[Graphic Medicine] 'Who Sanitizes the Sanitizer?': COVID Comics and Sanitisers

‘Who Sanitizes the Sanitizer?’: COVID Comics and Sanitisers Ishani Anwesha Joshi Department of Humanities and Social Sciences, National Institute of Technology Tiruchirappalli, Tiruchirappalli, Tamil Nadu, India Correspondence to Ishani Anwesha Joshi, Department of Humanities and Social Sciences, National Institute of Technology Tiruchirappalli, Tiruchirappalli, Tamil Nadu, India; ishanianweshajoshi097@gmail. com Accepted 2 February 2024 , Sathyaraj Venkatesan ABSTRACT Much like face masks, hand sanitisers have become a household item and a prominent symbol since the COVID-19 pandemic. As sanitisers began to be widely used, contingent issues related to toxic ingredients in sanitising products, heightened pandemic-related anxiety, unscrupulous profiteering through inflated sanitiser prices, obsessive sanitisation, contamination fear, stockpiling, panic buying, and concerns regarding the overall effectiveness of hand sanitisers emerged. Building on these themes, the present article investigates the various issues related to sanitisers after a brief review of the history of sanitisers. To do so, the present article analyses sequential comics and single-panelled cartoons from comic artists such as Randall Munroe, Sarah Morrisette, Shivesh Shrivastava and Dan McConnell. This essay extends its inquiry beyond examining sanitisation practices during the COVID-19 pandemic and associated cultural implications. Drawing on insights from Object Oriented Ontology, this article brings to relief how sanitisers have evolved into objects that hold, govern and shape our modern existence. Furthermore, the present article highlights how the comic medium visually enunciates the lived experiences of the pandemic, rituals of sanitising and associated issues. INTRODUCTION © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Joshi IA, Venkatesan S. Med Humanit Epub ahead of print: [please include Day Month Year]. doi:10.1136/ medhum-2023-012733 In March 2020, when the COVID-19 pandemic became a global phenomenon, various government agencies and healthcare institutions advocated for using hand sanitisers as a crucial precaution against the SARS-CoV-2 virus. Since sanitising practices became ubiquitous and sanitisers became an everyday object in households worldwide, our collective reliance on a (previously) rarely used item tremendously increased to the point that sanitisers became indispensable. Over the course of the pandemic, various issues such as obsessive hand sanitising and anxiety, efficacy of sanitizers, misinformation about sanitisers, consumption of sanitisers, shortage and hoarding of sanitisers, and the presence of toxic ingredients in sanitisers, among others, came to the forefront. Furthermore, sanitisers not only became ‘a marker of anxiety, precaution, discipline, and obedience’, they also highlighted ‘the fragility of the systems that fabricate and disseminate them, as well as the fragility of life, which is deemed to be protected and reinvented’ (Baronian 2020, 215–217). Given such a context, it is intriguing to examine the pandemic through the lens of Object Oriented Ontology (OOO), which treats all living and non-living beings, objects, events and thoughts as ‘objects’. Applying OOO to sanitisers, for instance, emphasises their autonomy as objects and their role in influencing the world. While a comprehensive understanding of these objects remains challenging, one can recognise their importance and role in the intricate relationships that define our modern existence. The present article examines how objects, especially sanitisers, not only shape human relationships and interactions but also mediate our understanding of the post-pandemic world by analysing single-panelled cartoons and sequential comics by Randall Munroe, Sarah Morrisette, Shivesh Shrivastava and Dan McConnell. These graphic texts have been chosen because they visually enunciate a crucial issue involving COVID-19 and sanitising. For instance, Munroe’s XKCD comic, even though it predates the COVID-19 pandemic by several years, visually underscores a vital point, that is, sanitisers are not entirely and unequivocally foolproof in their efficacy. In so doing, Munroe helps the reader understand the margin of error, suggesting that relying solely on sanitisers does not ensure immunity from contracting COVID19, particularly when they were marketed as infallible products. Similarly, Morrissette’s comic was chosen for its depiction of questionable and potentially toxic materials in sanitising agents, a pertinent matter given the ubiquitous use of sanitisers in daily