What is ‘hygiene theatre’ and why does it matter?

Are some of the methods we have adopted to combat Covid-19 actually fruitless? Joanna Whitehead finds out

Tuesday 13 July 2021 14:52
<p>Is the repeated cleaning and sanitising of hands the best way to combat Covid-19?</p>

Is the repeated cleaning and sanitising of hands the best way to combat Covid-19?

England is set to lift all Covid restrictions from 19 July, with government mandated rules relating to social distancing and face coverings set to relax from this date - individuals may choose to keep using them.

Although infection rates are increasing rapidly (there were 228,000 positive cases in the last seven days) and many people under the age of 30 are still weeks away from a second vaccine dose, health secretary Sajid Javid has pushed ahead with the so-called ‘Freedom Day’.

This is despite concerns from scientists and NHS chiefs. On Tuesday, the British Medical Association described the decision to lift restrictions as “irresponsible and perilous”, stating that the consequences could be “devastating”.

While masks and distancing might about to become optional, people - particularly business owners - might continue to scrub door handles, window ledges and menus with antibacterial products in an effort to minimise the spread of the virus (and restore confidence for their customers).

But how useful is a wipe in the face of an airborne disease? The term ‘hygiene theatre’ has been used to describe such behaviour – but what does it mean and where does it come from? Here’s everything you need to know.

What is ‘hygiene theatre’?

Hygiene theatre is the implementation of safety measures - particularly in response to the coronavirus pandemic - that offer the illusion of safety when the reality may not be so clear cut.

First coined by the US journalist Derek Thompson in a July 2020 essay for The Atlantic, he described hygiene theatre as Covid-related practices “that make us feel safer, but don’t actually do much to reduce risk – even as more dangerous activities are still allowed.”

Thompson cites examples including the proposed closure of schools in New Jersey for one day a week for “deep cleaning”, and the overnight closure of the New York subway for “power scrubbing”; measures that cost time, energy and resources but do not address the airborne nature of the virus.

Other examples include plastic facial visors that do not prevent wearers from breathing in infecting air or infecting those around them, the use of disposable menus and cutlery in packed, under-ventilated restaurant, and gyms that require users to wipe down equipment but pass on face masks.

What does the science say?

In the early days of the pandemic, it was broadly understood that Covid-19 was largely transmitted through droplets, direct contact – such as shaking hands – and by touching a surface that an infected person had recently come into contact with.

Reports suggested that people should quarantine their post when it arrived with Public Health England (PHE) publishing a blog post about the length of time it took for a virus-covered surface to no longer be contaminated (”likely to have decreased significantly by 24 hours”).

However, we know now that airflow and insufficient ventilation is more of a concern when it comes to transmission of Covid-19. In May, the US Centers for Disease Control and Prevention (CDC) acknowledged that Covid-19 is airborne and can be inhaled even when one is more than six feet away from an infected individual.

The new guidance marked a change from the CDC’s previous stance where it had said that infections happened through “close contact, not airborne transmission.”

In April 2021, consultant virologist at Leicester Royal Infirmary Dr Julian Tang published a new study in the British Medical Journal that urged governments and health leaders to focus on airborne transmission, rather than touching contaminated surfaces.

He said: “It is now clear that SARS-CoV-2 transmits mostly between people at close range through inhalation. This does not mean that transmission through contact with surfaces or that the longer range airborne route does not occur, but these routes of transmission are less important during brief everyday interactions over the usual one metre conversational distance.

“In close range situations, people are much more likely to be exposed to the virus by inhaling it than by having it fly through the air in large droplets to land on their eyes, nostrils, or lips.

“The transmission of SARS-CoV-2 after touching surfaces is now considered to be relatively minimal.”

Is theatre hygiene really a problem if everything just ends up cleaner?

While some people have argued that greater cleanliness in public spaces is largely a good thing, others are concerned that the focus on such preventative measures detracts from more effective ways to avoid transmission, such as the wearing of face masks and sufficient ventilation.

This will become increasingly important as we move into the next stage of restriction easing.

Thompson states in his article that hygiene theatre “builds a false sense of security” which he says leads to more infections. “Many bars, indoor restaurants, and gyms, where patrons are huffing and puffing one another’s stale air, shouldn’t be open at all,” he writes.

He describes the logic of establishments “boasting about their cleaning practices” while packing strangers into unventilated spaces to inhale the same air “warped”.

Pandemic measures have been helpful in other respects such as reducing other illnesses, however.

In February, Public Health England revealed that not a single case of the flu had been detected in England for the previous seven weeks, with infection rates at a historic low, with the wearing of face masks and increased hand washing and sanitising cited as one such reason.

Christina Pagel, a professor of operational research at University College London, told The Independent in February: “There’s been no flu season anywhere in the world this year, including the UK.

“Flu is one of the big reasons that the NHS struggles every winter. But what I think is really interesting is that people say we live with flu deaths every year and kind of assumed they were unavoidable. Yet clearly they’re not.

“If we wanted to, we’ve shown we can reduce flu deaths to pretty much zero. I don’t think that the damage we have done through lockdown is anything that anyone would support to prevent flu, but it does bring into question the idea of whether there is anything that we can do.”

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