How toilet lids and sunglasses can cut the spread of COVID-19 at home
An expert report submitted for use by the UK government recommends that people wear glasses or even sunglasses whenever they must be within two meters of a household member suspected of carrying COVID-19.
Presented to the government's advisory Scientific Advisory Group for Emergencies (SAGE) committee last week, the report also recommends a raft of other marginal-gain activities including closing the toilet lid before flushing.
Co-authored by three expert sub-committees, the paper suggests or reiterates several ways in which the risks of spread can be reduced. While the report notes that "The risks from transmission within households are likely to be elevated for the new variant (B1.1.7) due to its increased transmissibility," it insists that "transmission from a case to others within a household is not inevitable."
But what are the suggestions to avoid transmission? In each scenario, they are split into three sections: physical, procedural and personal.
Pre-emptive – for all households
Even without suspected cases, all households can benefit from cutting the three main routes of transmission – close-range, airborne, and surface contact. Routine measures include:
PHYSICAL
• Ensure regular ventilation of common areas, especially after having visitors
• Open windows and/or use extractor fans before, during and for a short while after any visit
• Keep visits as short as practically possible
• Maintain physical distancing from visitors
• Shared bedrooms can be a risk, so keep a window open slightly at night if possible
• However, maintain comfortable temperatures and indoor humidity.
PROCEDURAL
• Close toilet seat lids before flushing to minimize any contamination by faecal aerosols
• Limit use of sharing surfaces or objects (such as towels) wherever possible
• Frequent cleaning of shared surfaces, especially in bathrooms and after visitors
• However, beware excessive cleaning causing exposure to chemicals: maintain good ventilation during cleaning activities
• Ensure good ventilation during activities such as high energy exercise in shared indoor spaces
• Pay particular attention to good hygiene during food preparation, ensuring cutlery and crockery are washed thoroughly.
PERSONAL
• Wash hands, using soap and water, regularly – and immediately upon returning home is good practice.
• Safely dispose of tissues and immediately wash hands
• Suggest face coverings are worn during visits.
If someone is vulnerable or self-isolating
If a member of the household is particularly vulnerable to COVID-19 and is self-isolating, the report notes that "Sleeping in the same bedroom and dining together have also been identified as risk factors."
Because of this, "a person who is a suspected case, wherever possible, should stay fully apart from other members of the household, remaining within a dedicated room. Ideally, they should not share a bedroom, bathroom or toilet with others, nor should they eat alongside other members of the household."
The report includes a graphic from GermDefence, a multilingual online 10-minute questionnaire prepared by the Universities of Southampton, Bath and Bristol. The graphic includes the suggestion to "wear a clean face-covering and glasses or sunglasses" if you need to be within two meters of a suspected case.
GermDefence includes plenty of advice, noting that it can take up to 72 hours for the coronavirus to completely die on hard surfaces such as cardboard, plastic or metal. Therefore, "If you are receiving a delivery, can you put things in a spare cupboard for three days before you use them?"
The report submitted to SAGE again splits advice into physical, procedural and personal sections for households with someone vulnerable or self-isolating – adding the following to the measures suggested for all households:
PHYSICAL
• Increase ventilation, especially in areas where a vulnerable person has to interact with anyone else
• Consider strategies to maintain or increase distance – including rearranging furniture in shared areas, and the vulnerable person sleeping in a separate room if possible.
PROCEDURAL
• Pay greater attention to cleaning, especially high touch surfaces
• Identify strategies to limit the use of shared objects such as towels, cutlery and crockery.
PERSONAL
• Pay greater attention to maintaining good respiratory and hand hygiene
• Strongly encourage any visitors to wear face coverings.
If someone is a suspected case or quarantining
Moving up the danger scale to households in which there is a "contact" with a suspected case of COVID-19, the report's suggestions get correspondingly stronger – ruling out not just all non-critical visits, but also singing in shared areas.
PHYSICAL
• Consider further adaptions, including restricting the contact to different rooms whenever possible
• Ensure rooms where the contact spends time are well ventilated, especially if they must be shared with others
• Do not allow any visitors unless for critical healthcare or emergency reasons.
PROCEDURAL
• Avoid aerosol-generating activities, such as singing or high-energy exercise, within shared rooms
• Pay more attention to limiting the use of shared surfaces and objects: where possible, contacts should use a different bathroom; if not possible, they should always clean the bathroom after use
• Contacts should avoid preparing food themselves; if this is unavoidable, they should use kitchen facilities at a different time and clean afterwards
• Where possible the contact should eat separately from the rest of the household, ideally within the room where they are quarantining
• Wash clothes, towels and bedding more regularly, especially those used by the contact
• Ensure enhanced hand hygiene for all household members.
PERSONAL
• Wear face coverings during interaction with the contact
• Wash face covering regularly, or dispose of them properly.
If someone is a confirmed case
Obviously, the highest risk comes when someone is confirmed with COVID-19. At this point, the enhanced suggestions include hot-wash laundry, increased cleaning and widespread use of face coverings.
PHYSICAL
• Confine the infected person to a different room as far as possible, with their window open and door closed
• Maintain greater distancing between all other household members in case others are infected
• Maintain good ventilation in all rooms where people spend time.
PROCEDURAL
• Restrict all use of shared objects as far as possible between all household members
• Increase and maintain the standards of cleaning throughout the whole house – assume that any member could be infected
• Ensure enhanced hand hygiene for all household members
• Wash clothes, towels and bedding for all household members more regularly, with those from the infected person on a hot wash
• If providing care to the infected person, ensure high-touch surfaces such as door handles and the items they use (e.g. cutlery/crockery) are cleaned thoroughly: hot water and soap, bleach-based and alcohol cleaners are all effective.
PERSONAL
• All adult household members should wear face coverings if they have to interact with the infected person or in proximity to each other
• All face coverings should be regularly washed or properly disposed
• After any contact with the infected person, good hand hygiene is essential
• If providing care to an infected person, use additional PPE such as gloves and eye protection – and afterwards, remove this with care and either clean or dispose of it correctly.
It remains to be seen how much of this advice becomes government-endorsed policy: the subsequent discussions among the SAGE group has not yet been made public. However, the authors hope that their suggestions could cut within-household transmission risk by a quarter, which "could lead to a prevalence of 10-15 percent lower after three weeks."