life. Again, Shrivastava’s cartoon was chosen for its compelling depiction of issues such as panic buying, hoarding and the overpricing of sanitisers during the COVID-19 pandemic. Furthermore, it also offers criticism of such behaviours and instructs readers not to engage in them. Though the cartoon illustrates capitalist practices seeping into individual behaviours, the focus on sanitiser as an object of high demand signals its overall value during the pandemic. Lastly, McConnell’s cartoon was selected for its portrayal of the psychological anxiety surrounding viruses, both individual and collective, which has resulted in an obsessive use of sanitising products. While the graphic texts discussed in the article each revolve around different issues regarding the use of sanitisers during COVID-19, they all propose the value of the comic medium in enunciating the nuances of the same. Comics harness the power of visual story-telling to convey complex ideas and emotions through images and words. Since comics are accessible to a wide range of audiences, including those with limited literacy skills, they create a significant and sustained impact on a diverse population. Comics’ use of visual metaphors and symbols, humour and satire, among others, make it a pluripotent medium to sensitively ‘convey Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 1 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research immediate visceral understanding in ways that conventional texts cannot’ (Green and Myers 2010). Taking these cues, this article exclusively focuses on the portrayal of sanitiser-related issues in comics, though numerous popular culture artefacts (such as news articles, reports and photographs) have addressed the subject of hand sanitisers. Before delving into these issues, it is imperative to trace the interrelation between the COVID-19 pandemic and hand sanitising practices while parallelly tracing a brief history of hand sanitisers. Sanitisers: what? and why? Hand sanitisers, alternately known as hand antiseptic, hand disinfectant and hand rub, are gel-based, foam-based or liquidbased formulas used to kill microbes (such as viruses and bacteria) and are ‘marketed to help decrease bacteria on the skin when soap and water are not available’ (Knudson 2022, par.5). In November 1957, Lincoln L Stevenson filed and ‘received US Patent 2 814 081 for a Rapid Hand Sanitizer’, primarily targeting the food service industry (Bedi 2020, par.5). The sanitiser took the form of a ‘glass box with two openings at the front, through which the user would insert his or her hands’ and be sprayed with a ‘compound including lanolin, pure grain alcohol, perfume, and possibly a slight amount of additional disinfectant added if necessary’. (par.7). Similarly, in 1965, Warren W Nelson was issued US Patent 3 220 424 for hand sanitisers, which required ‘complete submersion of the person’s hands in the sanitizing fluid’ (par.8). Among others, Wendell H Tisdale and Ira Williams’s US Patent 1 972 961 (1934), William C Moore’s US Patent 2 054 989 (1936) and Lucas P Kyrides’s US Patent 2 246 524 (1941) prove that the general idea and process of preparing a disinfecting solution had been known for a while. It is generally believed that California-based nursing student Lupe Hernandez, in 1996, ‘came up with a way to deliver a disinfecting alcohol solution in gel form’, which led to the mass production of hand sanitisers (par. 2). Though germicides and antiseptic solutions were used in hospital settings, Hernandez’s discovery helped its commercialisation by companies like Purell and Gojo, which started selling hand sanitisers as early as 1988. According to Market researcher Nielsen, the first notable surge in sanitiser sales happened during the swine flu outbreak (2009– 2010) when ‘in the 24 weeks leading up to 3 October 2009, sales increased by 71% to $118.4m in the US, compared with the $69.4m in the same period a year earlier’ (Parker 2020, par. 31). Sanitisers are categorised based on the product form (gel, foam or liquid) and type (alcohol-based or alcohol-free). While gel sanitisers are more effective for germ protection, foam and liquid sanitisers are known to absorb much more quickly into the skin. Broadly, sanitisers are either alcohol-based and ‘contain varying amounts and types of alcohol, usually between 60% and 95%, and in most cases, isopropyl alcohol, ethanol (ethyl alcohol), or n-propanol’ or alcohol-free containing ‘quarternary ammonium compounds (usually benzalkonium chloride) instead of alcohol’ (Agrim 2020, par. 5-6). Though some prefer alcohol-free sanitiser to avoid skin irritation, itching and the presence of organic substances, most people use alcohol-based sanitiser as it is recommended by doctors and is more effective against viruses such as SARS-CoV-2, HCoV 229E and NL63, among others. In contemporary times alcohol-based sanitisers dominate the market so much that the WHO recommended two formulations: the first containing ‘ethanol 80% v/v, glycerol 1.45% v/v, hydrogen peroxide (H2O2) 0.125% v/v’ and the second containing ‘isopropyl alcohol 75% v/v, glycerol 1.45% v/v, hydrogen peroxide 0.125% v/v’ (Agrim 2020, par. 12-13). 