twice to allow enough time to remove and rinse away any germs.</p><img src="https://counter.theconversation.com/content/125330/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellen W. Evans received funding for research referred to in this article from the Cardiff Metropolitan University Vice Chancellor's Doctoral Award and Tenovus Cancer Care. She is affiliated with the International Association for Food Protection. This article refers to research co-authored with Dr Elizabeth C. Redmond.</span></em></p>Despite awareness of the importance of hand washing, most people often fail to do it properly.Ellen W. Evans, Junior Research Fellow, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1210292019-07-31T11:43:05Z2019-07-31T11:43:05ZWhat’s the scoop on kids and dirt? Get enough to help, but not enough to hurt, a doctor advises<figure><img src="https://images.theconversation.com/files/285900/original/file-20190726-43118-1ac4jda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kids may need more exposure to dirt and microbes than previously thought.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-funny-little-girls-playing-large-1021241443?src=Lk3KlOpQIiD7C_w_CR42yw-1-22&studio=1">MNStudio/shutterstock.com</a></span></figcaption></figure><p>Whenever I am asked what I do for a living, the phrase “I’m an allergist” is almost immediately followed by “So, <a href="https://www.cdc.gov/asthma/asthmadata.htm">where are all of these allergies coming from</a>?” </p>
<p>Maybe I’ll get sick of that question some day, but I haven’t yet. As a clinician and researcher on allergies and public health, I first explain that when a society begins to become aware of a disease, the <a href="https://jamanetwork.com/journals/jama/fullarticle/1734702">reported prevalence will go up</a>. This is understandable. People who have medically unexplained symptoms wonder “Could I have this allergy that’s being talked about?” and try on the diagnosis. Sometimes an allergy really is at the root of their problems, and sometimes it’s not. </p>
<p>For example, <a href="https://www.sciencedirect.com/science/article/pii/S0091674914006721">at least 50% of patient-reported</a> food allergies are only presumed. They have not been evaluated thoroughly enough to know for sure whether the patient is allergic. Research also demonstrates that, in many cases, we presume wrongly. The symptoms fit better with an intolerance than an allergy, or the events were coincidental. While 11%-12% of patients currently report a food allergy, only about 5% of adults and 8% of children likely <a href="https://www.sciencedirect.com/science/article/pii/S0091674914006721">have true food allergy</a>. Around 8% of patients report a penicillin allergy, but fewer than <a href="https://jamanetwork.com/journals/jama/article-abstract/409362">five out of 100 patients</a> who report a penicillin allergy can be shown to be allergic when tested. </p>
<p>Many people next ask whether allergies are genetic, but allergies in one’s family appear to explain only <a href="https://www.sciencedirect.com/science/article/abs/pii/S0749379702005895">10%-40% of a person’s</a> increased risk for allergies. Allergic diseases are also increasing at rates that are inconsistent with genetic diseases. </p>
<p>More interesting is that there appear to have been different waves in which <a href="https://www.sciencedirect.com/science/article/pii/S0091674915005849">allergies appeared in historical records</a>. Hay fever (environmental allergies) first appeared in the 1800s, followed by more recent increases in asthma and food allergy.</p>
<h2>What’s changed, and what’s dirt got to do with it?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Much of childhood eczema could be prevented by using barriers, such as petroleum jelly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-boy-scratching-his-allergy-462854470?src=7n9Nt-9WUtI5ouJVY0MyEQ-1-65&studio=1">all_about_people/shutterstock.com</a></span>
</figcaption>
</figure>
<p>So if genetics don’t fully explain the rise in allergy, what does?
Some of the most consistent risk factors for allergic diseases include <a href="https://www.ncbi.nlm.nih.gov/pubmed/31149702">overuse of antibiotics</a>; <a href="https://www.ncbi.nlm.nih.gov/pubmed/29733679">acute viral respiratory infections</a> in childhood; birth by <a href="https://www.ncbi.nlm.nih.gov/pubmed/30322585">cesarean section</a>; nutritional disorders; second-hand smoke exposure; pollution; and the <a href="https://clintransmed.springeropen.com/articles/10.1186/s40169-018-0195-4">environment where you grew up</a> </p>
<p>To organize these risks into categories, two conceptual hypotheses currently seem to be of value – the <a href="https://www.sciencedirect.com/science/article/pii/S0091674903023704">barrier hypothesis</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/">hygiene hypothesis</a>.</p>
<p>Imagine that your immune system is an army behind a castle wall. The castle wall is your skin, your respiratory tract and your gastrointestinal tract. The army is composed of your white blood cells in addition to other cells in the body that can activate these gung-ho Marines to defend you. </p>
<p>The central tenet of the barrier hypothesis is that when our skin, respiratory tract and gastrointestinal tract are chronically injured, your castle wall is broken down. The soldiers of the immune system are activated to aggressive defense, yet allergens can penetrate, and people can begin to experience allergic inflammation in those areas. This has been most clearly demonstrated with the allergic skin disease known as <a href="https://www.sciencedirect.com/science/article/pii/S0091674903023704">eczema</a>.</p>
<p>Research has also shown that activities in these barrier sites can <a href="https://www.sciencedirect.com/science/article/pii/S0091674916304985">flavor the immune response and profile</a> of a person, especially in childhood. Many risk factors for allergic disease, such as viral infections, nutritional disorders, smoke exposure and pollution, affect the health of our barriers. Studies have indicated that up to <a href="https://www.sciencedirect.com/science/article/pii/S0091674914011609">50% of childhood eczema,</a> a barrier disease, can be prevented simply by applying protective emollients like petroleum jelly to protect babies’ skin when we bathe them. </p>
