People generally feel better when they are empowered to take some control over the risks and dangers they perceive in their life. For many, that control starts in the home and with the very basic human need for cleanliness and good hygiene. We’ve all seen the reminders about the importance of good hand hygiene and gauging by the supermarket shelves and the orders we’ve received at New Directions, that message has been adopted whole heartedly. But while relying on others for what now seem like essential supplies is right for some people, others want to make their own.

Soap, Sanitisers, Alcohol, Essential Oils, Herbs and other brews all hold within them some seemingly magical powers to keep us safe and protected from this new threat. But how and why do these things work? Can people just make their own or do you need specialist knowledge, equipment or licences? Further, given that pandemics aren’t a modern invention, how on earth did our ancestors survive in times like this? Was their medicine better than ours? Has modernity created this monster? We thought it was time to do a little digging around the edges, to look for hope in history, to put this into context and to empower our next steps. Here’s what we found...

The Long View

The word Pandemic comes from the Greek words Pan (all) and Demos (people). Throughout history, humans have gathered, grown in numbers and strength and then travelled to see what lies over that hill, river or mountain. In doing so they naturally met up with other groups of humans resulting in the swapping of notes, customs, goods, services and microbes. I guess you could say that microbes are the price that humans pay for being so mobile, curious and social. (18)

Being of English heritage I grew up believing that the Great Plague of London (Bubonic plague) was the biggest health crisis of all time but no, that only killed a measly 100,000 people although that was a whopping ¼ of the population at the time. However, at the same time (1629-1631) Italy was also in plague, a plague that killed 1 million people (or ¼ of the population again) as it spread rapidly through on the backs of soldiers returning from the thirty-year war. While these figures are sobering, it is important to remember that the world was very different back then.

It was not until 1846 that European doctors began to make the link between microbes and human disease. A Hungarian doctor called Ignaz Semmelweis set about scientifically investigating the difference between maternal health outcomes in doctor-led maternity where maternal mortality was high, verses midwife care where outcomes were better. It turned out that the doctor-led maternity care was more likely to kill the new mothers as in-between delivering babies they were dissecting corpses and not washing their hands afterwards! While Semmelweis work didn’t quite explain why good hand hygiene made a difference, he was adamant that it did based on his evidence. However, as this ‘discovery’ made the doctors look bad, there was a tendency to down-play the importance of hand washing for many more years which ultimately led to a continuation of poor maternal outcomes and the professional demise of Semmelweis.

While improved hygiene and a more advanced understanding of microbes has put us in a better position to deal with the fall out when pandemics hit, modern life has presented us with other challenges. Our increased mobility, population density and (one could argue) ability to live for longer with chronic health conditions brings with it its own set of problems. Looking back through time, the gap between pandemic outbreaks is generally much smaller than which we saw prior to the industrial revolution of the 1800’s. However, although more frequent, the most recent pandemics have been shorter and had lower mortality rates (as a percentage of population) than their historical counterparts. On both counts, this is a good thing.

What started this pandemic? Getting to know your enemy...

The world first noticed Covid 19 when China started to suffer and as such, it is to one of China’s great military strategists that I’m going to for my inspirational quote:

"If you know the enemy and know yourself you need not fear the results of a hundred battles" Sun Tzu 545-470BCE

Scientifically, when thinking about pandemics, the above theory works. The first step in any new pandemic crisis is to try and establish the cause and once that’s established, the next step is to get to know that thing (virus in this case) as intimately as possible so that one may fight it.

On 30th January 2020 a paper was published in the Lancet (1) outlining the scientific thinking and methodology used to trace the virus back to a potential physical location- original infection site for this outbreak. The paper also explains how the viruses’ genome was mapped and how this mapping has enabled scientists to narrow down the point at which the virus jumped species; in this case the most likely jump was from bats to humans.

Laboratories around the world have been sharing data and analysing samples from confirmed cases to track, map and deepen their understanding of this novel virus and ultimately to beat it with a vaccine. While a vaccine isn’t quite ready yet, thanks to the coordinated global effort and innovative ways of data modelling, initial vaccine testing is already underway in the USA. (2)

The fight on our hands

So now we know what we are dealing with and how it compares to what we have seen before, we can take steps to beat it and this is where hand hygiene comes back into play.

