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[31]Gregory Barber
[32]Science
10.20.2020 07:00 AM

It’s Time to Talk About Covid-19 and Surfaces Again

In the early days, we furiously scrubbed, afraid we could get sick from
the virus lingering on objects and surfaces. What do we know now?
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Beth Kalb was worried about the pews. This summer, the century-old
Catholic church she attends in a small town outside Minneapolis had,
like many places, reopened its doors with new rituals of disinfection.
Kalb had quickly noticed the side effects. The varnish on the pews had
begun to wear, and the wood was often sticky with disinfectant, so the
volunteer cleaners had started using soap and water to remove the tacky
build-up. They were weeks in, and it had already come to cleaning off
the cleaner. Plus, all those chemicals couldn’t be good for the people
who were spritzing and wiping down the worship space after each use. As
a nurse, Kalb knew the importance of handwashing, but this all seemed
like a bit much. It was certainly too much for the wood.
sanitation workers cleaning stairs

[35]Everything You Need to Know About the Coronavirus

Here's all the WIRED coverage in one place, from how to keep your
children entertained to how this outbreak is affecting the economy.

For Erin Berman, in Fremont, California, it was the books. In the
spring, a federal project to help reopen libraries, [36]called Realm,
had commissioned tests to see how long the virus lasts on objects they
lend. Researchers had borrowed materials from the library system in
Columbus, Ohio, and applied an inoculum of the virus to them in a
nearby lab to see how long it could remain infectious. They started
mainly with books, measuring how much virus was left after a day or
two, but in subsequent months, expanded to magazines and DVDs and USB
drives. In August, a fourth round of tests addressed the question of
placing books in stacks, rather than laying them out individually.
Protected from light and drying air, the researchers were able to find
virus particles on them after six days. On leather book covers, a fifth
round of tests determined [37]this month, the virus lasted at least
eight days.

The Realm organizers emphasized that none of what they were reporting
was guidance—it was research, meant to inform the staff at individual
libraries who were deciding what to do with all those items gathering
dust, and possibly germs, in people’s homes. However, they also noted
it was not possible to disinfect every page of every book. So many
library staffers, after seeing the data, were considering “book
quarantines” that lasted a week or more.

Berman was aware of the practical issues raised by putting books in
purgatory for so long, but she had a broader concern: that all this
research was encouraging an undue fixation, or even a fear, of the
objects librarians are meant to joyfully share with the public. It was
hard to understand what those numbers—the number of days, the number of
viral particles that remained—actually meant for spreading Covid-19 via
books, but their very existence had generated anxiety among her
coworkers. And she suspected that it was drawing focus away from all
the other things she and her colleagues had to do to reopen safely—to
reimagine a community space in which people could no longer safely
linger, in which social connection would now be mediated by Plexiglass.
“I started to get very frustrated. I’m thinking, ‘We’re librarians. We
should be doing research,’” Berman says. “Of all the industries, we
should not be operating in fear.”

For Emanuel Goldman, a virologist at Rutgers University, the worries
began with the gentle nagging of his elderly mother-in-law. “She was
telling me, ‘Wipe down this, wipe down that,’” he says. He had been
obliging at the start of the pandemic. The requests seemed reasonable—a
set of small acts to keep his household safer. He knew from other
viruses that fomite spread—the technical term for passing on a virus
via objects—was possible, and at that time the Centers for Disease
Control and Prevention had little guidance on SARS-CoV-2. But as he
delved into the research himself, he grew concerned. Despite all the
fixation on how long and how much virus lasts on surfaces, there wasn’t
much evidence at all that it was relevant to how Covid-19 actually
spread. In July he laid out those concerns in a [38]tersely worded
commentary in The Lancet titled “Exaggerated risk of transmission of
Covid-19 by fomites.”
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“In my opinion, the chance of transmission through inanimate surfaces
is very small, and only in instances where an infected person coughs or
sneezes on the surface, and someone else touches that surface soon
after the cough or sneeze (within 1–2 h),” he wrote. “I do not disagree
with erring on the side of caution, but this can go to extremes not
justified by the data.”