<h2>The role of hygiene in allergy</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Protecting babies’ skin with a protective barrier can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-cleaning-little-baby-bathtub-sponge-155189309?src=oDrw5ODjKUulJx2ZcfNPsw-1-0&studio=1">FotoAndalucia/shutterstock.com</a></span>
</figcaption>
</figure>
<p>The central tenet of the hygiene hypothesis is that we have gone a bit too far and inadvertently killed off our good bacteria along with the bad. As our society progressed from one that was chronically burdened with infectious diseases caused by poor sanitation, the thinking goes, we reduced our exposures to the things that gave our immune system an appropriate training and tolerance. Historically, our totally rational fear of dying from a cholera epidemic led to <a href="https://www.sciencedirect.com/science/article/pii/S0091674915005849">sewage and water management</a>, but may have kicked off the allergy epidemic.</p>
<p>Our overuse of antibiotics and C-sections affects the set of organisms called the <a href="https://clintransmed.springeropen.com/articles/10.1186/s40169-018-0195-4">microbiome</a> that an infant is exposed to growing up. Both have been shown to increase the risk of childhood allergic diseases. </p>
<p>Growing up in a rural area exposed to farm animals appears to confer a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1398-9995.2010.02397.x">decreased risk of allergies and asthma</a> for your entire lifetime, even among <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1508749">genetically similar populations</a>. Studies in mice have shown that inhaling certain molecules from soil-dwelling bacteria can set off a beneficial cascade promoting an immune system which focuses more on threats rather than nonthreats, such as <a href="https://science.sciencemag.org/content/349/6252/1106.abstract">allergens</a>.</p>
<p>Vaccinations appear to be a crucial exception to the rule of the <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.94.6.985">hygiene hypothesis</a>. They confer protection against diseases without any associated increase in the risk of allergic disease, likely because they, unlike antibiotics, are very specifically targeting only the worst disease-causing organisms.</p>
<h2>Our current prescription</h2>
<p>The data currently paints a picture that we might prevent allergies in the future by protecting our barriers and introducing the right <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1414850">tolerizing exposures at the right time</a>, such as early introduction of peanuts. However, I can’t currently tell you how much dirt or what kinds of bacteria your child needs to safely experience while growing up. It’s too soon for that, but many wonderful scientists around the world are working on these questions, thanks to support from a variety of governments and foundations. </p>
<p>Until then, I will share with you the broad-brush advice that I currently give my friends and patients. </p>
<ul>
<li> Let your kids play outside, get dirty, try new foods and be exposed to a variety of things. Advocate for them to have outside recess time in school as much as possible.</li>
<li> Use plain soap and water; you don’t need to sanitize everything.<br></li>
<li> Talk to your doctor about watchful waiting to respond to an illness, rather than take antibiotics.<br></li>
<li> Be judicious about what you put on your body’s barriers, and become an advocate for clean air, clean water and a clean environment for everyone. </li>
<li> Get all of your routine vaccinations. The healthiest children in the U.S. are the ones who are fully vaccinated.</li>
</ul><img src="https://counter.theconversation.com/content/121029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cosby Stone, Jr. MD, MPH currently receives funding from K12HS026395-0 via the Agency for Healthcare Research and Quality and has previously received funding from the National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences for his research in allergy. </span></em></p>Can your kids be too clean? Increases in allergies suggest so. But how much dirt is too much? A pediatric allergist explains the fascinating reasons the immune system needs dirt for training.Cosby Stone, Instructor in Allergy/Immunology, Vanderbilt University Medical Center, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1202282019-07-15T19:43:05Z2019-07-15T19:43:05ZHand sanitisers in public won’t wipe out the flu but they might help reduce its spread<figure><img src="https://images.theconversation.com/files/284038/original/file-20190715-173351-1oww2xq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's quicker to use hand sanitiser than soap and water, which means people might be more likely to use it. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/488408785?src=EFYBbKwcQuQdWXEZuqNcPA-1-43&studio=1&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>This year’s flu season is off to an early start, with 144,000 confirmed cases so far in 2019. That’s <a href="http://www9.health.gov.au/cda/source/rpt_3.cfm">more than twice as many confirmed cases</a> of the flu than for all of 2018 (58,000), and almost as many as the 2017 horror flu season (251,000). </p>
<p>The number of cases so far this year, including <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-05-2019.pdf">more than 231 deaths</a> nationwide, led the NSW opposition <a href="https://www.canberratimes.com.au/story/6260141/calls-for-hand-sanitisers-to-fight-nsw-flu/digital-subscription/">health spokesperson to call</a> for hand sanitisers in public spaces to help slow the spread.</p>
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<strong>
Read more:
<a href="https://theconversation.com/its-a-bad-year-for-flu-but-its-too-early-to-call-it-the-worst-ever-5-charts-on-the-2019-season-so-far-120093">It's a bad year for flu, but it's too early to call it the worst ever – 5 charts on the 2019 season so far</a>
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<p>Influenza spreads via droplets from coughing and sneezing, which is why it’s a good idea to catch your cough. But coughing into your hand can leave flu virus on your hands, which is why <a href="https://theconversation.com/cough-and-sneeze-into-elbows-not-hands-13152">we recommend</a> coughing into your <a href="https://www.cdc.gov/healthywater/hygiene/etiquette/coughing_sneezing.html">elbow or sleeve</a> and washing your hands afterwards.</p>
