COVID-19: Marketing of tunnels continues, despite criticism from WHO and scientists
The spraying of sanitisers on humans in special tunnels or booths in order to combat COVID-19 has been condemned by scientists and government as unnecessary and potentially harmful. Some manufacturers nevertheless continue to market these products, insisting they are an important part of the larger strategy to reduce the spread of the disease.
The Ampamist warehouse in the East of Johannesburg normally produces portable cooling or misting systems, but with production halted during lockdown, all attention has turned to a small shed-like tunnel that comes with big hopes and promises. As you slowly walk through, sets of nozzles on the side spray up and down at you with a thin mist visible in the air but doesn’t leave perceptible moisture on your skin or clothes.
MD for Ampamist and technical manager, Luan Dreyer, explains that the team used their knowledge in the cooling industry to design and roll out the tunnel in a matter of weeks and have supplied various industries locally and on the continent, such as in Ghana and Uganda. “We’ve only had good feedback,” he says.
In another warehouse, this time in Midrand, a different version of the same idea has a strip of artificial grass running through it, so that the bottom of shoes may also be sanitised. Bradley Leech from Hygiene Hero usually works on the rigs for shows in the entertainment industry and built the booths as a way of finding new income in the COVID-19 crisis.
An entry-level unit that could fit in a doorframe starts at around R13 000, while full tunnels with temperature monitors and hand sanitiser dispensers easily go for over R100 000. Already there are various spin-off ideas, such as spraying systems fitted into taxis and buses or tunnels that are inflatable and portable, looking much like a children’s jumping castle. Golf courses can get a custom-made larger tunnel for golf carts to drive through.
These kinds of sanitisation tunnels, sometimes called disinfection booths, hit the limelight locally during an inspection of the Gautrain by Minister of Transport Fikile Mbalula in early May. Back then, the ministry lauded the tunnels, saying they were considering rolling them out across the public transport sector.
While various industries pivoted and geared up for this possibility of addressing COVID-19 risk by installing tunnels in schools, transport hubs, and offices, sentiments soon changed. Within a month, Mbalula confirmed there would be no use of tunnels. Scientists spoke out in the media and advisories from the Ministerial Advisory Committee (MAC) and the World Health Organisation (WHO) condemned the practice.
Yet manufacturing continues.
It’s all in the liquid
The manufacturers Spotlight spoke to argue that not all tunnels are made equally. They speak out strongly against companies they say are using harmful chemicals or spraying in a way that leaves a wet residue.
“The booth itself is extremely effective in what it does, it boils down to what you put through the booth,” says Leech. He says his company considered a handful of products and found offerings including alcohol, chlorine, hydrogen peroxide, and even acetone.
Ultimately Hygiene Hero and Ampamist, decided on an organic agricultural sanitiser called Organic Fresh, created by The BioConsulting. “I make the product myself in Paarl,” says owner Pieter van der Westhuizen. “And I can assure you I know exactly what’s going in there and there are no chemicals, and that’s been inspected and proved.” He says the product has been used for years on fruit and vegetables and in cosmetics before being used in the tunnels.
Dr Francois Lategan, an agricultural innovation advancement specialist consulting with The BioConsulting, says that the compound uses the natural preventative properties of bioflavonoids, which occur naturally in plants. He describes it as a “complex that you can drink, you can inhale it, it’s beneficial for your microbes, your microbiomes on your skin, it’s beneficial for your digestive system, it’s beneficial for your immune system”. “And this is where our research has taken us.”
Lategan says that the purpose is preventative, not curative. He says that they do not claim that they can kill SARS-CoV-2 but that some ingredients in their compound can help prevent virus replication both outside and inside of the body. “The ability of the virus to lodge itself and start to replicate is destroyed.”
These tunnel manufacturers agree that their product will not change the fact that someone has COVID-19 or is contagious, but they insist that their products are reducing the overall risk and lowering the chance of cross-contamination after someone brings virus particles into a place. “You have pathogens on your body and your clothes, and the idea behind the tunnel is to lower or reduce the pathogens,” Dreyer says.
Theo Oberholtzer, a mechanical engineer with The BioConsulting emphasises that the Organic Fresh product is food-grade and non-flammable. “I can’t see government basically halting this whole thing and even breaking all of these units down if they don’t really know the engineering or even the science behind it,” Oberholtzer says.
But top scientists disagree
The companies’ hopes and claims stand in strong contrast to the views of some premier scientists locally, such as infection prevention and control specialist, Prof Shaheen Mehtar, who is a member of the MAC and of the World Health Organisation’s (WHO) COVID-19 expert group. She does not mince her words in saying that there is no place for the spraying of humans with any substance in the fight against the virus.
“This is just like a magic trick, it’s really playing on people’s fears,” says Mehtar.
Mehtar, who has worked on several past pandemics, including Ebola in Sierra Leone and cholera in Haiti, explains that the practice of spraying started when environments were disinfected to target virus-carrying mosquitoes. Spraying humans with chlorine during Ebola became common but was destructive. She says that in the early panic around COVID-19, this idea resurfaced in the hopes of an easy fix.
