Hygiene theatre: how excessive cleaning gives us a false sense of security | Hygiene

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Claudia, a 26-year-old beauty worker, dreads it when her clients ask to go to the toilet. “It’s a whole other thing to clean,” she says. “They could have touched anything in there. I have to wipe down the whole thing with antibacterial spray and wipes.”

It is her job to maintain stringent cleaning protocols at the London skincare clinic where she works. When clients arrive for their appointments, Claudia checks them in, offers them a drink – the clinic only uses disposable cups or plastic water bottles – and takes them through to the treatment room.

Once her colleague is performing their treatment, Claudia begins furiously scrubbing every surface the customer could conceivably have touched.

After the customer leaves, Claudia scours the treatment room and replaces all the towels before wiping down the pump dispenser on the antibacterial hand gel visitors use when arriving. Then, when a new customer arrives, the process begins again. “I’ve had a few clients saying they feel really safe in here,” Claudia says, “because they know we are really careful and cautious about sanitising everything.”

Which makes it strange that the one measure that would contribute most to the safety of the clients and workers in Claudia’s clinic isn’t being implemented: ventilation.

Covid-19 is an airborne disease that is principally transmitted through respiratory droplets, as well as aerosols, that can linger in the air for many minutes after an infected person has left a room, and travel metres in distance. The most effective way to minimise the risk of Covid transmission in indoor settings is to open as many windows and doors as possible and mandate mask use.

But, although a window at the back of the clinic is open, the front door is closed. “We can’t have the door at the front open,” Claudia says, “because we’re on the main road. It’s more the security element than anything. Someone could just walk straight in … it’s probably not as well ventilated as we would like.”

What Claudia is performing on behalf of the customers who frequent her skincare clinic is “hygiene theatre”. The term was first coined by the Atlantic writer Derek Thompson in a July 2020 essay, in which he defined hygiene theatre as Covid safety protocols “that make us feel safer, but don’t actually do much to reduce risk, even as more dangerous activities are still allowed”.

Hygiene theatre is plastic facial visors that do not protect wearers from breathing in infected air or contaminating the people around them. It is single-use cutlery and disposable menus in restaurants and shields between tables. It is staff fastidiously cleaning communal touchpoints in pubs while maskless groups chant football songs at full volume. It is hazmat suit-wearing officials fumigating entire streets with disinfectant. It is gyms that require people to wipe down every piece of equipment they touch, but do not make them wear masks. It is quarantining your post by the front door and wiping down your groceries with bleach. All well-intentioned, but mostly ineffectual, gestures that make us feel safe, but do not keep us safe from the threat posed by Covid-19.

As England hurtles towards the removal of virtually all Covid restrictions on 19 July, with the other devolved nations likely to follow, albeit at a more cautious pace, a mantra of personal responsibility is being promoted by the government. Masks will be voluntary; social distancing scrapped; businesses no longer under any obligation to increase the ventilation in their premises.

But infections are rising exponentially, and only just over half of the total UK population have received two doses of the vaccine. From now on, the individual decisions we take about how to stay safe in public spaces will have powerful real-world consequences. As we enter the third wave of the Covid-19 pandemic, we are rushing towards a dangerous new phase in which hygiene theatre can do even more damage than it has.

Hygiene theatre builds on a concept originated by the security expert Bruce Schneier in his 2003 book, Beyond Fear. Schneier coined the term “security theatre” to describe the safety measures implemented at airports after the 9/11 terror attacks, such as banning nail scissors and cigarette lighters. In reality, these measures were pointless: a complicated charade to reassure nervous passengers rather than anything grounded in reality. They also came at a huge cost to taxpayers – the US has spent more than $100bn on aviation security since 9/11.

Schneier agrees that Covid-19 has ushered in an era of hygiene theatre. “Like security theatre,” he says, “hygiene theatre comes from bad risk analysis – really, from ignorance.” At the beginning of the pandemic, Schneier says, this was understandable. “Nobody knew anything,” he says. “We were all confused about what the right thing was to do. We legitimately didn’t know.”