That was months ago, and since then the scientific evidence has tipped
in Goldman’s favor. And yet, here we are all the same, wiping down pews
and hiding away books, among countless other disinfection rituals
molded by those early perceptions. “What’s done cannot be undone,”
Goldman tells me now. “And it’s going to take a lot of time and effort
to turn things around.”

In March, [39]I wrote about what we knew at the time about our
understanding of surface spread, which was very little. Nearly a year
into the Covid-19 pandemic, it’s time to ask: What do we know now?

The first widely covered [40]study on fomites and Covid-19, released as
a preprint in March by researchers at the University of California, Los
Angeles, the National Institutes of Health, and Princeton, was a look
at how long the novel coronavirus lasted on different kinds of
surfaces. At the time, little was known about how the virus was
transmitted, so the question was important. Depending on the material,
the researchers could still detect the virus after a few hours on
cardboard, and after several days on plastic and steel. They were
careful to say that their findings only went as far as that. They were
reporting how quickly the virus decayed in a laboratory setting, not
whether it could still infect a person or was even a likely mode of
transmission.

But in the hazy panic of the time, many people had already taken up
fastidious habits: quarantining packages at the door, bleaching boxes
of cereal brought back from the store, wearing hospital booties
outdoors. A single set of research results didn’t start those
behaviors, but—along with other early studies finding the virus on
surfaces in hospital rooms and on cruise ships—it appeared to provide
validation.

Dylan Morris, a mathematical biologist at Princeton who coauthored the
paper, recalls watching what he calls “the great fomite freakout” with
frustration. The number of days the virus remained detectable on a
surface in a lab wasn’t useful for assessing personal risk, he says,
because in the real world, that amount would depend on how much there
had been to start with and on environmental conditions that they did
not test. Plus, the amount of remaining virus doesn’t tell us much
about whether it could reasonably get into someone’s airways and cause
an infection. “People really picked up on those absolute times to
detectability,” he says. “Everyone wants to know the magical time when
something becomes safe.” In subsequent research, he says he’s avoided
giving hard temporal cutoffs.

Since March, additional studies have painted a picture that is much
more subtle and less scary. But like that first study, each can be
easily misinterpreted in isolation. One clear takeaway is that, given
an adequate initial dose, some amount of the virus can linger for days
or even weeks on some surfaces, like glass and plastic, in controlled
lab conditions. Emphasis on controlled. For example, earlier this
month, an Australian study [41]published in Virology Journal found
traces of the virus on plastic banknotes and glass 28 days after
exposure. The reaction to that number felt to some like a replay of
March: a single study with a bombshell statistic sparked [42]new fears
about touchscreens and cash. “To be honest, I thought that we had moved
on from this,” says Anne Wyllie, a microbiologist at Yale University.
Advertisement

Of course, this was another laboratory study done with specific
intentions. The study was done in the dark, because sunlight is known
to quickly deactivate the virus, and it involved maintaining cool,
favorable temperatures. Debbie Eagles, a researcher at Australia’s
national science agency who coauthored the research, tells me that
taking away those environmental variables allows researchers to better
isolate the effect of individual factors, like temperature, on
stability. “In most ‘real-world’ situations, we would expect survival
time to be less than in controlled laboratory settings,” Eagles writes
in an email. She advises handwashing and cleaning “high-touch”
surfaces.

The second consistent finding is that there’s plenty of evidence of the
virus on surfaces in places where infected people have recently been.
Wherever there has recently been an outbreak, and in places where
people are asked to quarantine or are treated for Covid-19, “there’s
viral RNA everywhere,” says Chris Mason, a professor at Weill Cornell
Medicine. That makes going out and swabbing a useful tool for keeping
track of where the virus is spreading.

