In a recent interview with the Mayo Clinic's resident infectious disease expert, Dr. Gregory Poland's list of surfaces to refrain from touching during the ongoing coronavirus outbreak included: "bathroom faucets, door handles, escalator rails, computer terminals and anything that is commonly touched by the public."

Poland, a straight-talking authority on germs whose expertise has spurred dozens of calls from national and international media in these first weeks of the crisis, went on to describe the potential viral load on touch screens as "bad," that on restaurant menus, "really bad," the contamination on doorknob handles, "really,  really bad," and the contamination found on computer keyboards as "really grossly contaminated."

(But you probably knew that already.)

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Thanks to the newfound importance of good hand washing and other virus transmission-reduction practices, the coronavirus outbreak has even carefree people suddenly pushing open doors with their feet, grabbing door levers with their sleeve, hitting elevator buttons with a pen and scrubbing in before meals like surgeons.

While these are all considered responsible practices today, prior to the arrival of coronavirus, this sort of hypervigilance around germs was considered something quite the opposite:

A symptom of debilitating anxiety.

As many well know, for persons with obsessive-compulsive disorder, a highly distressing condition believed to affect over 2 million men, women and children in the United States, the outsized fear of contamination can lead to intrusive thoughts about the need to wash their hands and avoid touching surfaces and the hands of others.

You may know of them as germaphobes.

"One of the classic presentations of obssessive compulsive disorder is an obsession that you're going to get sick from getting dangerous germs from common, everyday social surfaces, like railings and doorknobs and being near people," says Dr. Stephen Whiteside, a clinical psychologist at the Mayo Clinic and a national authority on the treatment of OCD.

"The fear of getting sick is larger than the actual risk," Whiteside says of OCD patients. "It's very unpleasant, and people respond to that by avoiding public surfaces and washing their hands repeatedly and thoroughly throughout the day, frequently to the point where their hands become chapped and bloody."

"They spend a lot of time being very scared and nervous about getting sick. They spend a lot of time washing their hands. And they feel pretty miserable about it. It's impairing and really disruptive to their lives."

Ordinarily, Whiteside says, the most effective treatment for OCD is what's known as exposure with response prevention.

"The patients have to go touch those surfaces, get the germs all over them, not wash, and learn through their own experience that the chances of getting sick are very low. More importantly, they have to learn that they can tolerate feeling anxious and distressed until that feeling goes away without washing."

It's a method that becomes much more complicated, however, when the touching of surfaces and not washing might actually, well, make a person sick.

"Yesterday, I heard it said word for word on the radio: If you touch a doorknob, wash your hands," he says. "So that clearly complicates the traditional treatment of OCD."

For now, Whiteside says, "I think we need to balance the patient's treatment needs with the importance of following the guidelines that we all need to follow in order to have heightened awareness and safety around germs."

While exposing patients to touching doorknobs may go to the wayside during the outbreak, he adds, "we will limit our hand washing to similar what other people are doing."

How does a viral outbreak affect patients whose lives had previously become taken over by the fear of contamination?

"If you are afraid that touching doorknobs will get you a horrible disease if you don't wash, and now there's advice to not touch public surfaces and to be sure to wash your hands afterwards, we certainly are concerned that that's going to be difficult to patients with anxiety and OCD, because that can very well heighten their symptoms."

On the other hand, he says, it's also possible that having the whole world validating a person's worst fear can replace the burdens of being ruled by false fears with the satisfaction of taking on real fears.

"Sometimes people don't necessarily react the way you think they will," Whiteside says. "There are times when an external fear can really put our unrealistic fears in perspective. ... It's possible that this calms those fears, or replaces them in a way that is adaptive, such that they can handle it, and say well, I'm less worried about getting some random disease, because now we're all worried about this real disease."

"Maybe I wash my hands more than other people do, but I don't feel compelled to do it. Maybe I feel like since I'm doing the right thing, it's not a problem."

After all, coronaviruses have a lipid envelope, meaning that fat-based soaps dissolve them.

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