Dr. Jay Walshon is a longtime Westporter. He spent 35 years as a chairman and director of emergency medicine; is a past director of EMS for South Central Connecticut, and the EMS advisory board; a 3-term president of the Connecticut College of Emergency Physicians, and recipient of the 2016 Phil Stent Achievement Award in Emergency Medicine.
On May 7, he spoke at a Parks & Recreation Commission meeting of his concerns about using portable toilets at recreational facilities. He shared those concerns in a letter to town officials. Dr. Walshon says:
It was recently announced that the new bathroom facilities at South Beach will remain closed owing to virus related concerns. This seems prudent, as those permanent restrooms are significantly more difficult to keep safe from spreading contagion. In addition, I support the cautious reopening public spaces for resident enjoyment.
Bathroom facilities at Compo Beach will be closed … (Photo/Matt Murray)
However, as a medical professional I must respectfully point out that the choice to rely upon portable toilets at the beach potentially presents serious unnecessary and unjustifiable risks to public safety.
The premise that portable toilets are safe is not one which survives scrutiny when a highly contagious organism like COVID-19 is involved.
Current CT statistics indicate that 99% of Westport residents remain vulnerable to COVID-19.
We know there is significant community spread by pre-symptomatic viral shed for 2-3 days – including in diarrhea – and those devoid of classic signs or symptoms of COVID-19.
Given that between 25 and 50% of COVID-19 infectious people might not be aware they are spreading the virus, 2,000 beachgoers from Fairfield County will likely include people who pose unsuspecting risk. Odds are that some who are contagious will utilize these enclosed spaces. We will not know who or how many.
Viral particles can be found in the air for up to 3 hours, and droplets survive on hard surfaces for 3 to 4 days, rendering poorly ventilated confined public spaces such as portable toilets dangerous to unsuspecting users.
Despite seasonality, UV light and humidity effects, COVID-19 transmission will not be aborted and may not even significantly diminish. Current mitigation is grounded in assuming everyone may be contagious.
… and be replaced by portable toilets. (Not this many — it’s a fireworks file photo!)
Using a toilet facility after someone who unwittingly aerosolized viral particles by coughing, sneezing, spitting, diarrhea, flushing, etc. can result in infection via inhaling micro-droplets or touching contaminated surfaces. While flushing does not occur, their poorly ventilated confined spaces can increase air and surface contamination. Outdoor spaces may provide elements mitigating viral spread, but port-a-potties provide environments that are the antithesis.
While I understand the these potties will be subject to “a stringent cleaning and sanitization protocol” by maintenance staff, to be reliably effective, disinfection needs to be performed between users by trained personnel wearing proper protective garments – a challenging and arduous task for our Parks staff in summer heat, and exposing them to undue risk.
These toilets will create queues of people who must maintain social distancing and wear face coverings within to optimally mitigate contamination, and they will encourage longer stays and larger gatherings – something we might wish to avoid at this juncture.
Compounding the risk is absence of hand washing stations. Residents will be unable to effectively cleanse as “sanitizer” is merely an adjunct to proper hand washing technique with soap and water.
The inconvenient truth is that for reopening public spaces where gatherings are inevitable, public toilet facilities are not safe spaces at this time.
Unless our residents can be assured otherwise, from an epidemiological perspective the port-a-potties represent an unnecessary and unjustifiable health risk to individual and community health. If effective mitigation against viral spread is the healthcare priority for Westport, providing portable toilets to the public during this early reopening phase may be inadvisable.
Notwithstanding the amazing notion that the famous 1.1 million dollar toilets have been padlocked owing to what I understand is an inability to keep them properly sanitized, I have to admit Dr. Walshon makes a lot of sense. Anyone from Parks & Rec. care to weigh in on the decision to use portable toilets at the beach?
Give it up, Morley.
What shall I give up; critical thinking or asking questions?
It’s nearly 5:00 pm so I guess I could easily go with either one.
Then are we better off with the existing facilities where there is at least a supply of hot water and soap- or is the answer no facilities at all,,- which will keep the load on the beach down.
Naples FL beaches re-opened yday after a forced closing earlier in the week, without any facilites being open.
Adrian,
The short answer to your question is that unless they can be reliably and effectively disinfected, during highly contagious events such as COVID-19 public restrooms unsafe. Both the P&R Department and WWHD have correctly acknowledged that the spacious enclosures, exacerbated by toilet plumes which settle upon surfaces up to 15 ft away, are too difficult and time consuming to adequately disinfect.