According to the CDC, the chance of contracting Covid-19 from a single infected surface is less than 1 in 10,000 Photograph: Peter Dazeley/Getty Images

In those fear-filled days of February and March 2020, many experts and healthcare authorities believed that Covid-19 was primarily transmitted through droplets, through skin-on-skin contact, such as shaking hands, being coughed on by an infected person or touching something they had recently touched. (Infection via contaminated surfaces is known as fomite transmission.) Academics told the public not to bother wearing masks, as the virus was not airborne, so masks would be futile.

This is why all the public health messaging from this time was about minimising direct contact. “Hands, face, space,” we repeated like a magic spell, as we shopped in supermarkets without face masks, pausing in poorly ventilated aisles to sanitise our hands. (Masks were not mandated on public transport and hospitals in England until 15 June, and in shops from 24 July.) Cabinet ministers at daily coronavirus press conferences persistently reminded the public to wash their hands.

Lost in this was any recognition of the dangers of airborne Covid-19 transmission. “Basic hand hygiene,” says Dr Christine Peters, a consultant medical microbiologist and virologist at Glasgow NHS trust. “That message got out very early, and that became the fixation of the public and politicians. But it was to the detriment of the other important message, which is: think about the air.” The World Health Organization (WHO) did not acknowledge the risk of airborne transmission until July 2020; in the US, the Centers for Disease Control and Prevention (CDC) acknowledged that fomite transmission of Covid-19 “isn’t thought to be the main way the virus spreads” in May 2020, and updated its guidance to include airborne transmission in October 2020. The UK government first acknowledged the risk of airborne Covid-19 transmission in about November 2020, although it was not until March 2021, more than a year since the pandemic first hit UK shores, that it finally published guidance on ventilation in indoor settings.

According to the CDC, the chance of contracting Covid-19 from a single infected surface is less than 1 in 10,000. And yet we remain obsessed with fomite transmission of Covid-19, as do our elected leaders. In June, a glove-wearing Boris Johnson was filmed wiping down a plastic chair, in a worrying indication of the prime minister’s lack of understanding. And when the G7 met in Cornwall, news cameras broadcast footage of hotel staff wiping down railings outside the hotel hosting the summit, in a bit of high-profile hygiene theatre.

Even at the government press conference announcing the relaxation of restrictions on 5 July, the chief medical officer, Chris Whitty, talked about handwashing, but not ventilation. “One of the problems we had from the beginning, that was critical at the time and actually still is critical, is senior people did not understand well enough the problem of … it being airborne,” said the former government aide Dominic Cummings in a blink-and-you’ll-miss-it excerpt from his marathon select committee appearance in May.

How to explain this continued misapprehension? “Shakespeare puts it well,” says Dr Emanuel Goldman, a microbiologist at Rutgers. “What is done cannot be undone. There was a great preoccupation with fomite transmission at the beginning of the pandemic. And that stuck.” Goldman was a leading voice challenging hygiene theatre throughout the pandemic. In July 2020, he wrote a sharp commentary for the Lancet Infectious Diseases, calling into question the then-received wisdom that Covid-19 could be transmitted by infected surfaces. “When the pandemic started,” he says, “my mother-in-law, who lives with us, was saying that we needed to wash the groceries and disinfect the mail. As a scientist, it seemed extreme, so I decided to look at the literature. And when I did, I was horrified to see that the basis for those interventions was very weak.”

Since then, Goldman has campaigned for an end to hygiene theatre, publishing in medical journals and reviewing the academic literature on fomite transmission. “The battle continues,” he says, telling me that the WHO continues to overemphasise the risk of Covid-19 transmission from contaminated surfaces. In the UK, a similar role has been played by the “fresh air” campaign, run by a group of frontline NHS workers arguing for greater recognition of the dangers of airborne Covid transmission in hospital settings, and better masks for NHS staff.

Many would argue that hygiene theatre is benign. Public toilets are cleaner than they have ever been. “One legacy of the pandemic is that general hygiene levels will increase,” says Dr Eilir Hughes of the NHS fresh air campaign. “I don’t like security theatre when it’s expensive,” says Schneier, “and the government is making the taxpayer pay for it. But if it’s someone wiping down their groceries because it makes them feel better, go to town.” Peters is sanguine about cleaning protocols in healthcare settings in particular. “Trying to maintain a clean environment in a hospital setting is fair enough.”

