Covid-19 hygiene: are we sanitising our way to the next health disaster?

Having coffee in central Hong Kong is now a different experience from eight months ago. My temperature is checked before ordering, a mask must be worn when not eating or drinking, the table I sit at is well spaced from others and only two people can enjoy this break together. We have become uneasily accustomed to this ritual, and apart from some mild personal inconvenience, there is no lasting effect from such social distancing measures. Yet before I am seated, my table has been liberally cleaned with disinfectant; I am likely to rub my hands with hand sanitiser, perhaps several times during the coffee break; and, at intervals, staff come by and spray the carpet between the tables with another disinfectant solution. Unlike social distancing, however, these chemical measures may be harming us in the long term, though they protect us in the short term. When US President Donald Trump made his now infamous gaffe about injecting disinfectant to cleanse the inside of the body to treat Covid-19, it seemed so preposterous and ill-informed that surely nobody would take him seriously. Alas, multiple reports detail that some people in the United States did just that, drinking hand sanitiser, bleach and household disinfectant products, which resulted in multi-organ damage, blindness and, in a few cases, death. This is an extreme scenario, but it highlights the insidious damage that disinfectants can cause to the human body. While we may not be guzzling Lysol along with our coffee, the simultaneous layering of different germicidal chemicals is also not good for our health: the chemicals which are secondarily ingested from the fine mists lingering in the air and which wipe out the very environmental bacteria that prime our immune systems to develop antibodies against common but potentially deadly opportunistic pathogens. The next pandemic might come from a factory farm. Is the world prepared? Even before Covid-19, antimicrobial resistance (AMR) was one of the major topics on the international health agenda. The threat of our obsession with germ removal was considered so great that a special report, commissioned by the British government and conducted by economist Jim O’Neill in 2016, predicted that AMR could result in 10 million deaths per year by 2050 and cost the global economy up to US$100 trillion. The dangers of germophobia urgently needed to be addressed and preparedness plans discussed, as if for an impending pandemic. How things have dramatically changed in the space of these past eight months; disinfectant manufacturers cannot keep up with demand and share prices for Clorox and Reckitt Benckiser, the company that owns Lysol, are blowing through the roof. Hand sanitiser was akin to gold in Hong Kong in January, shops were out of stock and impromptu street sales out of cardboard boxes were mobbed by eager and anxious punters, whatever formulation was on offer. Germs are out and sanitation is in. So are we inadvertently sleepwalking into a new public health nightmare, tumbling down a path to life-threatening antimicrobial resistance against an ever-dwindling arsenal of efficacious remedies? At the same time, are we harming our internal health through the passive ingestion of a concoction of sanitising chemicals? Hand sanitisers, for example, typically contain ethanol or isopropyl alcohol as active agents, yet some products have been found to contain hazardous methanol. Even topical application of such products removes the good bacteria that protect our skin against regular attacks by environmental microbes. Moreover, many of the products in circulation are labelled as antibacterial rather than antiviral. Various antibiotics, traditional medicines and non-specific drugs are also being self-prescribed as the lay public grapple with often complex and conflicting medical, scientific and government advice. And where are all the excess disinfecting chemicals ending up? Washed into the environment, where they may cause lasting harm to fragile ecosystems. While this is no Silent Spring-like plea to abandon all disinfectants and germicides at this precarious time, we should all be aware of the potential impact that their abuse might have on future health. The propensity to act first and deal with the consequences later is permeating all levels of society, as the immediacy of the pandemic takes precedence. Even the World Health Organisation, historically a strong advocate of AMR readiness, has been liberally advising on environmental decontamination practices while keeping quiet about the far-reaching perils of disinfectant overuse. Of course, this is a reactive moment in time, in the midst of the worst pandemic in a century, but the mandated frenzy of hygiene that has resulted is an overextension of decades of basic public health advice that may well backfire and leave us more vulnerable than ever to the microbial world. Ria Sinha is a Senior Research Fellow at the Centre for the Humanities and Medicine at the University of Hong Kong