<p>Along with <a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">getting vaccinated</a> and staying home if you’re sick, washing your hands is the best defence against getting the flu. </p>
<p>If the government can make this easier by providing hand sanitisers in public places, it may be worth the investment. It won’t solve our flu problem but it might be an important tool in the toolbox of measures to reduce its spread. </p>
<h2>What does the research say?</h2>
<p>The scientific literature on hand sanitisers isn’t so clear-cut. </p>
<p>A 2019 study in <a href="https://doi.org/10.1086/650396">university colleges</a> showed the use of hand hygiene and face masks didn’t protect against flu any better than mask use alone. But unlike some other countries, Australia doesn’t have a strong habit of mask use when people are unwell, so this may not be very helpful to us.</p>
<p>A <a href="https://doi.org/10.1371/journal.pmed.1001700">2014 study in New Zealand schools</a> showed that providing sanitiser didn’t reduce the rate of absenteeism from school either. </p>
<p>While these studies make it sound like hand sanitiser is not very effective, that’s not the end of the story. </p>
<p>Other studies show a positive effect – a <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">16% reduction</a> in respiratory illness in one and a <a href="https://doi.org/10.2105/AJPH.2007.124610">21% reduction</a> in another. For some infections, the <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">evidence</a> is even stronger – for example, gastroenteritis, most of which is also viral. </p>
<p>However, <a href="https://doi.org/10.1111/j.1365-3156.2006.01568.x">few of these studies</a> showing the benefits of hand sanitisers were done during a large disease outbreak, which means the potential benefit may be even greater. </p>
<p>Not all influenza-like illness is caused by the flu – it can be other viruses as well, so the estimates are a bit rubbery at best. Hand sanitiser trials which look at influenza-like illness or respiratory infections generally are more likely to show benefits than those that just look for influenza – meaning good hand hygiene prevents other infections as well.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284039/original/file-20190715-173342-133ztej.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If you have the flu, the best place to be is at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/650188465?src=DQxn5m0Iyy6jykQO2hC3vg-1-6&studio=1&size=huge_jpg">Tero Vesalainen/Shutterstock</a></span>
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<h2>Lessons from hospitals</h2>
<p>Although preventing infection in hospitals is not the same as doing it in the community, there are two important lessons from hospital infection control. </p>
<p>First, in hospital hand-hygiene programs, hand sanitiser is <a href="https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf">more effective</a> than soap-and-water hand-washing, provided your hands aren’t visibly dirty. </p>
<p>This is partly because of the rapid effect of the alcohol, but mostly because it’s much quicker and therefore <a href="https://doi.org/10.1001/archinte.160.7.1017">more likely</a> that staff will use it. </p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/health-check-should-i-use-antibacterial-hand-sanitisers-21384">Health Check: should I use antibacterial hand sanitisers? </a>
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<p>The second important point from <a href="https://dx.doi.org/10.3201/eid0702.700234">hand hygiene</a> and <a href="https://doi.org/10.1371/journal.pone.0015452">other areas</a> of hospital infection control is that introducing a “bundle” of strategies usually reduces healthcare-associated infection rates – even when the individual parts of these bundles don’t show benefits alone. </p>
<p>This could be because the individual effect sizes are too small, or that change in practice highlights a “safety culture”.</p>
<h2>Sanitisers can be one of many strategies</h2>
<p>Installing hand rub in public areas won’t solve this year’s flu outbreak by itself. But it can be part of a bundle of strategies – as long as the dispensers are kept topped up. </p>
<p>And it’s certainly a safe intervention – despite some <a href="https://www.change.org/p/all-schools-ban-alcohol-hand-sanitizers-in-schools">desperate hysteria</a> about the safety of hand gels, or the risk of people drinking them, there is little evidence this actually occurs in reality.</p>
<p>Hand sanitiser is also likely to be easier to implement than fixing the much larger social problem of Australians <a href="https://www.msn.com/en-au/news/other/australians-know-working-sick-is-bad-for-them-but-they-do-it-anyway/ar-AAE60oJ">going to work</a> when they’re sick. This may be because of inadequate sick leave, concerns about “letting the team down”, or other logistical problems such as child-care.</p>
<p>Get your flu vaccine – even now it’s still not too late – and get it for your kids as well, for <a href="https://www.immunisationcoalition.org.au/immunisation/influenza-and-children/">their sake</a> as well as <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1007-8">your own</a>. </p>
<p>Remember to stay home if you’re unwell, and always to cough into your sleeve. And don’t forget to clean your hands – even if the government doesn’t end up making it easier for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-2019-flu-shot-isnt-perfect-but-its-still-our-best-defence-against-influenza-120088">The 2019 flu shot isn't perfect – but it's still our best defence against influenza</a>
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</p>
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<img src="https://counter.theconversation.com/content/120228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trent Yarwood is affiliated with the Queensland Statewide Antimicrobial Stewardship Program and Cairns and Hinterland Hospital and Health Service. He is also a member of Future Wise - a not-for-profit research and advocacy organisation.
