What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

• Published in: The Science of the total environment Vol. 792; p. 148341
• Main Authors: Dancer, Stephanie J., Li, Yuguo, Hart, Alwyn, Tang, Julian W., Jones, Davey L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 20.10.2021
• Subjects: Aerosol transmission; Aerosols; airborne transmission; Bathroom Equipment; breathing; Communal washroom; COVID-19; environment; fomites; food retailing; Humans; Public health risk; public transportation; risk; risk assessment; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Toilet Facilities; COVID-19; SARS-CoV-2; Aerosol transmission; Communal washroom; Public health risk
• ISSN: 0048-9697; 1879-1026; 1879-1026
• DOI: 10.1016/j.scitotenv.2021.148341

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management. [Display omitted] •Public toilets may act as a contact hub point for SARS-CoV-2 transmission.•All accepted transmission mechanisms for SARS-CoV-2 co-exist in a public toilet.•Faecal and urinary derived aerosols contain viable SARS-CoV-2 virus.•Issues over space, ventilation, frequency of use, cleaning and maintenance compound the transmission risk.•Actions to prevent COVID-19 infection are offered in lieu of supportive scientific evidence.