Most people I’ve been talking to on the New Directions help desk are interested in either making or purchasing products such as soap and/or hand sanitiser. Compelling evidence exists to support the role that good hand hygiene plays in flattening the curve or, to put it another way, spreading out and slowing down the trajectory of this virus. (3)

Soap, a once boring thing that only granny used to what has now become a super-hero lifesaver. The science is so simple, viruses have a fatty outer membrane that soap gets attracted to. Once attached, it emulsifies this fatty layer away thus leaving the inner bit of the virus naked and vulnerable. With good hand hygiene and effective rinsing any viruses that are on the hands are eliminated thus reducing the risk of cross-contamination from your hands to surfaces, other people and the objects you touch! Because soaps functionality is down to its surfactancy, any surfactant product could be used be that shampoo, bubble bath, syndet bars, melt and pour, castile soap or those good old fashioned cold pressed bars. There’s also no need to use additional antibacterial ingredients in the soap or add expensive essential oils unless you want to. The soap is enough by itself.

As good, cheap and effective as soap is, it only works when you have access to hand washing facilities and that also runs to a facility or method for drying the hands afterwards. It’s no use giving your hands a good wash if you go about with wet hands afterwards. Efficient drying is half the battle. Hand sanitiser is for those times when you can’t wash your hands with soap and water but when we’ve put ourselves at increased risk.

Without wanting to turn everyone into germaphobes’, there are microorganisms everywhere – some good, some indifferent and some pathogenic. The pathogenic or disease-causing ones are those which we worry about the most. These can enter our bodies when our hands, after contacting a contaminated surface, person or product, then connect with our face.. This tiny study of 26 students found that the average incidence of face touching was 23 times per hour with the most common site to touch being a mucous membrane (virus vulnerable site). The most common mucous membrane was the mouth, then the nose and finally the eyes although there wasn’t that much difference between those three. Given that these are average rather than absolute figures and that different population groups may touch their faces proportionately more or less, you can see how important hand sanitisation becomes. (4)

Hand sanitisers rely on a high level of alcohol to do the micro killing and the World Health Organisation recommend levels of between 60-80% on a volume per volume basis of ethanol as the gold standard with Isopropanol being the second choice. (5)

These alcohols work by denaturing the protein coating that protects the virus. The alcohol needs to be concentrated enough to do the job but not too concentrated that it can’t spread out into the virus coating. Isopropanol is often cheaper which can make it an attractive first choice. However, this alcohol typically has a much higher odour and a higher toxicity than ethanol which makes it both more likely to be poorly tolerated by the public and more dangerous if misused (usually by accidental ingestion, often by children). Additionally, Isopropanol slightly underperforms ethanol in the speed and breadth of microbe it can denature or kill so yes it works but it’s often not the best choice.

The World Health Organisations report talks about keeping hand sanitiser formulations quite simple. That’s partly because of their focus on public health rather than commercial advantage and partly because the more complex your formula, the more parameters there are that might reduce the efficacy or tolerance of your product. For that reason, the WHO data should be viewed as a standard starting point and a good guide as to alcohol requirements rather than a mandated formula from which no brand can deviate. The key thing we are advising clients is to do their validation studies.

Validating the efficacy of hand sanitisers is essential as these products are relied on by the public for their disinfecting properties. Here in Australia, the TGA have produced guidelines which detail the responsibilities of the manufacturer. While hand sanitisers are not always classified as therapeutic goods here in Australia, they do have to be tested and they should be made in a Good Manufacturing Practice facility to ensure the safety and reproducibility of quality and efficacy. (6)

Most of us who work in the cosmetic industry appreciate that producing a technically great product is of no use if the product in question is aesthetically unpleasing or very irritating to use. When it comes to hand sanitisers both factors can result product failure when products hit the market. Many brand owners add humectants to protect the barrier functionality of the skin and perfumes (including essential oils) to both make the product more pleasant to use and to serve as a sensory reminder to apply again and to be mindful of where one’s hands go! While adding exciting things may lead to greater customer engagement, changes do need to be measured and validated. As this paper shows, adding too much humectant can reduce alcohol efficacy (7) while the work of Tissearand and Young outlines the potential of essential oils to become irritating, especially when applied to a compromised skin barrier. (17)

Do Essential Oils and Herbal Extracts Boost the Power of Hand Sanitisers?

The short answer is that they may indeed do that, the long answer is that it’s complicated.