It’s tempting to piece those two elements together: If the virus is on
the surfaces around us, and it also lasts for a long time in lab
settings, naturally we should vigorously disinfect. But that doesn’t
necessarily reflect what’s happening. In [43]a study published in
September in Clinical Microbiology and Infection, researchers in Israel
tried to piece it all together. They conducted lab studies, leaving
samples out for days on various surfaces, and found they could culture
the remaining virus in tissue. In other words, it remained infectious.
Then they gathered samples from highly contaminated environments:
Covid-19 isolation wards at a hospital, and at a hotel used for people
in quarantine. The virus was abundant. But when they tried to culture
those real-world samples, none were infectious. Later that month,
researchers at an Italian hospital [44]reported similar conclusions in
The Lancet.

In addition to environmental conditions, a confounding factor might be
saliva, or the stuff that we often mean when we talk about droplets
sticking onto surfaces. In her own research, Wyllie has studied how
long certain viral proteins remain intact in saliva to help determine
the reliability of Covid-19 spit tests. For her purposes, stability is
a good thing. But some proteins have appeared to denature more quickly
than others, she notes, suggesting the virus as a whole does not remain
intact and infectious. That could be because saliva tends to be less
hospitable to pathogens than the synthetic substances or blood serums
often used in lab-based stability studies.

Consider, Wyllie says, the extraordinary chain of events that would
need to happen to successfully spread SARS-CoV-2 on a surface. A
sufficiently large amount of the virus would need to be sprayed by an
infected person onto a surface. The surface would need to be the right
kind of material, exposed to the right levels of light, temperature,
and humidity so that the virus does not quickly degrade. Then the virus
would need to be picked up—which you would most likely do with your
hands. But the virus is vulnerable there. (“Enveloped” viruses like
SARS-CoV-2 [45]do not fare well on porous surfaces like skin and
clothing.) And then it needs to find a way inside you—usually through
your nose or your eye—in a concentration big enough to get past your
mucosal defenses and establish itself in your cells. The risk, Wyllie
concludes, is low. “I’ve not once washed my groceries or disinfected my
bags or even thought twice about my mail,” she says.

Low risk is not, of course, no risk, she adds. There are high-touch
objects that merit disinfection, and places like hospitals need clean
rooms and furniture. People at high risk from Covid-19 may want to take
extra precautions. But the best advice for breaking that object-to-nose
chain, according to all the health experts I spoke with: Wash your
hands.
Advertisement

Goldman, too, had come to similar conclusions months before all this
additional research came out, and US public health guidance followed
right along with him. Since his Lancet paper in July, the focus on
fomites has waned, and has been replaced by a focus on person-to-person
[46]transmission through respiration. The shift was based on
epidemiological evidence. Experts knew all along that droplets passed
by sneezing, coughing, or speaking were likely an important mode of
transmission—that’s just how respiratory viruses tend to move. Over
time, it became clear that aerosols, which remain suspended in the air,
can better explain why so many infections seemed to be passing between
people who did not directly interact, but could have shared the same
indoor air. That’s why public health officials now [47]emphasize mask
wearing and ventilation. The CDC’s [48]most recently updated guidance,
from early October, holds that “spread from touching surfaces is not
thought to be a common way that Covid-19 spread.” For those reasons, or
perhaps out of fatigue, the scrubbing became less scrupulous over the
summer.

But not for everyone. “I think that one thing that has been tough about
this pandemic is there has been such a strong initial message that gave
people the wrong intuition,” says Morris, the Princeton researcher. For
some people, and especially for institutions that were trying to
reopen, liable to employees and visitors, priorities had been set based
on what we knew back in the spring. It was also a way to show that they
were doing something, Morris adds, even if it didn't do much. In July,
The Atlantic’s Derek Thompson coined the term “[49]hygiene theater” to
describe the rash of corporate disinfection. It’s still around. It’s
part of the reason why New York City has committed [50]tens of millions
of dollars to cleaning each subway car each night, why Airbnb requires
[51]“enhanced” cleaning from its landlords, why countless schools,
stores, churches, and offices continue to emphasize disinfection. It’s
why some libraries are quarantining books this fall for a week or more.
It’s also a factor in what we are now less likely to do, a rationale
for why many businesses [52]no longer take cash and why playgrounds
have often been among [53]the last outdoor venues to reopen.