Spraying can be damaging, causing eye and skin problems and irritating the respiratory tract to the point that it is more susceptible to illness, Mehtar says. She also does not believe the distinction of some liquids being labelled as organic makes a difference. She says there is not enough evidence that spraying any product on humans is safe.
Mehtar also argues that the method is simply not necessary, nor is it fulfilling an important purpose. She disagrees that cross-contamination from clothes is a primary concern, since the virus may dry in the sun or through air currents. Mehtar also challenges the idea that spraying will remove contaminants. For disinfection to be effective a surface must first be cleaned with soap or a detergent, to remove organic matter such as dirt. “When you have a tunnel, you can’t clean the person because they’re wearing clothes,” she says.
The WHO’s interim guidance from mid-May discourages the regular use of spraying or fogging disinfectants even on surfaces. It cites damaging health effects of some chemicals as well as there not being enough contact time for pathogens to be inactivated.
“Spraying individuals with disinfectants (such as in a tunnel, cabinet, or chamber) is not recommended under any circumstances,” says the WHO. “This could be physically and psychologically harmful and would not reduce an infected person’s ability to spread the virus through droplets or contact.”
Peta de Jager is a research group leader focusing on healthcare facility design at the Council for Scientific and Industrial Research (CSIR). She says they have tried to look at fogging tunnels as an application, but that she hasn’t been able to find sufficiently satisfying requirements for safety and efficacy. She doesn’t know of a substance that would sufficiently sanitise through a tunnel without being harmful. She emphasises that “you can’t sanitise a person who is ill anyway, they are constantly producing particles”.
“We’re all looking for that silver bullet and if I’m wrong, that would be the best news ever,” says De Jager. She says that the scientific community is not closed-minded or trying to stop business with their recommendations, but is hesitant if safety and efficacy haven’t been fully proven. De Jager says the tunnels may offer a certain reassurance because they look systematic and like something is being done to reduce risk, but that this is not enough.
Ndeke Musee, from the Department of Chemical Engineering at the University of Pretoria, says he is concerned about the limited information about what chemicals are in some tunnel systems, particularly the long-term effects on both people and the environment. “There is no compelling scientific evidence that has been given that these sanitisers and disinfectants are benign,” he says. He also points out that it will be difficult for a layperson to know the difference between what is being used in booths and what is safe.
Instead of tunnels, the scientists agree that the often-stated measures of regular cleaning and disinfection, hand and mask hygiene and social distancing suffice. “Get the basics right, don’t panic too much, but you can’t disinfect people,” de Jager argues.
Is this being regulated?
While the advice from the WHO and government is clear, manufacturing nevertheless continues in South Africa. The question thus comes down not only to whether the booths should be used, but whether its use should be regulated, and if so, by who. There are a variety of industry bodies, private laboratories and regulatory agencies that could potentially play a regulatory role in this area, but establishing which entity is responsible is not straight forward.
The Bioconsulting, Ampamist and Hygiene Hero say they have all attempted some form of accreditation and say they would like clear specifications in place. Some also believe their products are not subject to regulation. “There’s absolutely no regulatory environment if you do not use any chemicals on people,” says Lategan, referring to the claim that their product isn’t chemical.
University of KwaZulu-Natal’s senior lecturer in Pharmaceutical Sciences, Andy Gray, is among those believing regulation is necessary. “As far as I can see this should fall under the Foodstuffs, Cosmetics and Disinfectants Act and therefore be regulated by the national Department of Health.”
Spokesperson for the department, Popo Maja, however, says that this is not the case. According to him, “any product that has a medicinal value is regulated by SAHPRA (the South African Health Products Regulatory Authority)”.
Senior Manager of medical devices and radiation control at SAHPRA, Dr Andrea Keyter, says that the body regulates medicines and medical devices, depending on the intended use. “As such the improper use of disinfectants, sanitisers, antiseptics and germicides would be investigated by SAHPRA,” she says. “And where relevant corrective action will be taken in line with the provisions of the Medicines and Related Substances Act.”
“Even if the spray is a so-called organic sanitiser, the practice is not recommended and should be reported to SAHPRA,” she says. According to her, the Regulatory Compliance Unit of SAHPRA will then investigate such reports and enforce the Act which describe offences and provides for various penalties including fines and medicines being forfeited.
Keyter explains that the practice is not recommended because of the possible physical and psychological harm, but points out that there could be an even bigger adverse effect. “It is also important to note that the spraying of any fluid in a tunnel, or chamber or cabinet would facilitate the mobilisation of the virus as the virus is dispersed and mobilised on these particles,” she says.
Gray points out such products may also be brought to standards regulators.
“There are currently no chemicals that are considered safe for use for disinfection via spray booths or tunnels,” the South African Bureau of Standards (SABS) states. According to the SABS, no national standards have been developed or tests conducted for tunnels or the chemicals used in them. The SABS supports the calls against such spraying.
Yet, despite the comments from SABS and SAHPRA, it remains unclear what the long-term prospect is for sanitisation tunnels. For now, these tunnels continue to be marketed in South Africa.