Various studies have investigated the use of herbal extracts in hand sanitisation. These studies have looked at herbs or essential oils as stand-alone actives, botanicals (in any or mixed form) plus alcohol and sanitisers based on synthetic chemistry such as triclosan or cationic quats. As everything in the formula, including how it is made plays a part in the product’s eventual efficacy, it’s hard to draw a definitive line and say ‘yes, this always works’ or ‘no, this never works. There have been many posts on the internet treating people harshly for trying to make their own sanitising solutions, especially when they are leaning towards just essential oils or herbs to achieve the efficacy. However, calling on the spirits and practices of our ancestors makes sense in times like these and when combined with our scientific powers that allow us to rank, test and measure outcomes, it seems like a very worthy project indeed.

This study (8), informed by Ayurvedic practice found extracts of lemon, Holy Basil and Neem to be effective at reducing microbe numbers under the test conditions studied.

This study looks at the efficacy of six essential oils against bacteria and fungus both when topically applied and in their vapour state (air care). The oils which included Oregano, Thyme, Clove, Lavender and Clary Sage all showed some micro fighting capacity across the tests although the oils didn’t perform equally. (9) Meanwhile, this study into the antimicrobial efficacy of essential oils establishes the efficacy of several more commonly used oils – Rosemary, Eucalyptus, Carrot and Cinnamon. (10)

Essential oils are volatile and rapidly evaporate from a surface. Using appropriate solubilisation techniques increases the oils contact time which in turn improves the overall performance of the blend when compared with using the oil alone.

While there are many more papers on the efficacy of essential oils, this one wraps things up nicely, if not entirely positively, by reviewing a whole range of oils before concluding that while essential oils appear effective when given a chance, they may be too volatile and, therefore, transient to replace synthetics and/or alcohol as stand-alone actives. (11)

So, what are we to make of all this? As formulators it is important to note that alcohol can damage the skin barrier, especially where adequate humectancy isn’t part of the formula. That plus high strength essential oils which can also increase dermal penetration may lead to a product that damages the surface we are trying to protect. However, when combined with skill, care, scientific knowledge and adequate testing it is more than possible that your herbs and/or essential oils could give your product the X factor and take it from being good to great.

Ancient Wisdom

While essential oils have become somewhat of the ‘go-to’ natural active for skin, air and home care it pays to remember that the availability of a great deal of essential oils is a relatively modern invention thanks to progressions in oil distillation. Modern distillation chemistry is attributed to an Arab alchemist Avicenna (Ibn Sina), born in 980. He was later nicknamed the father of modern medicine after changing the way we view and interact with plants and disease processes. It’s not that essential oils didn’t ‘exist’ before then, ancient civilisations did know about and utilise the ‘vital force’ of plants (Egyptian embalming fluid is one good example), more than the general public would have looked to a whole range of easier-picking ingredients to help them survive the down-sides of modernity.

Herbal extracts are very much still on the cards as useful actives in modern antimicrobial product formulations although often the smell, cost and colour of high potency herbal preparations often acts as a barrier to their greater use (in terms of potency) in the cosmetic industry. This paper gives a useful overview of many healing herbs, valued throughout history, and their efficacy against various viruses. Some Chinese herbs mentioned in this paper have been found to be active against the Corona virus family. (14) Further, here is a list of medicinal herbs compiled by the World Health Organisation. (15)

One herb that we commonly find featured in hand sanitisers is Aloe Vera. During Roman times this herb was used as a calming and soothing salve for skin conditions.

Roman Medical Expert Dioscorides wrote about Aloe being his favourite medicinal plant in his "De Materia Medica" in 41-68 AD. He cited it in the treatment of Skin irritation, acne, the treatment of wounds and more besides. (19)

Honey was another popular anti-microbial, skin soother and this ingredient is enjoying a resurgence now thanks to our renewed interest and need for finding ways to treat chronic skin ulceration without resulting to antibiotics. (12) However, medicine wasn’t always as straight-forward, progressive and as logical as that. England during the middle ages was prescribing a mix of magic and mayhem to cure the Black Death plague. The least objectionable cure on offer (and most scientific) suggested bathing the sufferer in a combination of vinegar (acid) and rose water. The use of acid as a sanitiser is backed by scientific evidence, indeed, reducing the pH of a cosmetic formula to 5 or below is one strategic way of reducing the products bioburden. (13)

Overall, there is much wisdom to be gained by paying attention to what those that have gone before us have done to ensure the survival of their genes. Further, recent scientific mapping of our modern genome has uncovered strands of ancient viral material sitting within our DNA – some of us are literally walking virus archives! (16) However, if looking back is all we do, we are in danger of missing out on new opportunities and important leaps in our understanding of the modern world, viruses and the many ways in which we can beat them at their own game!

