En español | You may be reluctant to go out to crowded areas now, especially since older adults are at increased risk of developing complications from COVID-19. But new research suggests there may be another reason to be worried: public bathrooms. A study published this past June in the journal Physics of Fluids found that the simple act of flushing can force as much as 60 percent of produced aerosols, which could be potentially infectious, high above the toilet seat (a phenomenon known as “toilet plume"). Another study published in the same journal in August found similar results with urinals —and, in fact, the tiny particles were able to rise even faster than when they were flushed from a toilet.
But whether or not these aerosols can actually infect you with COVID-19 is unknown. “The significance of the so-called ‘toilet plume’ is unclear,” says Albert C. Shaw, M.D., a Yale Medicine professor and infectious disease specialist. “Flushing the toilet does generate aerosolized particles that can contain viruses, and this raises the possibility of generating contaminated surfaces that could transmit COVID-19. But whether this is responsible for actual transmission of disease is not clear.” In addition, the novel coronavirus tends not to live that long in your intestines, adds Joshua Santarpia, an associate professor of pathology and microbiology at the University of Nebraska Medical Center. “It's difficult to extract the virus from both feces and urine,” he says.
Concerns go beyond the plume and toilet seat
There is another reason to be concerned about public bathrooms, though, says Santarpia: poor ventilation. “Add in the fact that there may be a large concentration of people in there, plus anything produced from toilet plume, and it exacerbates the situation even further,” he stresses.
In addition, there are risks from high-touch surfaces such as doorknobs and faucets, adds Charles Gerba, a professor of virology in the Department of Environmental Science at the University of Arizona. But, Shaw notes, “It's not likely that someone will be in the restroom long enough to come into contact with sufficient virus to become sick.” But there are some things you can do to make it less likely. The following seven steps will not only lessen the chance of catching COVID-19, but other bugs that you're even more likely to encounter in the bathroom, such as noroviruses and E. coli, says Gerba.
Tips to stay safe in the stall
- Go before you go. Most older adults can't go hours and hours without going to the bathroom, as bladder muscles tend to weaken with age. What's more, the older you are, the more likely you are to have issues such as urinary incontinence or prostate problems, says Rosanne Leipzig, M.D., professor and vice chair of education for the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai Hospital in New York City. If you think the answer is to hold back on fluids, don't: Older adults are particularly vulnerable to the effects of dehydration, Leipzig notes. Take all your necessary medications, too, including ones that can have diuretic effects, like blood pressure meds. What you can do? Avoid coffee and other caffeinated drinks, which can make you urinate more because they are diuretics. Also, when you go to the bathroom before you leave your house, practice double voiding: This means after you go to the bathroom, wait 20 to 30 seconds and then try again to fully empty your bladder.
- Wear a mask. Keep it on even in a seemingly empty bathroom, and wear it in the stall. It's also important to make sure the bathroom is well ventilated — you can usually tell if you hear a fan. Research shows that well-vented restroom air “moves out of the room so quickly that any aerosol droplets won't persist for very long,” Gerba explains.
- Spritz the stall before you enter. Philip Tierno, a clinical professor of microbiology and pathology at NYU Langone Health, recommends spraying the air in a stall, as well as the toilet seat, with a disinfectant that contains ethyl alcohol and dimethyl benzyl ammonium saccharinate, such as Lysol, and waiting up to a few minutes, ideally, before entering. “We know that the COVID-19 virus can remain suspending in the air as micro droplets for several hours,” he explains. “The spray will bring down the virus particulates that do remain in the air, so you're less likely to breathe them in.”
- Prepare to flush and rush. The problem of toilet plume can easily be dealt with by putting the lid down to flush, says Shaw, but public restroom lids often can't be lowered. In these cases, be prepared to exit as soon as you flush, says Tierno. Don't bother fiddling with paper toilet seat covers, either: It's not likely that they offer any additional protection. “There aren't any butt-borne diseases that I know of,” says Gerba.
- Double up with hand sanitizer. Even after you lather up and wash your hands after using the loo, Gerba suggests dabbing on some hand sanitizer as well. “It's a good extra barrier,” he says. Make sure to reapply it if you've touched any high-touch surfaces, such as doorknobs, faucets or wastebaskets, as well.
- Skip the hand dryer. A 2018 study published in Applied and Environmental Microbiology suggests that hot-air hand dryers could potentially be germ bombs, shooting out loads of viruses and bacteria from bathroom air directly onto your hands. Opt for a disposable paper towel instead, suggests Tierno.
- Don't putter around on the potty. Almost 75 percent of Americans admit to using their cell phone while on the toilet. But while you're in a public restroom, just skip it. “You really want to limit your time in the bathroom right now and just use it for what it's intended for,” says Leipzig.