These are his personal opinions and not those of his employers or of Future Wise.</span></em></p>Washing your hands helps protect against the flu. So it makes sense for governments to make hand sanitisers available in public places.Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1157002019-05-16T21:00:58Z2019-05-16T21:00:58ZHow to safely handle food and avoid salmonella<figure><img src="https://images.theconversation.com/files/274998/original/file-20190516-69189-11t63uv.jpg?ixlib=rb-1.1.0&rect=51%2C401%2C5704%2C3150&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In a recent research study, around 10 per cent of the recipes examined contained unsafe food preparation instructions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The Public Health Agency of Canada has announced a <a href="https://www.cbc.ca/news/health/salmonella-compliments-frozen-raw-breaded-chicken-1.5151779">national salmonella outbreak</a>, linked to frozen chicken strips. </p>
<p>Since 2017 there have been <a href="http://inspection.gc.ca/food/requirements/preventive-controls-food-businesses/meat/salmonella-in-frozen-raw-breaded-chicken/backgrounder/eng/1554141522231/1554141574415">several national outbreaks of salmonella infections</a> linked to <a href="https://www.canada.ca/en/public-health/services/public-health-notices/2018/outbreaks-salmonella-infections-linked-raw-chicken-including-frozen-raw-breaded-chicken-products.html">frozen raw breaded chicken products</a>. And foodborne pathogens account for about <a href="https://www.canada.ca/en/public-health/services/food-borne-illness-canada/yearly-food-borne-illness-estimates-canada.html">four million illnesses in Canada annually</a>, affecting one in eight Canadians. </p>
<p>Unsafe handling, chilling, cooking and cleaning/sanitation procedures in the home contribute to a significant proportion of these infections. </p>
<p>In many cases, because people can be led to believe that chicken nuggets are already cooked, they undercook them or microwave them — both of which can lead to the survival of salmonella, and thus human illness.</p>
<p>It is important to practise safe food behaviours to prevent you and your family from becoming sick. In fact, safe handling in domestic kitchens is critical in the prevention of diseases caused by foodborne pathogens. </p>
<p>One way you can receive food-safety education and guidance is through magazines, cooking shows, online recipes and cookbooks. This is why, as director of the Canadian Research Institute for Food Safety, my team conducted <a href="https://doi.org/10.1016/j.foodcont.2018.12.030">a study to examine the food safety information contained in a number of Canadian cookbooks</a>. </p>
<p>From an original total of 30 cookbooks examined, 19 were included in the study, because the recipes included a variety of meats and seafoods, major contributors to foodborne disease.</p>
<h2>Your burger is done at 71</h2>
<p>Around 10 per cent of the recipes examined actually contained unsafe food preparation instructions — in the form of incorrect procedures for thawing and washing meat in the home kitchen. </p>
<p>Only about eight per cent of the recipes mentioned that a food thermometer should be used. Furthermore, most of the recipes (approximately 96 per cent) provided the incorrect temperature, or were lacking a minimum internal temperature, for safe cooking. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/275000/original/file-20190516-69195-32r598.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Instructions for pork preparation were the most likely to include unsafe instructions, in the author’s research study.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>You should never use colour as an indicator of the readiness of meats. For example, when you are cooking ground beef, which has been the cause of <a href="https://www.cdc.gov/ecoli/2019/o103-04-19/index.html">a number of E. coli outbreaks</a>, the meat can actually turn brown well before it reaches the recommended internal temperature of 71C. </p>
<p>We usually use the slogan, <a href="http://www.beefresearch.ca/blog/your-burgers-are-still-done-at-71/">“Your burger is done at 71.”</a></p>
<p>Instructions for pork preparation were the most likely to include unsafe instructions. And fewer than one per cent of the recipes we looked at advised readers to wash their hands before starting meal preparation, or after touching raw foods.</p>
<h2>How to safely handle food at home</h2>
<p>These are six of the <a href="https://www.canada.ca/en/health-canada/services/general-food-safety-tips/safe-food-handling-home.html">most important safety measures</a> that cookbooks should explain:</p>
<ol>
<li><p>Wash hands before and after food preparation, especially when handling raw foods such as meat and fish.</p></li>
<li><p>Use different plates and utensils for raw and cooked meats and fish.</p></li>
<li><p>Check meats with a meat thermometer ensuring they reach an internal temperature of 71C for burgers, 74C for poultry parts and 82C for whole birds. </p></li>
<li><p>Thaw foods in the fridge or in pots of cold water, not on the counter.</p></li>
<li><p>Do not leave foods out at room temperature for more than two hours.</p></li>
<li><p>Do not wash raw meats, as this procedure only spreads pathogens that would be eliminated with proper cooking.</p></li>
</ol>
<p>Even one introductory page in every cookbook, containing these important food safety practices, would help.</p>
<h2>Celebrity chefs need to clean up their act</h2>
<p>From a risk communication perspective, I feel that Canadian cookbooks are not being used effectively to inform consumers about safe food handling and preparation techniques. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/275003/original/file-20190516-69189-1103nrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Always wash hands before and after food preparation.</span>
<span class="attribution"><span class="source">(Unsplash/maarten van den heuvel)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>It is possible that authors of cookbooks leave out food safety information because they have had little training in the area. It is important in such cases for cookbook authors to reach out to food safety experts — so that the information in their books is useful and accurate.</p>
