Are cleaning products that are meant to protect you from coronavirus harming your health?
Killing germs on household surfaces is nothing new. But in light of the COVID-19 pandemic, keeping all frequently-touched household surfaces germ-free is more on top-of-mind than ever.
Current evidence suggests that the virus can remain on surfaces made from a variety of materials for hours and even days. Cleaning of visibly dirty surfaces followed by disinfection is the best way to prevent COVID-19 and other viral respiratory illnesses in households and community settings, says the CDC.
However, cleaners and disinfectants may contain dangerous chemicals, warn experts. Researchers in one study warned that cleaning products are as bad for lungs as smoking about 20 cigarettes a day. The researchers initially found that level of lung impairment surprising. However, when one thinks about inhaling small particles from cleaning agents that are meant for cleaning the floor, maybe it is not so surprising after all, they say in their findings.
The team from University of Bergen in Norway found that women who work as cleaners or regularly use cleaning sprays or other cleaning products at home appear to experience a greater decline in lung function over time than women who do not clean.
"Excess risk of asthma and respiratory symptoms among professional cleaners, as well as asthma and respiratory symptoms in persons cleaning their own home has been reported in several studies. Long-term consequences of cleaning agents on respiratory health are, however, not well described," the experts state. Accordingly, the team followed 6,235 people for 20 years.
"Forced vital capacity (FVC), or the total amount of air a person can forcibly exhale, declined 4.3 ml/year faster in women who cleaned at home and 7.1 ml/year faster in women who worked as cleaners," says the study published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine. "Exposures related to cleaning activities may constitute a risk to long-term respiratory health," the study adds.
Another study found that using bleach and other disinfectants just once a week increases the risk of Chronic Obstructive Pulmonary Disease (COPD) by nearly a third. The 30-year study by Harvard University and the French National Institute of Health and Medical Research (Inserm) found that those who used the products just once a week had 32% increased chance of developing the condition. The researchers looked at incidence of the disease in over 55,000 nurses in the US.
According to the American Lung Association, many cleaning supplies or household products can irritate the eyes or throat or cause headaches and other health problems, including cancer. Some products release dangerous chemicals, including volatile organic compounds (VOCs). Other harmful ingredients include ammonia and bleach. Even natural fragrances such as citrus can react to produce dangerous pollutants indoors, says the Association.
"VOCs and other chemicals released when using cleaning supplies contribute to chronic respiratory problems, allergic reactions, and headaches. Studies are underway to assess how these chemicals affect people who have asthma and other respiratory illnesses," says the ALA. It adds, "However, past studies link exposure to chemicals from cleaning supplies to occupational asthma and other respiratory illnesses," say experts.
A common health consequence of cleaning, though a less potentially deadly one than a respiratory condition, is contact dermatitis, which occurs when products irritate the skin. “It mostly affects the hands, because these are the parts of the skin most likely to be in contact with possible causes of inflammation," says a blog.
What does the CDC recommend?
There is much to learn about the virus — SARS-CoV-2 — that causes COVID-19. Based on current evidence, the CDC says that person-to-person spread of this virus happens most frequently among close contacts (within about 6 feet). This type of transmission occurs via respiratory droplets.
“On the other hand, the transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. Transmission of coronavirus occurs much more commonly through respiratory droplets than through fomites," says the CDC.
The CDC has issued guidelines on cleaning and disinfection that are focused on household settings and are meant for the general public. It provides recommendations on the cleaning and disinfection of households where people under investigation or those with confirmed COVID-19 reside or are in self-isolation.
The experts describe cleaning as the removal of germs, dirt and impurities from surfaces. It does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection. Disinfecting refers to using chemicals, for example, EPA-registered disinfectants, to kill germs on surfaces.
People can practice routine cleaning of frequently touched surfaces — for example, tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and electronics (see below for special electronics cleaning and disinfection instructions) — with household cleaners and the US Environmental Protection Agency (EPA)-registered disinfectants that are appropriate for the surface.
The CDC says it is important to follow instructions on the labels for safe and effective use of the cleaning product including precautions when applying the product — such as wearing gloves and making sure there is good ventilation during the use of the product. "Consult the manufacturer’s instructions for cleaning and disinfection products used (concentration, application method and contact time, etc.)," it says.
The CDC advises wearing disposable gloves when cleaning and disinfecting surfaces and says gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated to cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes, say experts.
Diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can also be used if appropriate for the surface. In this case too, experts urge following the manufacturer’s instructions for application, ensuring a contact time of at least 1 minute, and allowing proper ventilation during and after application. “Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted,” it adds.
The American Lung Association also suggests reading all labels on cleaning supplies and household products before buying them. “Choose products that do not contain or have reduced amounts of VOCs, fragrances, irritants and flammable ingredients,” they say.
For electronics such as cellphones, tablets, remote controls and keyboards, the CDC suggests removing visible contamination if present. “Follow the manufacturer’s instructions for all cleaning and disinfection products. Consider use of wipeable covers for electronics. If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids,” say guidelines.
What about hand sanitizers?
Experts have recommended regularly and thoroughly washing hands with soap and water or alcohol-based hand rub to kill viruses. While there is not enough research to show that hand sanitizers definitely pose a threat, there is also no evidence that they do a better job of protecting a person from harmful bacteria than soap.
The CDC recommends washing hands with soap and water whenever possible because handwashing reduces the amounts of all types of germs and chemicals. “But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others,” says the CDC. Hand sanitizers without 60-95% alcohol may not work equally well for many types of germs, and merely reduce the growth of germs rather than kill them outright.
The agency says while alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, sanitizers do not eliminate all types of germs.
The CDC also cautions ethyl alcohol (ethanol)-based hand sanitizers are safe when used as directed, but they can cause alcohol poisoning if a person swallows more than a couple of mouthfuls. The US poison control centers received nearly 85,000 calls about hand sanitizer exposures among children between 2011 to 2015. “Children may be particularly likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children and should be used with adult supervision,” warns the CDC.
According to Dr David Coil, project scientist at the UC Davis Genome Center, hand sanitizers are complicated. "They are good at killing many things, including coronaviruses from what we know so far. However, they also don't do much against some other microbes, which is why normally handwashing is recommended as the most important protocol. Both norovirus and C. diff are pretty resistant to hand sanitizers. So they can be problematic in terms of giving a false sense of security. But again, that's not relevant here since they work against coronavirus," Dr Coil told MEA WorldWide (MEAWW).
One article quotes an expert saying that using too much hand sanitizer could remove “normal bacterial flora” that coat the skin. Another says overusing hand sanitizer kills all microorganisms, “including the harmless ones that help your immune system.” When questioned regarding the same, Dr Coil said that hand sanitizers probably disrupt the hand microbiome. “So does handwashing of course. I think it's really hard to predict what impacts that might have on health. In the context of COVID-19, any possible negative health effects from disrupting the hand microbiome would be indirect, hard to quantify, and would be irrelevant next to the far more important consideration of killing the virus,” he told MEAWW.
A blog published by Rush University Medical Center, Chicago, says that there is no proof that alcohol-based hand sanitizers and other antimicrobial products are harmful. "They could theoretically lead to antibacterial resistance. That's the reason most often used to argue against using hand sanitizers. But that hasn't been proven. In the hospital, there hasn't been any evidence of resistance to alcohol-based hand sanitizers," it says.
The article says that hand sanitizers are useful in the hospital to help prevent the transfer of viruses and bacteria from one patient to another by hospital personnel. "Beyond a hospital setting, it's very difficult to show that hand sanitizing products are useful," it says.