2 During the COVID-19 pandemic, hand sanitisers were heavily marketed as crucial tools for preventing the spread of the virus, not only by the public health authorities and government organizations but also by major corporations and pharmaceutical companies. Positioned as far more than just tools for pandemic preparedness, sanitisers have been marketed as essential items for everyday life, often fostering a medicalised or heightened focus on hygiene well beyond clinical environments. For example, hand sanitisers were heralded as indispensable for safeguarding vulnerable populations, including children, the elderly, disabled, and those with pre-existing health conditions. While this shift towards medicalised hygiene signifies a cultural pivot towards valuing health and cleanliness in daily life, it also engendered adverse consequences, including heightened anxiety and obsession with cleanliness, the commercialisation of hygiene products (potentially rendering them costly and inaccessible to marginalised groups), increased reliance on chemical products with potential environmental repercussions, and the stigmatisation of individuals and communities who are perceived as lacking in hygiene. When the COVID-19 pandemic started, purchases of hand disinfectants skyrocketed across the globe, with sanitiser sales in the USA shooting up by 470% in March 2020 ‘compared to the same week a year earlier’, especially in an industry ‘that already sees more than $200 million in annual sales of hand sanitizer products’ in the USA (Huddleston Jr. 2020, par. 4). Among others, Reckitt Benckiser Group (UK), Gojo Industry (USA), Henkel AG & Company (Germany), Himalaya Global Holdings (India), Unilever (UK) and Bacardi Limited (Bermuda) emerged as key players in the sanitiser industry (Fortune Business Insights 2021, par. 5). Interestingly, on 11 March 2020, Turkey’s Minister of Health championed the efficacy of cologne in combating COVID-19 due to its high alcohol content of 80%, resulting in a remarkable eightfold increase in cologne sales in Turkey (Scatena 2020, par. 4-10). During the later stages of the pandemic, though hand sanitisers were widely used, concerns regarding the addition of toxic substances like methanol became an issue. However, concerns regarding hygiene, postpandemic anxiety, and a greater awareness of germs and viral infections among the general populace ensure that hand sanitisers will continue to be a household staple in the near future. Sanitisers as objects Proposed by philosopher Graham Harman in the late 1990s and early 2000s, Object Oriented Ontology (OOO) is a philosophical framework that emphasises the agency and autonomy of individual objects rather than viewing them as mere representations or tools for human understanding. The ‘flatness of the ontology implies that humans, or any other object that may possess consciousness, do not have any ontological priority over other objects’ (Howdyshell 2020, 7). It rejects traditional metaphysics, which focuses on the nature of being or reality as a whole, in favour of a focus on individual entities and their relationships, which means, among other things, OOO ‘holds that the external world exists independently of human awareness’ (Harman 2018, 10). According to OOO, hand sanitisers, as objects, have ontological priority over any properties or relations that are attributed to them, such as their ability to kill germs or their role in the pandemic. In OOO, since ‘every real event is also a real object’, the COVID-19 pandemic would be considered an object that is composed of a complex network of relations between other objects, such as viruses, bacteria, people and medical equipment (53). In this context, the pandemic and Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research sanitisers are not two separate things but rather two different aspects of the same reality, and the relationship between them is vital. As an object, the pandemic is a complex network of relations, and sanitiser is one of the elements related to the pandemic and its spread. Additionally, sanitisers have influenced life in itself by altering the relationships