<p>Cooking shows could also do a better job in informing viewers about how to handle, cook and store foods properly. Celebrity chefs have a large influence on imparting food safety knowledge and yet a recent study of cooking shows found <a href="https://doi.org/10.1093/pubmed/fdw026">many exhibited behaviour that can lead to cross-contamination of foods</a> — such as adding food with their hands, touching hair and licking fingers.</p>
<p>You have a very important role to play in the safety of the foods you consume. And the household kitchen is really the last line of defence before you actually eat a food!</p><img src="https://counter.theconversation.com/content/115700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey M. Farber receives funding from ILSI North America, OMAFRA and the Canadian federal government. </span></em></p>A food safety expert offers six tips on safe food handling that many cookbooks and cooking shows fail to deliver.Jeffrey M. Farber, Professor of Food Safety, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/914632018-02-13T22:11:53Z2018-02-13T22:11:53ZHow to eradicate the flu virus from your home<figure><img src="https://images.theconversation.com/files/206109/original/file-20180213-44651-ja7ic9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Once a respiratory virus like influenza has entered your home or workplace, it is wise to treat the space like a hospital and practice infection prevention and control. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Homes are germy places. Microbes come from a <a href="https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-015-0144-z">variety of sources</a> such as ventilation systems, plants, the outdoor environment and our own <a href="https://peerj.com/articles/1258/">microbial cloud</a>. Usually, they pose no threat to our health and you need not worry. </p>
<p>When someone contracts a respiratory virus, such as influenza, you might want to reevaluate the situation to keep others safe from illness. </p>
<p>So how do you evacuate those flu germs from your home and workplace?</p>
<p>The best way is to follow a process known as infection prevention and control. It’s been used for decades in health care to keep patients, visitors and staff safe. All that’s required is a change of mindset: You must view the home like a hospital. </p>
<p>Then, by following a few easy steps, you can reduce the chances of the infection spreading to everyone who lives in, or enters, your home. </p>
<h2>Stop touching your face</h2>
<p>The first step in the process is to determine how the pathogen of interest spreads. For influenza, there are two well-known routes. The first is direct transmission from one person to another via droplets and possibly <a href="http://www.pnas.org/content/early/2018/01/17/1716561115">through the air</a>. </p>
<p>The other is indirect transmission in which people inadvertently <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2672.2002.01734.x/full">infect themselves</a> after touching contaminated surfaces, sometimes called <a href="http://aem.asm.org/content/73/6/1687.long">“fomites.”</a></p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206104/original/file-20180213-44657-maptlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One study found that medical students touched their faces 23 times per hour, with 44 per cent of touches involving a mucous membrane.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Which route is most likely to contribute to infection spread? Direct may seem the obvious choice. But research has shown indirect transmission may be a <a href="https://www.calhospital.org/sites/main/files/file-attachments/NicasJonesRiskAnalysis2009.pdf">significant contributor to an outbreak</a>. </p>
<p>That’s because humans have a habit of regularly touching their faces, increasing chances for the <a href="https://www.researchgate.net/profile/ML_Mclaws2/publication/271647859_Face_touching_A_frequent_habit_that_has_implications_for_hand_hygiene/links/5a4c47870f7e9b8284c2f580/Face-touching-A-frequent-habit-that-has-implications-for-hand-hygiene.pdf">introduction of the virus</a>. </p>
<h2>Use steam to kill flu</h2>
<p>The next stage involves figuring out methods to prevent and/or control the routes of infection. </p>
<p>The easiest option is to eliminate spread by keeping infected people away from areas where healthy ones tend to congregate. But, unlike in a hospital, isolation is not usually possible — or ethical — in the home. </p>
<p>The only option then is to reduce the likelihood of self-inoculation by killing the virus on surfaces, a practice known as disinfection.</p>
<p>Disinfection is different from general cleaning as it is designed to kill certain types of microbial species. In health care, <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/disinfectants/safety-efficacy-requirements-hard-surface-disinfectant-drugs.html">disinfectants are regulated and approved by governments</a> and offer specific killing claims. However, the same cannot be said for consumer products and they may not be as effective as needed. </p>
<p>Thankfully, killing influenza can be achieved by wiping with <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0008987">simple detergents</a>, <a href="https://www.cdc.gov/h1n1flu/qa.htm">diluted bleach, or hydrogen peroxide</a>. </p>
<p>If chemicals are not desired, flu also dies in the presence of steam, a fact known for well more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2400131/pdf/brmedj08439-0048c.pdf">100 years</a>.</p>
<h2>Disinfect the TV remote</h2>
<p>After choosing a disinfectant, the final step involves identifying the surfaces to clean. Those of greatest concern are <a href="http://www.vericlean.com.au/images/pdf/whitepapers/additional/Huslage_Rutala_2010_High_Touch_Surfaces.pdf">“high-touch surfaces”</a> — those that are touched on a regular basis by many individuals. </p>
<p>In hospitals, these include bed rails, tables and carts. <a href="http://arizona.openrepository.com/arizona/bitstream/10150/194991/1/azu_etd_1347_sip1_m.pdf">In the home</a>, high-touch surfaces also exist such as refrigerator and microwave handles, faucets, light switches, door knobs, the toilet and, not surprisingly, the TV remote control and other electronic devices. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206108/original/file-20180213-44636-19cg2qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">(Unsplash/Alexander Dummer)</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>All of these are prime sources for virus contamination and need to be disinfected regularly.</p>