“There are bizarre policies that haven’t changed or adapted,” says
Julia Marcus, an epidemiologist at Harvard Medical School. “It’s one
thing for an individual to decide to stop bleaching their groceries.
It’s much more difficult to steer the ship of an institution as the
science evolves, with different levels of decisionmaking and different
levels of health literacy and risk tolerance.”

What is it about fomites? There’s surely something psychological in the
belief that we can “see” an invisible virus, manifesting as an object
that we can quarantine, avoid, wipe down. That’s evident in how we
think about the research, even. Recall the [54]salt shaker in Germany?
Or the [55]elevator buttons in a Chinese high-rise? In New Zealand,
there was that hypothesis that [56]containers of frozen fish were
responsible for an outbreak there. Some of those conclusions can be
attributed to aerosol starting off as a [57]dirty, alarmist word.
Public health officials were searching for something, anything, to
explain why groups of people who didn’t gather closely were becoming
infected.

It’s impossible to rule out that some transmission could occur that
way—and examples still come up, like a case in New Zealand possibly
linked [58]to a communal trash can—but most incidents now look like a
case of shared air. Wyllie points to a friend who remains convinced
they got the virus from a contaminated door handle. She thinks that’s
unlikely, but for her friend, it’s an answer to a question of how they
got sick that ambient virus floating in the air simply doesn’t offer.
It’s a good story.
Advertisement

Sharon Streams, director of the Realm project, says she sympathizes
with that demand for answers. The group’s research on library materials
was conceived after the surface research in March. At the time, the
talk was all fomites, at the time. Library employees wanted specifics
to better understand how the virus interacts with the billions of
materials they handle each year, many of which are currently marooned
in people’s homes, exposed to who knows what. “They’re pulling their
hair out about what is the appropriate level of quarantine,” she says.

Streams acknowledges that the conditions modeled in their experiments
are based on a vague foundation. It’s hard to know whether the
researchers started with a realistic dose of the virus, or whether the
amount of it that remains on surfaces after a few days or hours would
actually cause an infection. (The group’s latest [59]research release,
last week, included more language about aerosols and droplets being the
likeliest modes of transmission.) But to her, that’s the point of
gathering more data. And Streams points out that even if a weeklong
quarantine looks like overkill to some virologists or health experts,
quarantines and disinfection satisfy an emotional need that’s often
overlooked. Much like the wiping down store shelves, church pews, or
subway cars, cleaning policies are also about signaling which spaces
are safe to come back to—that libraries are ready for visitors and
employees. “‘Hygiene theater’ has been thrown around as a bad word, but
they’re embracing it to show that we care about the people coming
here,” she says. “They feel comforted.”

But communicating that point is difficult. Marcus points back to the
original paper on surface spread in March: “They couched it
appropriately. But even with those caveats, it spun into a lot of
obsessive behaviors,” she says. Even seemingly benign procedures, like
quarantining items, can wear people out over time. “There’s such a high
level of tension in our lives and decisionmaking right now. We all need
to feel some ease,” Marcus says. “For me, the question is, where are
the low-risk areas where we can ease off the gas now that we know more
about how transmission happens—which is overwhelmingly from being
together in indoor environments? It’s not from a book that somebody
sneezed on and brought to the library a week ago.”

Worrying about the small stuff exhausts people from focusing on things
that do matter. There are all sorts of ways to imagine what might go
wrong. Maybe a person feels so confident in the disinfection methods
around them that they eat indoors without a mask, despite the much more
substantial known risks. Or perhaps someone feels they don’t need to
quarantine themselves after traveling because they wore disposable
gloves and booties over their shoes on the plane. “When you ask more of
people than what is needed, they grow tired of doing what actually
matters,” Marcus says. Her advice: Keep it simple.

