COVID transmission should not be a touchy subject

Our understanding of COVID-19 is still evolving, but after observing millions of cases worldwide over the last nine months, we can speak to transmission patterns with a modicum of confidence.  SARS-CoV-2 is spread primarily through the air.  Contact with contaminated surfaces, by comparison, plays a minuscule role in transmission.  Why, then, has every surface with the slightest prospect for human contact become subject to “enhanced cleaning?”

Yes, there are studies reporting that SARS-CoV-2 can live on various surfaces for days at a time, but these studies use very large quantities of viral particles in tightly controlled environments.  From our real-world observations, most infected people are unlikely to deposit that much virus at one time – especially if they wear a mask, which they should while in public now.  At the same time, forces like UV light, heat, and desiccation start working to inactivate the virus within minutes.  While regular handwashing is always a good idea, we have grossly overblown the risk of acquiring COVID-19 from touching the environment.  In health care and other industries, this has generated a marked increase in waste from implementing more disposable containers, increasing the use of cleaning supplies, and throwing away reusable items after a single use.

I see a lot of compulsive behaviors surrounding writing utensils these days, so let’s take a look at the sequence of events that would need to occur for someone to get sick from a contaminated pen.  The infected user would need to cough or sneeze into their writing hand, or maybe use their writing hand to wipe away facial secretions, then forego washing their hands before handling that pen at the check-in desk.  Health care businesses, in particular, should be requiring their patrons to wear masks and perform hand hygiene upon entry, making it much harder for this initial contamination to take place.

Even if SARS-CoV-2 managed to reach the surface of the pen, it would likely be a very small quantity of virus compared to the amounts we see spread through the air.  The unsuspecting victim of transmission would need to handle the pen relatively quickly before environmental factors significantly reduce the quantity of viable virus.  They would then need to forego washing their hands as well and touch the contaminated area of the hand near their eyes or mouth with a large enough inoculum of viable virus to lead to infection.  Once again, if everyone is masking and performing routine hand hygiene, this chain of events is very unlikely.

Environmental cleaning rightfully plays a more prominent role within health care facilities to control the spread of other diseases, but even hospitals have overreacted when it comes to contact precautions for SARS-CoV-2.  I recently went to get a flu shot from one of the hospitals I cover, and I couldn’t help but think that several steps in this process seemed wasteful.  Even though everyone was already masking and maintaining appropriate distance, recipients were each assigned one large desk and one pen to fill out the obligatory paperwork.  Once complete, the pens went into a “dirty” cup, and a gloved staff member had to wipe down the pen, clean the entire desk surface and dispose of the cup before anyone else was allowed to use that station.  Before I could sit down and receive the vaccine, I had to stand back and allow the administering nurse to wipe down the whole chair with isopropyl alcohol.  We didn’t go to these lengths before the pandemic, so why go over the top now for a virus that, for all intents and purposes, is not spread by contact?

I prefer pragmatic, evidence-based solutions when it comes to disease management.  Each of us washing our hands is a lot easier, cheaper, and probably more effective than converting everything in our environment to single-use or compulsively cleaning our surroundings.  Likewise, “don’t touch your face” really isn’t practical advice – you’re going to do it at some point no matter how hard you try.  If you wear a mask and wash your hands, it won’t matter. Let’s try to keep transmission risks in perspective as we navigate policymaking in the time of COVID.  I, for one, would like our “new normal” to be both sustainable and palatable.

Clayton Foster is an infectious disease physician and founder, AirborneID. He can be reached on Facebook and Twitter @AirborneID_CO.

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