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How safe is it to use public bathrooms right now? (Vox)

When Steven Soifer, a social work professor at the University of Mississippi, and his wife finally left social isolation for the first time since early March, they encountered a familiar problem: the call of nature. They first stopped by a Starbucks, but the franchise was taking drive-through orders only — the bathrooms were closed. Eventually, the couple came across a gas station, where one toilet seemed to be open.

“I walked in, and I had my face mask on and rubber gloves, so I figured, no problem at all,” explains Soifer, who also heads the American Restroom Association. “And so I lift up the toilet seat, and I realized: Oh my god, that touched the rubber gloves. So I’ve got a problem here.”

Soifer explained that he used his other, cleaner hand to open the door. He noticed the handle was made of stainless steel, which is not as antiviral as the copper fixtures you see in many bathrooms. But it’s virtually impossible to keep any bathroom completely sanitary, especially in the midst of a pandemic.

“So that there is an exact example of trying to navigate this out in public” Soifer added.

As states and localities move forward with allowing businesses to open up, more and more people will need to use public restrooms for the first time in months. But while a patron might be comfortable sitting down at a socially distanced, outdoor restaurant, bathrooms are another story. They’re rife with high-touch surfaces: doorknobs, toilet handles and seats, faucets, and paper towel dispensers. This, in addition to the fact that toilets themselves can possibly spew a plume of aerosol particles into the air with every flush.

So what do you do if you have to go and you’re not at home? Restaurants, parks, and other public spaces are now looking for ways to safely manage lavatories, trying everything from managing traffic flows with “bathroom monitors” to taping off urinals to installing pedals so people can open doors without touching knobs. Some public spaces are simply opting to keep their restrooms closed.

While these are all short-term solutions, they stand to shape how future public restrooms might change during and after this pandemic. But in the meantime, if you do decide to venture out, there are some very common-sense precautions you can take in the bathroom to keep yourself, and the next person in line, a bit safer.

Social distancing at the bathroom matters, even at your friend’s house

The Centers for Disease Control and Prevention (CDC) says that the novel coronavirus primarily spreads when people are in close contact, like when you’re less than 6 feet away from others. That means that when you’re in a public or shared bathroom, your first worry should be to maintain social distancing.

“It can be harder to maintain physical distance when using public restrooms, especially in a crowded setting,” Susan Amirian, a research scientist at the Texas Policy Lab, told Recode. “Some facilities with public restrooms have taped off middle sinks or taken other measures to keep people from standing too close to each other.”

States that are beginning to reopen have this concern in mind. Health agencies’ guides for reopening encourage restaurants to monitor high-traffic areas like bathrooms and to make sure people don’t congregate too densely in those areas. To ensure social distancing, some restaurants have even turned to using staff as bathroom monitors or to taping up some urinals to prevent people from standing too close when peeing.

If you see these measures in effect, you should feel better about that public toilet option. The same principles apply for gatherings at people’s homes. If you’re the host, be mindful of some crowd control. After speaking to Marybeth Sexton, who studies infectious diseases at Emory University, the Los Angeles Times reports:

If someone goes into the house to use the restroom, let them go in alone. When they’re done, it’s critically important that they wash their hands really well. Then you’ll want to clean the restroom afterward.

Almost all household cleaners have indications that they kill coronavirus. As long as you clean surfaces and wash hands, you should be safe.

(You can read the CDC’s published guidelines for disinfecting these spaces here.)

Inside the bathroom, take basic precautions, like washing your hands

Let’s repeat that point: When you use a public bathroom, the best thing someone can do is wash their hands thoroughly. Vox explains how best to do that. You should also avoid touching your face and try to keep your mask on.

Amesh Adalja, a scholar at Johns Hopkins Center for Health Security, emphasizes that while surface transmission is possible, hand-washing is an essential way to stay safe and clean.

“If you’re washing your hands, you really don’t have that risk,” Adalja said. “So if you’re someone that washes your hands meticulously, any of the other stuff is going to be additive and probably a marginal value.”

Even if you’re diligent about hand-washing, there are other threat zones in every bathroom. You should also pay attention to the bathroom’s ventilation as well as frequently touched fixtures like door handles and contactless air dryers.

“Although your hands are probably clean after washing, you will still recirculate the air in the bathroom, and most bathrooms have poor air circulation,” warns Eric Feigl-Ding, a senior fellow and epidemiologist at the Federation of American Scientists.

Consider using paper towels if they’re available. Researchers from the University of Leeds previously found that jet-air dryers could help spread aerosols that contaminate other surfaces and have warned that they shouldn’t be used in hospital restrooms. You might as well steer clear of them in public restrooms, too.

If you don’t have a choice, it’s not the end of the world. Adalja, the Johns Hopkins scholar, argues that the choice of paper towel versus hand dryer likely won’t have a significant impact on your chances of catching the coronavirus.

What about fecal transmission of Covid-19?

Don’t freak out. There is some evidence that the novel coronavirus can be found in poop, though the CDC says that it’s not clear that the virus has actually spread to other humans in that way. Even if it’s possible, the odds of actually catching the novel coronavirus through poop are likely extremely low. (Again, the best precautions a person can take are wearing a mask, not touching their face, washing their hands, and keeping their distance from others.)

“The main problem is the flushing, because unlike private homes that have lids, most public bathrooms only have a toilet seat and not the natural lid,” says Feigl-Ding. “We know that flushing is an aerosol-generating event.”

He explains that the result of an aerosol-generating event is sometimes called a “toilet plume.” A 2013 review of such plumes, which are caused by flushing, pointed to studies showing that “potentially infectious aerosols may be produced in substantial quantities” and that “aerosolization can continue through multiple flushes to expose subsequent toilet users.” The study did not make a conclusion regarding the actual transmission of illness through flushing and was not about the current coronavirus.

“Regardless of how likely it is that Covid-19 could be transmitted through fecal contamination,” Amirian said, “it’s always important to practice good hygiene in a public bathroom or even at home.”

(Side note: Even if the coronavirus can’t be transmitted to other people through poop, a startup called Biobot is working with health researchers to track the spread of Covid-19 by testing water collected from sewage systems.)

What we can learn from the coronavirus bathroom problem

The coronavirus pandemic has highlighted the importance of bathrooms for not just our own cleanliness but also for public health more broadly. And it’s not just about convenience: Access to toilets is a human rights issue, especially for people who are homeless who can struggle to find lavatories, many of which are owned by private businesses, like Starbucks, and not maintained by the government.

“It’s a huge problem,” Soifer said.

Another challenge is while counties and states continue to open up, increased sanitation duties will inevitably fall on the workers of those establishments. For instance, in its guide to reopening its locations, McDonald’s has directed its franchisees to clean bathrooms every half hour in its restaurants. In order to clean bathrooms safely, Feigl-Ding says those workers should have access to tons of personal protective equipment, including protective goggles and N95 masks. Some McDonald’s workers say the company isn’t doing enough.

While these are short-term measures, the pandemic could actually change how we design bathrooms in the future.

“What we want to see in the long run are single-stall, gender-neutral, full-enclosed water closets,” argues Soifer, explaining that sinks could be available outside the area that houses the toilet, a set-up he says that’s already popular in Europe and parts of Asia.

Those changes could also come with increased interest in more separation between stalls, contactless dispensers for soap and paper towels, and improved ventilation. Some experts think that these bathrooms could clean themselves, perhaps using automated disinfectant sprays or blasts of UV light. This future sounds appealing as we’re all becoming hyper-aware of cleanliness in public places.

But for now, you’ll be safer if you maintain social distancing, wear a mask, avoid touching your face, and seriously, wash your hands.