Modern public facilities often provide convenient hand washing stations with soap and hot water outside toilet enclosures thereby allowing the public to effectively hand wash without risking contamination within.
COVID-19 is not the only circumstance where that may be an issue.
Makes sense, I certainly will not be using any port a potties…I mean they’re bad in the best of times!
Thank you, Dr. Walshon, for addressing and confirming what I myself suspected: Port-a-potties sound WORSE than regular bathrooms. I will not set foot in one. I’ll coordinate my beach sitting with the endurance of my bladder.
Arlene,
I apologize if I gave you the impression that permanent toilets are safer than the portables – that was not what I stated.
Permanent spaces such as the SB ones, while more comfortable and aesthetic, are far more difficult and time consuming to effectively and safely disinfect. Their high velocity flush toilets can create surface contamination up to 15 ft. away. The very nature of a “submarine-like” design intended to prevent any intrusion by storm and sea water can entrap contagion within its walls – pertinent to SB as those rooms always lack open entry/exit, effectively preventing flow-through ventilation and dilution effects that can diminish contamination and infection by contagious respiratory organisms. The COVID-19 virus has now publicly exposed these consequential disadvantages.
Modern portables can offer advantages over permanent toilets, with relative ease of disinfection, mobility and replacement being significant ones.
However because the COVID-19 virus is such a highly contagious respiratory pathogen that can linger airborne in closed spaces and be spread by asymptomatic people, their disinfection advantage is rendered insufficient because the degree, frequency, protective equipment and technique of disinfection required to consistently ensure individual and public safety in even these smaller and less complicated spaces, becomes burdensome, unrealistic and potentially dangerous.
Unfortunately at this time neither is a safe option for our residents, – especially knowing that our most vulnerable population might utilize or be secondarily affected by them.
I trust this clarifies my comments.
I appreciate is professional facts , might have been more helpful if we saw this earlier ! As a public health person, I totally agree with the Dr… and we all know people won’t be distancing 6 feet from each other wearing masks in line for the porta potties….This could set us back..remember, goal is to reduce contagibility and get the kids in school all over the country….
The problem is, of course, which alternative is worse. Can’t use regular bathrooms because they are, apparently, disasters.
https://www.fastcompany.com/90502942/we-may-have-to-rethink-the-toilet-seat-altogether-how-coronavirus-could-change-bathrooms-for-the-better
Porta-potties, on the other hand, often deteriorate to the far side of disgusting and, as Dr, Walshon notes, have their own health issues.
I would imagine the theory is that, knowing how disgusting they are, people will only use them in an emergency, preferring to depart before having to relieve themselves. Further, with no tables or cooking at the beach, maybe there will be less need. Anyway, with limitations on capacity, turnover is good so more folks can use the beach so perhaps this will encourage turnover.
Then again, there is always the old fashioned Long Island Sound alternative….🙂
Under these circumstances, 99% of adults and 100% of children will simply piss in the water and use provided facilities only when extremely necessary.
As an owner of A Royal Flush, a Fairfield County family owned business, I welcome the opportunity to discuss the safety concerns of the portable toilet business during this Covid crisis. The number one priority for our company is the safety of our customers and our team members. To that end, we have enhanced training. We have increased capacity for additional services. We have added two new levels of sanitizing for our units. We have increased our inventory of portable sinks. We have manufactured and distributed thousand of hand sanitizer stands.
We certainly appreciate that there are risks involved in any sanitation solution, home, business, public or portable. We also understand that there is a risk of spread of viruses caused when aerosolized by flushing a toilet. However, this does not occur in a portable toilet. I am by no means saying that there is no risk in using a portable toilet. However, people need to take precautions, be smart and take personal responsibility. There are also risks associated with limiting people’s access to public parks. If as a society, we have made the decision to make these spaces available, we need to do the responsible thing and provide restroom solutions.
As part of our response to this crisis ,we have been providing services to the hot zones (field hospitals in Central Park and throughout NYC), local testing centers and hospitals, popup morgues, etc. In the hot zones the local health officials have required daily upgraded sanitizer services. In CT, the Governor has required construction sites to have twice weekly services. No health organization or government body has suggested that portable toilets or public restrooms be cleaned after each use. Such a call is for no public facilities at all. In county and state parks that were kept open during the past month but where our services were ordered to be discontinued, people began filling up empty bottles with urine and defecating behind the toilets or in the woods. This created its own public health issues.
There are many options to minimize the risks. Communities can choose to increase the number of services, upgrade the level of services, provide portable sinks or provide hand sanitizer stands. Other options include restroom trailers or semi-permanent restrooms. But if the parks and beaches are to be open, not providing a restroom solution in not an option.
