Why You Should Still Be Washing Your Hands in 2023 — Just Not for COVID

Online handwashing tutorials. Hand sanitizer hoarding. And in every public bathroom, signage urging you to wash your hands to slow the spread of the coronavirus.

It may be hard to believe now — after over three years of passionate conversations about masking — but when the COVID pandemic first hit in 2020, vigilant hand hygiene was positioned alongside social distancing as a key measure in the fight to slow the spread of SARS-CoV-2 around the country. And while it’s true that conversations about hand hygiene haven’t entirely vanished — just look at the laminated 2020-era handwashing posters you’ll still see in many public bathrooms around the Bay Area — “wash your hands” has undoubtedly receded as a core public health message at this point in the pandemic, in favor of masking, vaccination and booster shots.

But as we continue into Year Four of the COVID pandemic, should handwashing be something we keep in mind for our daily health?

The short answer is: absolutely — but it’s no longer really about COVID. Keep reading for the science behind those 2020 recommendations, the kinds of illnesses that handwashing can help protect you against and how useful hand sanitizer really is.

Why was handwashing such a big thing when the pandemic first hit?

To understand why hand hygiene was so emphasized in the first weeks of the pandemic, it’s crucial to understand just how little was initially known about the coronavirus, says Dr. John Swartzberg, clinical professor emeritus of the Infectious Diseases and Vaccinology division at UC Berkeley.

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“In March of 2020, we didn’t really know much about how this brand-new virus was transmitted,” said Swartzberg. “And we assumed that it was transmitted like other respiratory viruses, probably just by droplets, maybe by air, but probably just droplets.”

In the absence of initial research, the medical community “said the basic things about transmission of respiratory viruses,” said Swartzberg. “Many of them were transmitted by inanimate objects, what we call fomites. And so, therefore, handwashing would be very important.”

“We didn’t know that in terms of any science to support that. Just like we didn’t know that SARS-CoV-2 is primarily transmitted as an airborne virus, but also can be droplets,” said Swartzberg.

Another reason handwashing was so initially emphasized, says Swartzberg, was based on the earliest research on the coronavirus and fomites — that is, those surfaces and objects that could carry the virus.

He notes that early research in spring 2020 indicated that SARS-CoV-2 could survive anywhere from a few hours to as much as 36 hours on a surface — “and so because of that, the assumption was, ‘Well, if it can survive on fomites for hours to days, then therefore we ought to make sure that we wash our hands frequently because we could get a viable virus on our hands.’”

But all of this begs the next question …

Of course, as Swartzberg notes, “an absence of evidence doesn’t mean there’s evidence of absence” — meaning, there is no evidence that surface transmission hasn’t been the way some people have gotten COVID over the last three years. This is echoed by UCSF infectious disease specialist Dr. Peter Chin-Hong, who notes that someone with a job that raises their chances of COVID exposure through surfaces — say, a teacher in close quarters with coughing kindergartners — might still have a higher chance of COVID infection from fomites than the average person represented in studies.

The fact remains: If you want to protect yourself against COVID, focus more on getting your primary vaccination series if you haven’t already, getting a bivalent booster and wearing a well-fitted N95 mask in poorly ventilated or crowded spaces, especially during a COVID surge in your region. But just because handwashing wasn’t the key to stopping the spread of COVID doesn’t mean it can’t help fight the causes of many other nasty illnesses.

Which leads us to …

What viruses does handwashing help fight?

Handwashing has been “revered” for many years in the health care field, said Chin-Hong, “because there’s so much ample evidence showing that it not just prevents infections, but it actually saves lives in hospitalized patients” when health care workers practice good hand hygiene to reduce the risks of infection.

“COVID is not the only game in town anymore,” said Chin-Hong. “I think washing your hands should have a big comeback, because we have a big diversity of things that affect people now” when it comes to infections. Ultimately, “washing hands will save you a lot of grief,” he said.

So what viruses, bacteria and illnesses can handwashing protect you from?

