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Do you really need hand sanitizer?

GOJO Industries Inc. has a problem that most companies can only dream about: the Akron, Ohio-based inventor of Purell hand sanitizer can't keep up with demand. You can guess why.

Not everyone agrees that hand sanitizers are the best choice — and some health experts argue that hand sanitizers not only offer little protection from swine flu, they are wasteful.

Health Sciences graduates pass a bottle of hand sanitizer during Northeastern University's commencement ceremony in Boston in May 2009. ((Associated Press))
GOJO Industries Inc. has a problem that most companies can only dream about: the Akron, Ohio-based inventor of Purell hand sanitizer can't keep up with demand. You can guess why. 

Since March, when the first swine flu cases appeared in Mexico, public health agencies around the world have revved up the message that washing your hands is one of the best ways to protect yourself. And if you can't get to a sink, they say, using alcohol-based hand sanitizers is the next-best thing. 

But is it all an illusion? Not everyone agrees that hand sanitizers are the best choice — and some health experts argue that hand sanitizers not only offer little protection from swine flu, they are wasteful. 

"If they make people feel better, that's okay with me, but I think it's a waste of time and money," Dr. Arthur Reingold, an infectious disease specialist who has advised on vaccine policy for the World Health Organization, said in an interview with cbcnews.ca

Swine flu has been a boon for companies like GOJO that make alcohol-based hand sanitizer. New York-based market research firm Panjiva recently estimated that three million kilograms of hand sanitizer were shipped globally in the third quarter, three times more than the same quarter last year. 

Students sit near a hand sanitizer dispenser at Simon Fraser University in Surrey, B.C. The dispensers have been placed throughout the school to help combat the spread of the H1N1 flu virus. ((Darryl Dyck/Canadian Press))
Purell stations are often the first thing to greet you in government offices and institutions. Little bottles can be found in most office cubicles. In October, every municipal civil servant in Toronto was given a bottle, and school boards are ordering extra supplies. 

While health officials universally agree that handwashing is a good thing against many bugs, they don't all agree that it will protect you from every bug, including the flu virus. 

Masks 'really effective' 

Reingold's big fear is that people will think they're protected from swine flu simply by applying hand sanitizer. 

"What worries me, in the determination to tell people what they can do to protect themselves, people pooh-pooh things like masks, which really are effective against influenza, and are reluctant to get vaccinated," said Reingold, who is also a medical doctor and head of epidemiology at the School of Public Health, University of California, Berkeley. 

"Studies done 40 and 50 years ago pretty much show it's impossible to get influenza through hand-to-hand contact," said Reingold. 

Washing your hands with soap and water is the best way to rid your hands of nasty viruses that cause the common cold and diarrhea, he says. But by his estimation you could sanitize your hands "hundreds" of times and it won't protect you against the flu. 

Reingold described this scenario. A person infected with H1N1 coughs into his hand, then shakes your hands. You then rub your nose or eye.  

Will you get swine flu? He doesn't think so. 

To catch the flu, you must breathe the virus into your lungs. If the virus ends up in your nose or your eye, the concentration needs to be much higher to infect you — a concentration that would be impossible to pick up by swiping your hand over a contaminated surface, he said. 

And for that reason, Reingold says hand sanitizers don't protect people from the flu. 

Never far from sanitizer 

Dr. Bonnie Henry, director of Public Health Emergency Management at the B.C. Centre for Disease Control, and author of the book Soap and Water & Common Sense, says she's never far from a bottle of hand sanitizer. 

"I feel like I can't eat anything without putting it on. It's like a seatbelt," Henry told cbcnews.ca, adding, "I'm not obsessive about it." 

Kindergartners are given hand sanitizer before going to lunch at a summer school program in Brookhaven Elementary School in Rockville, Md. ((Associated Press))
The French Catholic School Board for Southern Ontario just placed its second order for Purell late in October, and they consider themselves lucky that supplies were even available, said board spokesperson Mikale Joly. 

Last April, when news of swine flu first broke, the board put in an order at a cost of about $15,000, and it only arrived at the end of the school year, too late to do any good for its 13,300 students before the summer holiday. 

When supplies started getting low last month, they called their supplier for more. 

"We were lucky — I think we had a window of availability," said Joly. 

Health experts who believe people can be infected through hand-to-hand contact argue, why take the chance? And when you're not near a sink, why not use hand sanitizer?  

One of Canada's best-known public health experts, Dr. Donald Low, advised parents during a CBC TV interview to carry a bottle of hand sanitizer when taking their kids out for Halloween and apply it on their kids' hands periodically between trick-or-treating.  

Dr. Bonnie Henry agrees with Reingold that the principal way to get swine flu is through the lungs, but she says animal studies have shown the virus can infect you through your nose and throat, even through your tear ducts.

Flu fears drive profits

"I think it's one of those things we can do that will make a difference," Henry says of hand sanitizers. 

Sgt. Alain LeBlanc of the RCMP provides hand sanitizer to attendees of a news conference about the confirmed cases of Influenza A (H1N1) at the training depot on Friday, June 12, 2009 in Regina, Sask. ((Troy Fleece/Canadian Press))
In the absence of agreement among experts, hand-sanitizer sales are soaring. And while no one has alleged that companies selling disinfectant products are exploiting the public's fear, those companies are producing significant profits.  

Clorox Co. has directly credited swine flu fear for driving up sales of its Lysol disinfectant wipes. It reported earnings were up 23 per cent in the last quarter. 

Other companies, such as Minnesota-based EcoLab Inc., and Ohio-based Steris Corp., have predicted sales of their alcohol-based hand sanitizer will double or even triple within the year. 

"This is about the power of commerce," said Nancy Tomes, professor and chair of the history department at Stony Brook University on Long Island of New York. "It's being pushed by a lot of companies that make money on every bottle of sanitizer. You're a communist if you don't support the use of hand sanitizer." 

Tomes, who wrote the 1998 book The Gospel of Germs, doesn't use hand sanitizer. She believes a strong immune system is the best bet, and for her that means eating healthily and getting lots of sleep. 

"What I see as most annoying is the message that there's something magical about hand sanitizer," Tomes told cbcnews.ca. "This is not a public health issue. It's a mental health issue." 

Mental salve or not, companies will make it as long as people want to buy it. And right now there are plenty of willing buyers. 

Jacalyn Duffin, the Hannah professor of the history of medicine at Queen's University in Kingston, Ont., has even postulated that hand sanitizing become permanent, where people "anoint" themselves with it before social interactions. 

"It might become ritualized," said Duffin, who began wondering about the permanency of the trend after seeing friends apply hand sanitizer automatically. 

In mid-October, GOJO, which manufactures Purell for hospitals, schools and institutions, issued a statement, warning against hoarding. Johnson & Johnson, which distributes Purell under licence for the retail market, reported there could be regional shortages. 

"There is absolutely no need to stockpile product," Mark Lerner, GOJO's chief operating officer, said in a prepared statement in mid-October. "In fact, stockpiling could cause an actual shortage which, in turn, could threaten public health."