While ARF has proudly provided services to Westport over the years, we currently have no presence at the town beaches.
Stay safe, stay healthy, be responsible.
Tim Butler
Chairman
A Royal Flush, Inc.
As a practicing primary care internist, I completely agree with the comments and opinions of Dr. Walshon. There are great risks associated with any toileting solutions by the very nature of the virus, its transmissibility and the pandemic itself and unfortunately there is no really safe option available unless toilets are completely and thoroughly sanitized between each individual user including the use of self contained disinfectant spray, complete air exchange and cleaning and use of ultraviolet light. Any other toilet option has risks whether it be permanent bathroom facility or portable toilets. To assume that one option offers greater safety than the other defies scientific and medical evidence. There is no perfect solution beyond all good hygiene and sanitation. Wear masks, wash hands thoroughly and often, use sanitizer and do not touch your face including mouth, nose and eyes. Access to running water and soap is imperative. Be respectful and courteous to others and continue social distancing.
Agreed.
Tim Butler
Mr. Butler,
I appreciate your comments, and the increased sanitation efforts your company has taken.
We obviously agree on many of your points, but I will highlight the most pertinent:
“I am by no means saying that there is no risk in using a portable toilet. People need to take precautions, be smart and take personal responsibility.”
This rings particularly true when individuals understand that they do not control what is being provided, and that safety cannot be reliably assured.
My obligation is and always has been individual and public health protection based upon best known science – and when confident information is lacking, to always act with caution to “do no harm”.
Unknown, exaggerated or false assurances can and have had significant consequences, particularly when there is individual (and community) intolerance for error. There are no shortages of examples where “good enough” was hazardous and resulted in disaster – no matter how well intentioned.
Residents are sufficiently concerned to forgo schools, offices, public transportation, and even prefer shopping on-line, to avoid the potential for infection and enhancing viral spread. One needs to only look at the extensive PPE that HCW wear when testing even asymptomatic people for COVID-19 to appreciate that current circumstances require a different degree of vigilance – they are not fashion statements.
COVID-19 is not the only thing novel in this pandemic – and what was otherwise acceptable, routine or reasonable is now undergoing reexamination and scrutiny.
Like you, I’ve publicly expressed advantages that portable toilets provide over permanent. However, acknowledging that disinfection cannot reliably ensure safety prior to an individual’s use, neither has currently proven sufficiently safe – for individuals (that include our vulnerable population being enticed to use them), nor for the community at large. I appreciate the acknowledgment that even you cannot state that using a portable toilet is currently without risk to drive this fact home.
Reliable, consistent and effective disinfection of multiple portable toilets in large public gathering places becomes exponentially more arduous and unrealistic following the May 15 W.H.O. recommendation that surfaces be disinfected only by hand, warning against using spray techniques that increase hazard and ineffectiveness. The special training, PPE requirements, attendant dangers, and effectiveness monitoring, further adds to this burden.
Like you, I’ve publicly acknowledged the critical importance of having hand washing sinks that utilize soap and hot water. Many newer public restroom facilities segregate permanent sinks from the private toilet spaces, thereby eliminating contamination by toilet plumes and permitting independent usage by the public.
Finally, I couldn’t agree with you more that: “People need to take precautions, be smart and take personal responsibility.”. However I would add one more admonition to your list: “the responsibility for people to act in the best interests of those beyond the individual self”.
Doctor Walshon,
I think we are losing sight of the issue. The issue is whether to open the beaches or to not open the beaches. It is not whether to provide portable toilets or not. In making that decision to open or not all of relevant risks must be taken into account, including the need to address restroom solutions. Not the CDC, nor any state or local health department that I am aware of has banned the use of portable toilets for open recreational facilities. Once you decide to open, you need to provide restroom solutions. Residents of the state have shown great responsibility to date, and I expect and hope they will continue to do so. But the residents have also spoken, and they pressed the government to begin to open up the state. In Connecticut the state and towns have worked diligently to ensure our continued safety. There is no reason to believe that this will change.
Finally, I have not addressed the question of whether the beaches and parks should be open or not. I leave that decision for people with far more experience in public health issues. I note, however, that keeping public facilities closed disproportionally impacts poor and minority communities who have less access to other options for outdoor experiences. It also has financial and social impacts on the community. This is a complex issue. Unfortunately, if the decision is made to open and the public supports this, we can not sit by and do nothing. We do not have that luxury. We have to come together to provide the best options available. Not to do so would not be in the best interest of our fellow citizens. I welcome any suggestions on how we can effectively and responsibly meet our community’s needs.