<p>Of course, <em>regularly</em> is an arbitrary term. To know how often to disinfect, you need to understand the pathogen’s ability to stay alive in the environment. <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0027932">Experiments with influenza</a> reveal the virus can remain infectious on surfaces for up to 24 hours. </p>
<p>This means you should disinfect as often as possible while an individual is showing symptoms and, to be safe, for a few days after they subside. </p>
<h2>Wash your hands regularly</h2>
<p>As infection prevention and control has learned, such frequency is hard to maintain. That is why surface disinfection must be supplemented with constant <a href="https://academic.oup.com/cid/article/48/3/285/304169">hand hygiene</a>. </p>
<p>After contact with a suspect surface, people should wash their hands. If there’s a sink available, wash with water and soap making sure to lather for at least 20 seconds and drying the hands fully. You can also use an alcohol-based hand rub, consisting of between 62 per cent and 70 per cent ethanol, as long as the hands stay wet for at least 15 seconds. </p>
<p>When executed properly, a combination of hand-washing and disinfection will help to prevent the unnecessary spread of flu and allow for a quicker return to normal.</p>
<p>This process can also help to stop the spread of other pathogens, such as colds, skin infections and the dreaded norovirus. </p>
<p>Though the process does require time and energy, making sure loved ones stay safe from the toll of these infections certainly makes the effort worthwhile.</p><img src="https://counter.theconversation.com/content/91463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Tetro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From face-touching to virus-contaminated electronic devices, a scientist offers some tips on eradicating the flu virus from your home.Jason Tetro, Visiting Scientist, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752192017-04-02T19:27:25Z2017-04-02T19:27:25ZExplainer: what’s cytomegalovirus and why do pregnant women need to know about it?<figure><img src="https://images.theconversation.com/files/162853/original/image-20170328-21254-g451vb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cytomegalovirus infection in the womb is more common in Australia than infection with listeria or toxoplasma in pregnancy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/580440025?src=TwN-eTjcWPQZbtH2Fjl_wQ-1-34&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p><a href="http://journals.sagepub.com/doi/abs/10.1177/1753495X14552719">Cytomegalovirus</a> (CMV) is a virus transmitted from person to person via body fluids like urine or saliva. For people with a healthy immune system, CMV is likely to cause no more than a temporary fever or headache. But when a pregnant woman is infected, the results can be far more serious.</p>
<p>While a pregnant woman herself may not feel sick, the virus can cross the placenta to infect her unborn child and cause permanent disability, including hearing loss and intellectual disability.</p>
<p>In Australia, nearly 2,000 babies are born infected with CMV every year. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2005.00665.x/abstract">About 380</a> of these are born with permanent disabilities, including deafness, blindness and intellectual disability.</p>
<p>In developed countries, about one in five babies born with CMV will have permanent disabilities. This makes CMV the <a href="http://cmr.asm.org/content/26/1/86.full?sid=f07ec33d-9722-4133-ad4d-0b313d9e9d08">leading infectious cause</a> of disability in newborns in the developed world.</p>
<p>Researchers don’t know the exact mechanism by which CMV can infect the developing baby. But they <a href="http://jvi.asm.org/content/77/24/13301.long">suspect</a> the virus in the pregnant women’s blood first infects the cells of the placenta, where it multiplies and then enters the baby’s circulation via the placenta’s blood vessels.</p>
<p>Researchers also <a href="http://cmr.asm.org/content/22/1/99.long">do not fully understand</a> how CMV then causes hearing loss or intellectual disability. But CMV is thought to directly infect and damage a part of the inner ear. CMV also seems to infect neural stem cells, which are the building blocks of the developing brain. This infection may stop these brain cells from dividing and multiplying, which could affect the size of the baby’s brain and how it matures. CMV infection in the placenta may also prevent the placenta from developing properly. This could reduce the oxygen and nutrients to the baby, which can lead to brain abnormalities.</p>
<h2>Most pregnant women are not aware</h2>
<p>Most pregnant women are unaware of CMV and the simple measures they can take to reduce the chance of contracting this virus.</p>
<p>Studies in <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0844-9">Canada</a>, <a href="https://www.hindawi.com/journals/idog/2006/080383/abs/">the US</a>, <a href="http://www.journalofclinicalvirology.com/article/S1386-6532(12)00002-9/abstract">France</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690918/">Switzerland</a>, <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-98">the Netherlands</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1111/cga.12030/abstract;jsessionid=CE65575B0BDF8CDEE1FBDC590ED2EB56.f02t04">Japan</a>, and <a href="http://www.sciencedirect.com/science/article/pii/S0020729212000860">Singapore</a> report 61-87% of pregnant women have not heard of the virus. We predict similar rates in Australian pregnant women, although studies to confirm this have not been done yet.</p>
<p>There are no CMV awareness campaigns to provide pregnant women with much needed information about how to protect their baby from CMV, except those run by community organisations, such as in the <a href="http://www.nationalcmv.org">US</a>, the <a href="http://www.cmvaction.org.uk">UK</a> and <a href="http://cmv.org.au/">Australia</a>.</p>
<p>This means, without knowing, many pregnant women are unintentionally putting their baby at risk of CMV infection.</p>
<p>Contrast this with the public awareness of other potentially serious infections in pregnancy, like <a href="https://theconversation.com/health-check-what-to-eat-and-avoid-during-pregnancy-30356">listeriosis</a> (with the advice to avoid soft cheeses, unpasteurised dairy, raw fish and raw meat) and <a href="https://theconversation.com/health-check-what-bugs-can-you-catch-from-your-pets-40954">toxoplasmosis</a> (with the advice to avoid contact with cat faeces).</p>