Read all of our coronavirus coverage [60]here.

That sort of clear, simple guidance is hard to come by. Since The
Lancet publication, Goldman has become a consultant and therapist of
sorts for people who are questioning the utility of overly rigorous
disinfection, but who are unsure of what to make of the scientific
evidence. He’s been in touch with administrators at a local school that
planned to close once a week for “a deep clean,” but who weren’t paying
attention to their ventilation systems. He has fielded inquiries from
people who still leave their groceries out for days, and who barely
leave the house, encouraging them to find a healthier balance. He may
be able to change minds one at a time, he reasons, or at least help
people put the risks in perspective. It worked, he says, on his
mother-in-law. But behaviors are hard to shift, especially when the
decision is made by committee. The tendency, in the absence of firm
guidance to do otherwise, is to cater to the most cautious.
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In Minnesota, Kalb, who is one of his acolytes, says her concerns about
the pews, and the lack of evidence driving the deep cleaning, were
carefully considered by the church reopening committee. But her fellow
parishioners advised caution. The daily disinfection was part of a list
of changes for safe reopening, including cordoning off rows for social
distancing and a sign-up process to enable contact tracing. It was
safest, the committee decided, to continue doing it all, much like
every other nearby church and school and store was doing. After all,
Kalb couldn’t point to a specific study that said fomite transmission
was never happening. And there was news going around of [61]an outbreak
at a church in Texas. “It was like, OK, we don’t want to be that
church,” she says. The church now uses a misting machine to spray
disinfectant, which requires less active wiping.

It’s tempting, in other words, to play it conservatively, says Berman,
the librarian. “Some of it is just making sure the employees or the
public feel safe,” she says, and she sees the benefits of disinfecting
library surfaces that get a lot of use. But she points out that
institutions have the power to alter our perception of safety, cutting
through the ambiguity of risk by offering clear guidance. Holding out
these scientific conclusions—the number of days the virus lasts on
every imaginable type of library material surface—had done just the
opposite, she believed, producing more fear than empowerment.

Like so many decisions about risk and public safety in this pandemic,
the burden had been displaced onto people like her, a librarian, not a
virologist. She marveled at how much effort she was personally
expending trying to educate herself and the people around her about the
risk of books as fomites, when there was so much else to worry about.
And, well, now she had done the research, and she knew the biggest risk
in a library is the risk of sharing the same air, not touching the same
book. Wouldn’t it be nice if someone with more authority would just
come out and say so? “There’s so much fear out there,” she says. “I
don’t want to put anyone at undue risk, but I want us to reopen.”
__________________________________________________________________

More From WIRED on Covid-19
* 📩 Want the latest on tech, science, and more? [62]Sign up for our
newsletters!
* The pandemic closed borders—[63]and stirred a longing for home
* What does it mean [64]if a vaccine is “successful”?
* How the pandemic [65]transformed this songbird’s call
* Why is it so hard to study [66]Covid-related smell loss?
* Testing won’t [67]save us from Covid-19
* Read all of [68]our coronavirus coverage here

[69]Gregory Barber is a staff writer at WIRED who writes about
blockchain, AI, and tech policy. He graduated from Columbia University
with a bachelor’s degree in computer science and English literature and
now lives in San Francisco.
Staff Writer
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51. https://news.airbnb.com/introducing-airbnb-enhanced-clean/
52. https://fortune.com/2020/08/11/coronavirus-is-cash-safe-during-covid-germs-money/
53. https://www.sfchronicle.com/bayarea/article/Coronavirus-State-allows-playgrounds-to-reopen-15606113.php
54. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30314-5/fulltext
55. https://wwwnc.cdc.gov/eid/article/26/9/20-1798_article
56. https://khn.org/morning-breakout/is-a-frozen-shipment-the-source-of-new-zealands-new-outbreak/
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