The rhinovirus — the most common cause of the common cold — is one of those viruses that’s “transmitted easily by inanimate objects,” said Swartzberg, referring to when you touch a fomite and then touch your face. (Something you might not expect: As for the flu, Swartzberg says the jury’s still out: Even though scientists have known about the influenza virus for almost a century, “there is still a debate as to whether handwashing makes a difference with that virus,” he said.)

The common cold aside, your risks of even more unpleasant illnesses can be raised by you neglecting to wash your hands — and very unpleasant gastrointestinal infections are ripe for transmission through unwashed hands. Cases of norovirus — a highly contagious virus that causes nausea, vomiting and diarrhea — surged in February within the Bay Area, and as recently as late March, California health officials have warned of “elevated norovirus activity” around the state. The bacterial infections shigella and salmonella, which both are also characterized by diarrhea as well as stomach pain and fever, are often transmitted from surfaces via unwashed hands.

So when should I be washing my hands?

In a public bathroom, for starters.

That’s because if someone has an enteric infection — that is, a bacterial sickness that’s entered their gut — they’re likely to be in the bathroom more often, explained Swartzberg, saying “and so bathrooms are likely places where you’re more likely to find enteric pathogens.”

A good rule of thumb when you’re out in public, advises Swartzberg, is to ask, have a lot of other hands been where my hands are right now? If so, it’s probably a good idea to wash your hands. Think: straps on BART, poles on Muni, frequently handled items in the grocery store. But “if you’re touching something that’s rarely touched by somebody else, it makes it less, far less important” to run to wash your hands straightaway, said Swartzberg.

That said, Swartzberg doesn’t want his advice to prompt people to take their hand hygiene too far. “While cleanliness is always a good, reasonable thing to strive for, obsessiveness with cleanliness is probably not only unnecessary, but perhaps not a good idea,” he advised.

What’s the best way to wash my hands?

It’s especially important to wash your hands before and after preparing or eating food, using the bathroom or touching garbage.

To wash your hands effectively, lather them with soap and running water, and scrub for at least 20 seconds. The lathering action of handwashing is so you create friction on your hands, which helps lift dirt and microbes off your skin. Try your best to dry your hands afterward, because germs have an easier time being transferred to and from wet hands.

Do you need to use antibacterial soap? No: The CDC says that studies indicate there’s “no added health benefit for consumers” for using antibacterial soap over regular soap if you’re not a health care professional. So go ahead and just use plain soap, which the CDC says is enough to achieve the end goal of handwashing: lifting dirt and microbes from your skin and washing them off your hands. Read the CDC’s guide to effectively washing your hands, and the science behind the agency’s handwashing recommendations.

For his part, Swartzberg says he thinks antibacterial soaps shouldn’t even be on the market, saying there’s a “strong argument against them” not just because of the potential for contributing to microbial resistance, but because “some of these products may have toxicities.”

Finally: What about hand sanitizer?

Of all the many now-bizarre memories from the early stages of the COVID outbreak, the hoarding and price gouging around hand sanitizer — a type of antiseptic that can help kill pathogens on your hands — might be one of the most indelible.

The placement of sanitizer dispensers and pumps in places you wouldn’t previously have seen them is one of the lasting effects of the COVID pandemic. But in 2023, should using hand sanitizer still play a role in our daily lives?

Absolutely, says Swartzberg, who notes that these hand sanitizers “play an important role in limiting the transmission of some pathogenic microorganisms.” Washing your hands well for at least 20 seconds with soap is best, but that’s “not always practical,” said Swartzberg, adding, “As long as your hands are free of visible dirt, hand sanitizers will kill many of the microorganisms that can make us sick.”

That said, Swartzberg noted, hand sanitizers “don’t do a very good job killing norovirus.” This is one of the reasons the CDC suggests you should use “an alcohol-based hand sanitizer that contains at least 60% alcohol” when you can’t wash your hands, but not as an alternative to handwashing if both options are available.

So, as useful as hand sanitizer can be in certain scenarios — for example, after using a park bathroom with no running water — be aware that it can’t protect you against every bug out there, and that washing your hands is always your safest bet.

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