So, can cosmetic chemistry empower us and help us survive this pandemic?

Fighting viruses sits outside of the legal realm of a cosmetic. However, general antimicrobial skin care such as hand sanitisers and hand cleansing products, air care products (spritzers, diffusers etc) and essential oil blends do not, just so long as you don’t make any outlandish crossing-the-line claims.

Creating your own ‘cosmetic’ products to help you keep yourself, your family and your home clean, in good condition and calm is something that people have been doing for thousands and thousands of years and as doing something is infinitely more empowering than sitting back and doing nothing. We are at a unique time in history where we can blend our ancestral knowledge and instincts with accessible scientific testing to produce products that are validated in terms of their efficacy and potential.

If the Australian government does progress to shutting down the country and placing us in home quarantine over the coming weeks or months, we could do worse things than retrace the steps of our ancestors. Taking a deep and thorough look through time and space, discovering what our forefathers and mothers did to stay safe, discovering where their instincts took them, what rituals brought them a sense of peace and calm. Then to experiment with ways that this ancient knowledge can be applied today before finally putting the fruits of our labour to the test using modern science, creating validated data.

Pandemics have come and gone throughout history, and over that time every culture had developed its own Materia Medica, its healing rituals and salves, its ways to thrive and survive. All this begs the question of why would we want to abandon all that, to turn our backs on our own DNA and distil the world down to one, generic perspective?

Creating your own antimicrobial cosmetic products such as those discussed here may or may not be as scientifically balanced or effective as professionally made items but what they will be is a part of you, a reflection of your past, your present and, we hope, your ongoing legacy. Of course, if you plan to sell these products to others you must take care to validate any claims you make and test that your products are otherwise safe but all things being equal, doing this is arguably a better use of your time than binge watching Netflix or becoming fixated on the 24/7 news cycle.

Happy Mixing!

Amanda Foxon-Hill

Reference

1. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding
2. Mining coronavirus genomes for clues to the outbreak's origins by Jon Cohen
3. Coronavirus: What is 'flattening the curve,' and will it work? By Brandon Specktor
4. Face touching: a frequent habit that has implications for hand hygiene by Kwok, Gralton, McLaws.
5. WHO Guidelines on Hand Hygiene in Health Care
6. OTC medicine monograph: Hand Sanitisers - Australian Government Department of Health
7. Glycerol significantly decreases the three hour efficacy of alcohol-based surgical hand rubs by Miranda Suchomel, Manfred L Rotter, M Weinlich, M Kundi
8. Formulation, Evaluation and Antibacterial Efficiency of water-based herbal Hand Sanitizer Gel by Shri Balakrishna Acharya, Saradindu Ghosh, Giriraj Yadav, Kavita Sharma, Dr.Sirsendu Ghosh, Dr. Sushil Joshi.
9. The antibacterial and antifungal activity of six essential oils and their cyto/genotoxicity to human HEL 12469 cells by Andrea Puškárová, Mária Bučková, Lucia Kraková, Domenico Pangallo & Katarína Kozics
10. Antibacterial, antifungal, and antiviral effects of three essential oil blends by Amandine Brochot,Angèle Guilbot, Laïla Haddioui,Christine Roques
11. Essential Oils as Antimicrobial Agents-Myth or Real Alternative? by Wińska, Katarzyna; Mączka, Wanda; Łyczko, Jacek; Grabarczyk, Małgorzata; Czubaszek, Anna; Szumny, Antoni
12. Traditional and Modern Uses of Natural Honey in Human Diseases: A Review Tahereh Eteraf-Oskoueiand Moslem Najafi
13. Cures for the Black Death Citation: C N Trueman
14. Essential Medicines and Health Products Information Portal
15. Antiviral Natural Products and Herbal Medicines by Liang-Tzung Lin,Wen-Chan Hsu and Chun-Ching Lin
16. More ancient viruses lurk in our DNA than we thought. University of Michigan Health System
17. Essential Oil Safety Book by Robert Tisserand, Rodney Young & Tony Balacs
18. Visualizing the History of Pandemics by Nicholas LePan
19. The Ancient 'Plant of Immortality' That Treats Over 50 Medical Conditio By Veronica Parkes