But hygiene theatre can lull people into a false sense of security. “I roll my eyes when I see people walking around in visors,” sighs Hughes, “because it’s such a shame.” There have been Covid outbreaks in restaurants where workers used only plastic visors, instead of face masks. (After one such outbreak in a Swiss hotel, local health officials cautioned the public against wearing facial visors.) Hughes feels similarly about hand sanitiser. “It gives people this sense of an invisible cloak.”

‘I’ve seen a lot of people who’ve had really bad dermatitis because of this obsession with hand hygiene.’
‘I’ve seen a lot of people who’ve had really bad dermatitis because of this obsession with hand hygiene.’ Photograph: Tahreer Photography/Getty Images

Hygiene theatre can be actively dangerous because it prevents people from making informed choices about the levels of risk they’re willing to accept in their lives. “Your feelings of safety have to be science-based,” says Peters. “People can make their own judgment calls about the risks they are willing to tolerate, but the key is for people to understand how Covid spreads.” She fears that hygiene theatre causes people to avoid taking the mitigating measures that actually would reduce risk, such as opening windows or investing in high-efficiency particulate air purifiers. “In a restaurant,” Peters says, “instead of looking at how many hand sanitisers there are on the table, people should be looking at reassurances around the air exchanges.” With all restrictions on indoor contact likely to cease in England on 19 July, correctly assessing the level of risk in any given setting will be crucial. In short, it’s time to finally do away with hygiene theatre.

In addition, all those antibacterial wipes and single-use plastics are environmentally ruinous. “It’s the waste we’re creating that I find annoying, more than anything else,” Claudia says. Goldman says that public institutions are spending vast sums on disinfectants and cleaners. “For a year, the New York subway closed every night for deep cleaning,” he says. “That cost hundreds of thousands of dollars. Money doesn’t grow on trees for public institutions.”

Transport for London installed more than 200 ultraviolet sanitising devices on 110 escalators on the London underground, even as the transport authority has to find £900m of savings or new income over the coming year. Vendors of sanitiser, antibacterial wipes and cleaning products post record profits: the manufacturers of Dettol and Lysol recorded their highest-ever sales growth in 2020, largely due to the pandemic.

Hughes is a practising GP. “I’ve seen a lot of people who’ve had really bad dermatitis and skin irritation because of this obsession with hand hygiene. And for people who are susceptible to obsessive-compulsive disorder, particularly around hygiene, it’s been absolutely devastating,” he says. For people with multiple chemical sensitivity (MCS), too, an extreme sensitivity to fragranced products – such as disinfectants, soaps or detergents – the hygiene theatre of the Covid-19 pandemic has been a nightmare.

“It’s unbearable,” sighs Anna Meyerson, a 59-year-old dentist from Westchester, Pennsylvania. First diagnosed with MCS in 2016, Meyerson has been essentially housebound for years. “There’s only one place I can eat near me,” she says, “and it took me years to get them to stop using air fresheners.” But the pandemic has exacerbated her condition. Before, her husband could do the food shopping without incident. “Now, with Covid, they fumigate and disinfect everything,” she says, “and that permeates my husband’s clothes and makes me sick. Before, when he came back from the store, it would be fine. Now he has to shower.” She is desperate for hygiene theatre to stop. “They are killing me with all these chemicals.”

How to explain this befuddling attachment to hygiene theatre when we know that it does not measurably keep us safe, comes at an exorbitant cost and can be measurably damaging to some people? “People are keeping it up because it’s largely self-soothing,” says Schneier. “This is how I feel better.”

“Even though I know in my head that wiping everything down makes no difference,” says Claudia, “it kind of makes you feel safer. Even though it’s completely illogical … it’s like, peace of mind.”

At its heart, hygiene theatre is a perhaps inevitable response to the worst public health crisis in a century. Because when events career out of control, humans respond the only way they know how: by attempting to impose order upon chaos, one Dettol wipe at a time.

Some names have been changed.

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