Last week, the CDC acknowledged what many of us have been saying for almost nine months about cleaning surfaces to prevent transmission by touch of the coronavirus: It’s pure hygiene theater.
“Based on available epidemiological data and studies of environmental transmission factors,” the CDC concluded, “surface transmission is not the main route by which SARS-CoV-2 spreads, and the risk is considered to be low.” In other words: You can put away the bleach, cancel your recurring Amazon subscription for disinfectant wipes, and stop punishing every square inch of classroom floor, restaurant table, and train seat with high-tech antimicrobial blasts. COVID-19 is airborne: It spreads through tiny aerosolized droplets that linger in the air in unventilated spaces. Touching stuff just doesn’t carry much risk, and more people should say so, very loudly.
Derek Thompson: Hygiene theater is a huge waste of time
I’ve been writing about our misplaced obsession with surface hygiene since the summer. Like many, I spent the early months of the pandemic dunking my apples and carrots in soap. That was before I read a persuasive essay in the medical journal The Lancet by Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School: “Exaggerated Risk of Transmission of COVID-19 by Fomites.” (In medical jargon, fomites are objects and surfaces that can transmit an infectious pathogen.) This opinion ran contrary to the conventional wisdom of the broader scientific community, and Goldman told me that several journals rejected his essay. But he was not alone in his quest. Writers such as my colleague Zeynep Tufekci and researchers such as Jose-Luis Jimenez, an aerosol scientist at the University of Colorado Boulder, were also outspoken in their insistence that we needed to focus on ventilation rather than surfaces, windows rather than Windex. They were rebuffed, not only by loudmouths on Twitter and on TV, but by other scientists who clung stubbornly to an outdated view of viral spread.
Over the weekend, I caught up with Goldman to ask how it felt to be vindicated by the world’s most famous public-health organization. “On a personal level, I feel great,” he said. “But I’m kind of wondering what took them so long. There is so much inertia in the scientific establishment.”
These days, Goldman is extending his crusade against fomite fear from COVID-19 to other diseases. The old story is that if you make contact with a surface that a sick person touched, and then you touch your eyes or lips, you’ll infect yourself. While Goldman acknowledges that many diseases, especially bacterial diseases, spread easily from surfaces, he now suspects that most respiratory viruses spread primarily through the air, like SARS-CoV-2 does.
“For most respiratory viruses, the evidence for fomite transmission looks pretty weak,” Goldman said. “With the exception of RSV [respiratory syncytial virus], there are few other respiratory viruses where fomite transmission has been conclusively shown.” For example, rhinovirus, one of the most common viruses in the world and the predominant cause of the common cold, is probably overwhelmingly spread via aerosols. The same may be true of influenza. Many experiments that suggest surface transmission of respiratory viruses stack the deck by studying unrealistically large amounts of virus using unrealistically ideal (cold, dry, and dark) conditions for their survival. Based on our experience with SARS-CoV-2, these may not be trustworthy studies.
Unlike the coronavirus, hygiene theater is very much alive on surfaces across America. Transit authorities are still taking subway cars offline to power-scrub their walls. Baseball parks are banning cash to protect fans from fiat germs. Schools throughout the country still require deep cleanings that sometimes shut down classes for hours or days. The Los Angeles Unified School District’s COVID-19 posters still urge people to “clean high-touch surfaces frequently,” with no mention of ventilation, air filters, or keeping windows open. Target is still running ads on Hulu bragging about how it calls in workers at 6 a.m. to mop and scrub for several hours, for the comfort of its germophobic customers.
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Alas, not even my own employer is immune to the scourge of hygiene theater. In an update on our back-to-office policies yesterday, The Atlantic instituted a “clean desk” protocol starting this summer that will require “daily neatening and sanitation of workspaces.” Anybody who works in journalism, or has ever seen a movie about journalism, knows that journalists take to daily neatening the way lions take to vegetarianism. Beyond being unnecessary, workplace-sanitation rules also carry the risk of enforcing an awkward parent-teen relationship between bosses and employees. In this business, “clean up this paragraph” is hard enough on one’s self-esteem; “... and clean your filthy desk while you’re at it” is not the sort of workplace banter that eases one’s psychological transition back to the office.
Whenever I’ve written about hygiene theater, some people have responded with the same objection: “Hey, what’s the matter with washing our hands?” That’s an easy one: Absolutely nothing. “Pandemic or no pandemic, you should wash your hands, especially after you prepare food, go to the bathroom,” or touch something yucky, Goldman said.
But hygiene theater carries with it an immense opportunity cost. Too many institutions spend scarce funds or sacrifice scarce resources to do microbial battle against fomites that don’t pose a real threat. This is especially true of cash-strapped urban-transit authorities and school districts that have spent hundreds of millions of dollars on soap technology rather than their central task of transporting and teaching people.
Hygiene theater also muddles the public-health message. If you tell people, “This disease is on surfaces, on your clothes, on your hands, on your face, and also in the air,” they will react in a scattered and scared way. But if you tell people the truth—this virus doesn’t do very well on surfaces, so you should focus on ventilation—they can protect themselves against what matters.
At the ideas level, the jealous protection of hygiene theater is an example of a larger American crisis. “When the CDC doesn’t update its fomite language for months while scientists are screaming about aerosolized spread, it just seems like a case of the precautionary principle taking over,” Goldman said. In his 2011 book, The Beginning of Infinity, the physicist David Deutsch defined the precautionary principle as a form of pessimism that “seeks to ward off disaster by avoiding everything not known to be safe.” The opposite of the precautionary principle is something like epistemic optimism: We don’t know enough, and we should always try to learn more.
That point might sound airy and theoretical, but it makes direct contact with America’s worst pandemic failures. Too many U.S. institutions throughout the pandemic have shown little interest in the act of learning while doing. They etched the conventional wisdoms of March 2020 into stone and clutched their stone-tablet commandments in the face of any evidence that would disprove them. Liberal readers might readily point to Republican governors who rejected masks and indoor restrictions even as their states faced outbreaks. But the criticism also applies to deep-blue areas. Los Angeles, for instance, closed its playgrounds and prohibited friends from going on beach walks, long after researchers knew that the coronavirus didn’t really spread outdoors. In the pandemic and beyond, this might be the fundamental crisis of American institutions: They specialize in the performance of bureaucratic competence rather than the act of actually being competent.