Fear the 'toilet plume'? Why experts say flushing in a public restroom may not pose a 'major risk' for COVID-19

The toilet flag was not definitely associated with an illness. However, a new study shows that flushing a toilet in a public toilet can increase the risk of being exposed to aerosol particles containing SARS-CoV-2. (KENA BETANCUR / AFP via Getty Images)
As if going out in public is not fearful enough for many people these days, a new study shows that flushing a toilet in a public toilet can increase the risk of exposure to aerosolized particles that contain the SARS-CoV-2 virus that causes COVID-19.
The study, published on Tuesday in the journal Physics of Fluids, performed several simulations to determine how far aerosolized particles can spray after a flush. The study shows how water that flows into a toilet bowl during flushing displaces air in the bowl and creates a vortex that moves upward. The power of the flush pushes out around 6,000 small liquid droplets, which were in the toilet bowl, together with aerosolized particles.
Different flushing methods can move 40 to 60 percent of the particles across the toilet seat and sometimes spray them up to three feet high.
The concept that particles shoot into the air after flushing is not new - it is a phenomenon known as the "toilet flag". However, as the study authors point out, it is the age of COVID-19.
Video: is it safe to use a public toilet during the pandemic?
Research has shown that SARS-CoV-2 can attach to receptors in your gut where it can cause symptoms such as diarrhea and vomiting. SARS-CoV-2 has also been detected in toilet bowls and sinks in rooms where COVID-19 patients have been isolated. So if someone had COVID-19 and went to the bathroom in front of you, there is a theoretical possibility that particles from the feces or urine will be pushed up into the air by the cloud.
It remains to be determined whether you can actually become infected with COVID-19 in this way. However, there is some important information about the toilet flag and your COVID-19 risk.
What is a toilet flag?
A toilet cloud is what happens when the power of a toilet flush sprays tiny particles into the air, says Dr. Amesh A. Adalja, senior scientist at the Johns Hopkins Center for Health Security, told Yahoo Life. These particles can contain urine, feces and everything else in the toilet bowl - including germs and bacteria - in the air. "Whatever could be in the bowl can dissipate," says Adalja.
The toilet flag was not definitely associated with an illness. "We don't know that toilet flags were the source of another infection," William Schaffner, an infectious disease specialist and professor at Vanderbilt University's medical school, told Yahoo Life. "It is theoretical."
Can you get COVID-19 from a toilet flag?
It is possible, says Dr. Adalja, but he's not overly concerned. "I don't think it's a big risk," he says.
When someone flushes the toilet and shoots aerosolized particles into the air, they usually fall to the ground or surrounding surfaces pretty quickly, says Schaffner. "Of course there are situations in which you enter a public toilet shortly after someone leaves, but for the most part you usually go into a stall after it has been empty for a while," he says. "Even if you use a bathroom after someone leaves, I think the risk is very low."
Also remember that when you flush the toilet, you expose yourself to your own toilet flag, says Adalja. Technically, there might still be bacteria and viruses in the bowl from the person who used the toilet in front of you, but "I wouldn't worry much about that," he says. Particles from the toilet plume can land on surfaces with normal contact. However, if you wash your hands well after using the toilet, it shouldn't be a problem, he says.
Adalja says that the stable partition walls should provide protection. "It would have to be a pretty powerful cloud to climb over a partition and then descend on you," he says.
While SARS-CoV-2 was detected in the faeces, according to Schaffner, it is currently unclear whether the virus actually lives in the faeces. And if it doesn't live, it can't infect you.
Can you do something to lower your risk?
If you are particularly concerned about this, Adalja recommends lowering the toilet seat cover before rinsing, if available. You can also try to use a booth that was previously empty, rather than entering one immediately after leaving a booth, says Schaffner.
Here too, washing your hands is crucial. For more extreme measures, like holding your breath while purging, Adalja says that this really isn't necessary. "We don't need people to faint in the bathroom," he says.
For the latest corona virus news and updates, go to https://news.yahoo.com/coronavirus. Experts say people over the age of 60 and those with weakened immune systems remain the most at risk. If you have any questions, please read the CDC and WHO resource guides.
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