<p>But in Australia, CMV is now more common than listeriosis and toxoplasmosis in pregnant women. For instance, between 2001 and 2014 there were between <a href="http://www.foodauthority.nsw.gov.au/_Documents/foodsafetyandyou/listeria_and_pregnancy.pdf">one and 14</a> confirmed listeria infections in pregnant women each year. And between 2000 and 2010 there were only <a href="https://www.mja.com.au/journal/2012/196/7/congenital-toxoplasmosis-over-10-years-low-incidence-population">two cases</a> of congenital toxoplasmosis. These data make it clear that more public awareness needs to be raised about CMV infection during pregnancy.</p>
<h2>CMV can be avoided</h2>
<p>The lack of awareness about CMV among pregnant women may be about to change. Recently published <a href="http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30143-3/fulltext">recommendations</a> from an international team of CMV experts now recommends all pregnant women be told about CMV and what they can do to reduce the risk of contracting it.</p>
<p>Pregnant women can, for instance, contract CMV via intimate contact with young children. This is because CMV can linger in children’s urine and saliva for months after they are infected, while rarely showing symptoms other than a runny nose. </p>
<p>Therefore, good hygiene measures can help avoid contracting CMV. These include:</p>
<ul>
<li><p>not sharing food, drinks or utensils with young children</p></li>
<li><p>not putting a child’s dummy in your mouth</p></li>
<li><p>avoiding contact with saliva when kissing a child</p></li>
<li><p>thoroughly washing your hands with soap and water after changing nappies and after wiping a child’s nose or drool.</p></li>
</ul>
<p>Other precautions pregnant women can take are avoiding sleeping with children and wearing gloves when changing nappies.</p>
<h2>Can CMV be treated?</h2>
<p>At the moment, there is not enough scientific evidence to recommend a therapy to prevent or treat CMV infection during pregnancy.</p>
<p>But scientists are conducting clinical trials to investigate the effectiveness of a CMV vaccine. The first results of these trials are expected between 2017 and 2019. Also, at least one large clinical study is currently on the way to investigate the effectiveness of existing antiviral therapeutics. And scientists are continuing to investigate novel CMV antiviral compounds in the laboratory.</p>
<p>In the meantime, taking the recommended hygiene measures is the best option to prevent CMV infection during pregnancy.</p>
<hr>
<p><em>If you or someone you know is affected by congenital CMV, <a href="http://cmv.org.au/">Congenital CMV Association Australia</a>, the <a href="https://www.nationalcmv.org/">National CMV Foundation</a> in the US and the UK’s <a href="http://www.cmvaction.org.uk">CMV Action</a> provide information and support.</em></p><img src="https://counter.theconversation.com/content/75219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy van Zuijlen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We can prevent congenital deafness and intellectual disability due to cytomegalovirus by simple hygiene measures. So, why don’t pregnant women know about this?Wendy van Zuijlen, Postdoctoral Scientist, Virology Research Laboratory, Faculty of Medicine, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/666472016-10-10T10:53:55Z2016-10-10T10:53:55ZIs it safe to wash my hands, doctor?<figure><img src="https://images.theconversation.com/files/140750/original/image-20161006-32691-aau60t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are downsides to clean hands.
</span> <span class="attribution"><span class="source"> ProStockStudio</span></span></figcaption></figure><p>A battle is waging about how often and how carefully we should wash our hands. Many allergy experts say it is vital for our future health and that of our children to reduce hand washing and allow friendly microbes back into our mouths. Some authors go as far as <a href="https://www.theguardian.com/lifeandstyle/2016/sep/24/snap-crackle-and-filth-let-kids-eat-dirt">urging us to eat dirt</a>. But other experts, such as those working on infectious diseases, say this is highly irresponsible and dangerous advice because of the recent rise in cases of food poisoning and transmission of viruses.</p>
<p>So, who is correct? We desperately need some sensible guidance.</p>
<p>Allergies have been rising since the 1970s in all developed countries and problems caused by previously harmless pollen, house dust mites and various foods are reaching epidemic proportions. Remarkably, while the first case of a documented food allergy was reported only in 1969, nut-free schools are now commonplace. Originally, <a href="http://onlinelibrary.wiley.com/doi/10.1111/all.12423/full">we were told to deal</a> with allergies by eliminating or avoiding them – vacuuming, disinfecting, removing pets, restricting diets and staying indoors. But this has done nothing to stop rates rising. </p>
<h2>The hygiene hypothesis</h2>
<p>Some 25 years ago, <a href="http://thorax.bmj.com/content/55/suppl_1/S2">a paper</a> suggested a different mechanism to explain allergy – which has since been called the “hygiene hypothesis”. It discovered that children in large, poor families living in rural farms, surrounded by animals and dust, had less allergies. These findings have been replicated multiple times around the world in different environments. Children from small families in rich, urban neighbourhoods are consistently found to have the highest allergy rates.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140753/original/image-20161006-32727-1pkmi7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Mladen Mitrinovic</span></span>
</figcaption>
</figure>
<p>The initial idea was that children exposed early on to pathogens must have better tuned immune systems, which don’t overreact when later exposed to harmless proteins like pollen or peanuts. However a mechanism for this was never proven and recent scientific breakthroughs suggests the infections themselves <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Bloomfield+SF+2016">may not be the main story</a>.</p>
<p>Instead, the realisation that the functioning of our immune system is totally dependent on the normal inhabitants of our guts – in particular the 100 trillion microbes in our colon (known as the microbiome) – has changed our view of hygiene. These microbes <a href="https://www.ncbi.nlm.nih.gov/pubmed/27383981">are key</a> to digesting food and producing vitamins and chemicals that keep our immune system in check. When our normal microbiome gets disturbed, we lose species diversity and this makes us prone to an inappropriate response to harmless proteins – and allergies and autoimmune diseases ensue.</p>
