Do you kiss with a dental dam?

Adjusting what you worry about
might do you do a world of good

(One of a two-part series.)

My niece is one of the most adorable kids I’ve ever met (although I admit, I’m biased). She’s very curious about the world, very sweet, and very outgoing. A few years back, she went through a phase of “But what if it does?” She would hear about an earthquake in the Ring of Fire, then get scared. When she would be told that an earthquake like that can’t happen in Toronto, she would reply, “But what if it does?” Same with hurricanes and tornadoes and similar natural disasters. She didn’t understand the concept of minuscule, or theoretical, risk. The anxiety she created for herself made me really sad for her.

I’m seeing a fair bit of that these days, but it’s coming from adults.

At the beginning of this pandemic, we were told that surfaces were a source of transmission. The solution: Clean everything. Three times. In an hour. Well, as it turns out, there’s no evidence this helps with what we now know is an airborne virus. This was to be expected — as we learn more about the virus, our practices and reactions to it are going to change.

But people everywhere are still scrubbing.

Not just are people still scrubbing, they’re attacking those who aren’t scrubbing everything incessantly. In a Facebook argument about disinfecting your groceries and packaging (I know, I know, but I couldn’t help this), one person tried showing me up with CDC guidance.

From March.

The concept of outdated seems to be lost on this guy.

The Atlantic dubbed this hygiene theater. It looks good, and people like it … but it doesn’t do much. Much, that is, besides causing a false sense of security. And redirect resources needed elsewhere. And redirect our attention from actions that could make a difference. So there’s all that.

Yes, I know. The odds of contracting the virus like this isn’t zero, so you might as well disinfect your groceries. Well, aside from the above concerns, I have one question for you:

Do you kiss with a dental dam?

This goes back to a pandemic I’m very familiar with. After all, it’s been in my community for decades. I’m talking about HIV.

We know to use condoms for safe(r) sex. For the really cautious, this even applies for oral sex. But dental dams for kissing? Even most hypochondriacs would consider that over the top.

But you can get HIV from kissing. And it has happened.

Once. Maybe.

In this case, the boyfriend kissed his girlfriend with bloody gums a lot of the times. But they also had sex, and reported condom breakage, so it’s not even clear that this is an example of transmission via kissing. Nevertheless, the risk isn’t exactly zero. So do you kiss with a dental dam, just in case?

No? That would be a waste of time? It’s virtually impossible? But what if you do get HIV from kissing?

Still, there were studies that showed the virus can survive on surfaces. What about that? Well, from the Atlantic article:

All those studies that made COVID-19 seem likely to live for days on metal and paper bags were based on unrealistically strong concentrations of the virus. As [Emanuel Goldman, a microbiology professor at Rutgers New Jersey Medical School] explained to [the article author], as many as 100 people would need to sneeze on the same area of a table to mimic some of their experimental conditions. The studies “stacked the deck to get a result that bears no resemblance to the real world,” Goldman said.

Perhaps nothing better illustrates this than a recent panic about a study in Australia. It showed that the virus can, in very controlled conditions, survive on Australian money (and, I presume, other types of currency) for up to four weeks. Scary stuff.

Except there’s this:

All the experiments were carried out in the dark, to remove the effects of ultraviolet light, as research has demonstrated direct sunlight can rapidly inactivate the virus.

Well, that kind of an important detail. I mean, most money does see the light of day during usage. So unless someone is offering you a wad of cash straight from a lab, it’s unlikely you’ll come across money that meets the criteria of the study.

Is this study worth doing? Of course. It helps our understanding of the virus. Does it mean that you must disinfect your cash bills? No. Lab conditions are generally not a good proxy for the real world.

There’s also this:

The peer-reviewed study, published on Oct. 7 in Virology Journal, involved drying the virus in an artificial mucus on different surfaces, at concentrations similar to those reported in samples from infected patients, and then re-isolating the virus over a month. (Emphasis mine)

Is it just me, or does this seem like a very high amount of the virus? Like, say, getting 100 people to sneeze on this dollar bill high? Again, while it’s important to study the virus, and I’m not questioning the study (I’m not qualified to), is it worth panicking about when you’re beginning with a situation that you’ll never come across in real life? (If you are an epidemiologist, feel free to correct me, but it seems to me that an infected person would have a much higher concentration of the virus than a random money sample, by virtue of the virus having had time to replicate to very high levels in patients.)

It is also worth noting that the study did not examine whether these polymer bills could actually infect people. After all, lab conditions and real life are two very different things. And theoretical might not translate into actual.

I’m not the only one thinking this, by the way.

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 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 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 (emphasis mine).

As for the question above, as to what the real world might look like, it turns out we might have some answers:

In a study published in September in Clinical Microbiology and Infection, researchers in Israel … 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 reported similar conclusions in The Lancet.

This post is getting long, so I’ll save the rest of it for part 2, coming in the next few days, on the topic of accepting a certain level of risk. But there is a major point to be had about theoretical risk. And it’s not to chastise anyone for behaving the way they are (within reason — anti-maskers are just messed up).

We thought surfaces were a source of transmission. Many months of this pandemic later, we know they’re not — in fact, it seems that transmission is extremely rare, if at all. So recommended practices have moved accordingly.

Everyone reading this: I know you’re afraid. I’m concerned for a whole lot of things about the future, as are you. But that’s the point. This isn’t one of those things you need to worry about, and in fact, doing this might actually lull you from more serious problems that we need to face.

You’re doing the best you can here. You’re worried about your next paycheque, or how all this will affect your children’s future, or something else entirely. So cut yourself some slack here. Don’t worry about theoretical risks when you have a whole world of realistic risks to deal with. You deserve to do well here, and you can’t do that by worrying about everything, no matter how unlikely it is to happen. And don’t be surprised if official guidance changes again, once we learn more about the virus.

Above all, take care of yourself and those you care about — and you can do more for those people when you start focusing on the actual risks. You can stop worrying about the earthquake and hurricane.

Oh, and wash your hands. Don’t be gross. And by all means, wear a mask.