Tim Butler
PS ARF does not have a presence at the Westport Town Beaches.
Agreed. The true challenge is the reopening of communities. Any steps to reopen beaches, parks and public places will no doubt have multiple risks associated with it, among which is indeed the issue of toileting. Unfortunately each individual will have to weigh the risks versus benefits of enjoying public spaces and toileting contingencies. With unlimited resources a toilet could be completely sanitized immediately after use by any one individual but that is unlikely to occur easily and without prohibitive expense during times in which resources are already overextended and scarce. It’s upsetting and distressing on so many levels but unfortunately I think solutions are limited at best if indeed the beaches are opened as they have been.
The scary part of this is the “weighing the risk” part based on incomplete and confusing information.
For my part is seems that no public restroom is an acceptable solution.
Thank you doctors for the unvarnished truth
Mr. Butler,
Your premise that: “The issue is whether to open the beaches or not open the beaches” is untrue. The Westport beaches have never been closed. That fact has be emphasized by the P&R.
The actual issues at hand are how to most safely provide vehicular access to our beaches, what amenities and activities to provide, how to do so most efficiently, most fairly, and with most safety. In so doing, recreational activities will be slowly, cautiously and judiciously added. I have personally applauded the Town for their emphasis on safety as they engage the complex task of reopening Westport, and carefully crawling towards “normalcy”. “Reopening” is an experiment that to optimally succeed requires as few potentially deleterious variables as possible.
The singular issue that I addressed is the decision to encourage the use of enclosures that have a significant contagion risk associated with them, and in so doing dispel the implied impression of safety by their provision, to educate my Westport neighbors in the truth of their risk, and protect them from harm. What makes this even more challenging and important is that with COVID-19 adverse effects reach beyond any individual willing to take a “personal” risk.
I fully comprehend the conundrum that public restroom amenities present in the face of COVID-19. My opinion piece does not minimize that. However unless leadership can personally assure the public safety of an amenity, many believe that they should not be made available. Items and activities that pose far less danger potential are routinely prohibited from the public domain.
Dr. Saunders correctly reiterates and advises: “There are great risks associated with any toileting solutions by the very nature of the virus, its transmissibility and the pandemic itself and unfortunately there is no really safe option available unless toilets are completely and thoroughly sanitized between each individual user…” and “Wear masks, wash hands thoroughly and often, use sanitizer and do not touch your face including mouth, nose and eyes. Access to running water and soap is imperative.” Unfortunately thus far we have been advised that sinks with running water and soap will not be available. Hopefully that will change.
I recognized that currently having no safe toilet option complicates and challenges the reopening of spaces where large gatherings will occur. However having access to recreational spaces and minimizing health risk are not mutually exclusive prospects – they just require adjustment (at least temporarily) to a different expectation, as well as maintaining heightened awareness and strict adherence to health vigilance, as inconvenient and disappointing that might be in the near term.
Any incidental thinning of crowds, diminished group sizes, and lessened time spent might actually have beneficial consequences – including promoting a higher turnover of the limited capacity spaces and activities, thereby providing more residents a turn to participate and enjoy them.
I wish to thank Dan for providing the opportunity to engage in this important and timely discussion – and to those who took time to listen.
For anyone that knows anything about SARS, it can be spread through plumbing and flushing can eject it into the air from the toilet. Air will linger inside both a portapotti and the normal bathroom / float around. There simply is no safe solution. That is fact. Anyone choosing to use a shared bathroom is taking a risk.
I am a land surveyor that works on many construction sites. Last week I urgently stepped into a porta potty that was unfortunately filled with a massive amount of smoke from someone sitting in there smoking a cigarette. I had to go & had no other option but to stand there & suck in 10 cigarettes worth of someone’s nasty second-hand smoke. It quickly made me realize that an asymptomatic or symptomatic individual with COVID-19 could easily infect multiple people in such a situation. I was not a happy camper. I just read an article where multiple construction workers were infected @ a job site in Santa Clara County here in California. We’ve been deemed essential, but as a mostly male group, are more likely to encounter severe symptoms. Just one more reason why women live longer than men: job-related exposures to contagions, UV radiation, particulates, machinery, chemicals, etc.
Use the woods, next time…or that dumpster you can hide behind….just sayin’
There’s a time and a place to go in the woods. This wasn’t one of them. Nor do I ever find it appropriate to go behind a dumpster. I see enough needles and other garbage around that I don’t need to add to it in a city by peeing or defecating there!