<p>This has happened over the last 30 to 40 years in developed countries due to a deadly combination of events that disrupt microbes – <a href="http://www.theatlantic.com/health/archive/2015/11/taking-antibiotics-can-change-the-gut-microbiome-for-up-to-a-year/415875/">antibiotic overuse</a>, <a href="http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html">processed sterile diets</a>, <a href="http://advances.nutrition.org/content/4/1/16.full">reduced fibre intakes</a>, reduced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464665/">breast feeding and high caesarean section rates</a>. We are estimated to have 40% less gut and mouth microbial species diversity than <a href="https://www.ncbi.nlm.nih.gov/pubmed/27624970">hunter gatherers</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23416520">pre-medieval people</a>. This is compounded by trends of increasing urban living moving us ever further away from our natural outdoor environment of dust, animals and soil.</p>
<h2>How dangerous is dirt?</h2>
<p>So is not washing your hands the answer? It will certainly increase transmission of microbes between people. And, although unproven, it could increase gut diversity and health. But clearly this is very unwise for high-risk individuals such as the elderly or immune deficient – or during a norovirus outbreak or in environments such as hospitals. </p>
<p>There is also no reason to alter advice and habits on good toilet hygiene. Some people believe that transmission of cold and flu viruses could be reduced by regular hand washing – <a href="https://www.ncbi.nlm.nih.gov/pubmed/27383981">but the data is inconclusive</a> and could be offset by the reduced immunity to viral infections caused by a potentially reduced microbiome. Still, if you are a professional food worker, hand hygiene is vital and we still have fatal <a href="http://www.connexionfrance.com/-chain-Quick-sales-slump-after-Avignon-food-poisoning-death-manslaughter-12544-view-article.html">outbreaks from fast-food</a> and to remind us. </p>
<p>The nature of food poisoning outbreaks is changing and new threats emerge due to the modern way we make and eat food. The microbe <em>Campylobacter</em> used to be rare. Now it is commonplace in refrigerators and causes an estimated 100 deaths and around 300,000 serious infections a year, <a href="https://www.food.gov.uk/science/microbiology/campylobacterevidenceprogramme">costing the UK £900m and the US several billion</a>. Pork is another regular problem as shown by <a href="https://www.theguardian.com/environment/2016/oct/03/revealed-mrsa-variant-found-in-british-pork-at-asda-and-sainsburys">a recent MRSA outbreak</a> in the UK.</p>
<p>A <a href="http://www.consumerreports.org/cro/2012/05/how-safe-is-that-chicken/">2015 food safety survey</a> found that <em>Campylobacter</em> was present in 73% of the supermarket chickens tested and, of those, the majority were resistant to some antibiotics and many with high enough levels of microbes to cause infections. The meat <a href="https://www.food.gov.uk/sites/default/files/multimedia/pdfs/campyloconf.pdf">industry says</a> they can’t eradicate the problem and keep prices low. While we have a culture of cheap processed food at any price, the consumer and taxpayer take the risk – and <a href="http://tna.europarchive.org/20141204090942/http://www.food.gov.uk/news-updates/news/2011/4805/iid2">11m days a year off work </a> just in the UK is the result.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140751/original/image-20161006-32702-1q1679z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just let them.</span>
<span class="attribution"><span class="source">Manoonson Sonon</span></span>
</figcaption>
</figure>
<p>Educating parents and children about refrigerator hygiene is vital if we insist on eating cheap meat. Until the meat is cooked thoroughly it should be treated like a radioactive substance from the moment you touch the wrapper in the supermarket and ensuring surfaces, utensils and hands washed with soap, detergent and hot water. </p>
<p>Vegetables are much less of a problem. For the trendy modern semi-vegetarian family who knows where their vegetables come from, the only significant risk they run is a bit of grit while gaining millions of temporary soil microbes which may be beneficial. The only greens I would always avoid are sprouted foods (bean sprouts, watercress) used in salads which you shouldn’t trust. They are usually grown in a warm, moist environment where bacteria thrive. Sprouts contaminated with E.coli caused the worst outbreak in modern history <a href="http://edition.cnn.com/2011/WORLD/europe/06/05/europe.e.coli/">killing 51 Germans in 2011</a>. </p>
<p>If you’re healthy you don’t need to wash your hands after going on public transportation, chopping veg, gardening or a walk in the woods. But do be careful around meat, refrigerators, toilets and disease outbreaks. And if your kid drops something on your floor and you are sure it isn’t in a puddle of chicken blood – then the five second rule should still be fine. If it’s a fallen dummy sucking it yourself <a href="http://www.telegraph.co.uk/news/health/news/10875756/Mothers-should-suck-their-babies-dummies-scientists-say.html">has been shown</a> to reduce allergies. Playing with the dog and other animals and getting dirty outside in the garden or park should also be encouraged. </p>
<p>As we increasingly discover the benefits of increased exposure to microbes we urgently need more information and education so we can make informed decisions on the foods we buy, the antibiotics we ingest and the lifestyle choices we make to reverse our decline in diversity. All this has to be balanced against taking too many risks with modern intensively farmed foods which should now come with health warnings.</p><img src="https://counter.theconversation.com/content/66647/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Spector is director of the British Gut Project, co-founder of MapMyGut Ltd and receives grants on the microbiome from the MRC, CDRF and NIH. He is an SAB member of Optibiotix Ltd.
He is author of a book on gut microbes "The Diet Myth: the real science behind what we eat "- by W&N 2015 </span></em></p>Food poisoning or allergies – which to go for.Tim Spector, Professor of Genetic Epidemiology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.