between objects in the pre-pandemic world, such as the relationship between humans (taken as an object) and other objects (the notion of cleanliness) or between human beings (concerns regarding the spread of disease). Harman’s philosophical framework asserts that every nonhuman object possesses ‘an ‘I’ in the sense of having a definite inwardness that can never be fully grasped’ (70). Since one cannot grasp the full essence of an object, COVID-19, being both an object and an event, remains, to some extent, beyond complete human comprehension. While scientists and researchers strive to understand it, the SARS-CoV-2 virus and the COVID-19 pandemic remain fundamentally unknowable. Furthermore, OOO proposes that objects are inaccessible in their entirety and can only be understood through their relations with other objects (401–5). Consequently, an object can be approached and understood by examining the intricate network of relationships that shapes its unique causal profile. This relational framework forms the foundation of our knowledge and understanding of objects around us. In light of the above, it is fitting to assert that sanitisers as objects are not isolated entities but are entangled within a broader network of objects. They engage with containers, manufacturing processes, transportation systems, and the broader cultural and economic context. Through these relationships, sanitisers influence various facets of human life, including health practices, economic markets and cultural norms. The social and cultural significance of sanitisers stems from how they have been imbued with multiple significance on various levels. On the most basic level, humans rely on hand sanitisers to prevent the spread of disease, which, in various ways, shape human relationships and interactions. Hand sanitisers have changed how people interact with each other and with objects in the world, such as how people now interact with doors, staircase railings, handles and other surfaces. Furthermore, hand sanitisers have become symbols of cleanliness, health, and safety and have been used to communicate the importance of personal hygiene and the need to prevent the spread of disease. Apart from its various symbolisms, the manufacturing, distribution and marketing of hand sanitisers to meet the increased demand for personal hygiene products during the pandemic also signifies how our focus has collectively shifted to sanitisers and sanitising practices. Put together, hand sanitisers have been produced, used, consumed, and imbued with meaning and value by human culture, thereby shaping human relationships and interactions during the COVID-19 pandemic. ‘Kills 99.99% of Germs!’: the remaining 0.01% Award-winning American comic artist, author of four books,1 and a former programmer and roboticist at NASA, Randall Munroe, comments on the effectiveness of hand sanitiser in his 1161st comic self-published in <xkcd.com> on 16 January 2013, long before the COVID-19 pandemic began. Titled ‘Hand Sanitizer’ (2013), (figure 1) the cartoon is a mathematics joke that visually enunciates what is mentioned in the fine print on company-manufactured hand sanitisers. In so doing, it draws the reader/viewer’s attention to the margin of error (degree of error in the result received) inherently present when evaluating the efficacy of products such as sanitisers. The comic depicts a short narrative where an individual comes across public safety information that asserts that ‘[a]n invisible sneeze droplet can contain 200 million germs!’ following which the protagonist checks the efficacy of hand sanitisers (figure 1). Following a short calculation of the margin of error, the protagonist concludes that there will still be 20 000 particles of germ that the sanitiser cannot eradicate. Put differently, Munroe’s ‘Hand Sanitiser’ conveys that adopting precautionary measures reduces the probability of contracting COVID-19 but does not guarantee perfect immunity against diseases. Given that our relationship with sanitisers as objects is not merely aesthetic but a matter of survival, such information is crucial to help people calibrate their sanitisation practices and manage their expectations accordingly. Characterised by artistic simplicity, Munroe’s protagonist, a faceless stick figure denoting the commoner, hardly moves as he is bombarded with numerical information and the sudden realisation of his biological vulnerability to diseases despite taking precautions. The mathematics joke and the dark humour encapsulated within it is not difficult to understand. Interestingly, Figure 1 Munroe, Randall. ‘Hand Sanitizer.’ XKCD, 16 January 2013, https://xkcd.com/1161/. Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 3 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research Munroe encourages the reader to calculate the margin of error, which in turn produces the desired emotional effect such that the reader is able to comprehend the surprise, anxiety, and fear of the protagonist and by extension, the author. To calculate the number of germs/viruses left after using a hand sanitiser, one has to multiply the original number of germs contained in a sneeze droplet (200 million) with the margin of error specified on the sanitiser bottle (100%–99.99% = 0.01% = 0.0001). Here, 200 000 000 × 0.0001 results in 20 000 germs, which is a relatively large number of germs left, considering that ‘droplets less than 5 microns in diameter, called aerosols, can linger in the air for hours’ (Mandavilli 2020, par. 20). Divided into three panels linearly progressing from left to right, Munroe’s black and white comic delineates a short narrative that can be temporally encapsulated/performed in minutes. However, the knowledge it imparts is so monumental that it reverberates within the reader for a long time, especially after being exposed to infection, confinement and deaths following the COVID-19 pandemic. To animate such dynamics, Munroe situates the image of the protagonist, calculating the margin of error in the liminal space of the gutter between two panelled images. In so doing, the comic artist foregrounds the third image where, for a split second (it takes for a calculator to come up with the results), the protagonist anxiously awaits a result/ information yet unknown to him. In contrast, all three panelled images contain factual information, be it either concrete facts (as in the first two panels) or the protagonist’s emotional state (in the concluding panel). Drawing from the above, it can be concluded that Munroe uses the formal features of comics to visually deliver the powerful punch line (which is the calculation itself), emphasising the implied point regarding the efficacy of sanitisers. Though important, such information leads to fear, anxiety, obsessive-compulsive behaviour, and in some cases, a sense of hopelessness and loss of agency, which Munroe encapsulates in a single utterance: ‘Ew’ (figure 1). In conclusion, Munroe’s comic not only delineates mathematical facts regarding disease transmission and the efficacy of sanitisers but also presents the emotional after-effects of uncovering such disturbing information. ‘Fair is Foul’: toxic ingredients in sanitisers The COVID-19 pandemic created a massive demand for sanitisers, masks, gloves, face shields, Personal Protective Equipment (PPE) kits, COVID testing kits and, more importantly, vaccines. In response, the manufacturing industry saturated global markets with these essentials. With the supply meeting the demand—after the shortage of sanitisers in the initial phase of the pandemic— sanitisers became commonly used worldwide. However, the shortage of ethanol (an active ingredient of sanitisers) led manufacturers to substitute it with highly toxic substances such as methanol, 1-propanol, benzene, acetaldehyde, acetal and other carcinogens which can cause ‘nausea, vomiting, headache, blurred vision, coma, seizures, permanent blindness, permanent damage to the central nervous system, or death as well’ according to USA’s Food and Drug Administration (FDA) (Sanzo 2022, par. 3). Such apparent negligence of public health by neo-capitalist money-making enterprises raises questions about the active ingredients in sanitisers. Hence, the addition of questionable/toxic substances in sanitisers raises questions of safety and dilutes the cultural significance of sanitisers. Vienna-based painter and cartoonist Sarah Morrissette raises such issues in her cartoon titled, ‘Just for the Fun of It, Let’s Add Some Goat Turds to This Batch of Hand Sanitizer’ (2020). Initially self-published 4 on her Instagram handle on 21 March 2020, Morrissette’s cartoon was later uploaded to Cartoonstock—an online cartoon depository selling posters and prints—on 3 October 2020. An English graduate from the University of California, Los Angeles (USA), Morrissette invokes the opening scene of William Shakespeare’s Macbeth (1623), where three witches are concocting a portion to dramatise a similar ethos of manufacturing companies selling sanitisers with toxic substances. The visually arresting cartoon has three main aspects: the witches (symbolic of neoliberal and neo-capitalist industries), the cauldron (symbolising sanitisers) and the goat droppings (symbolising toxic ingredients in sanitisers), which will be explored in detail in the subsequent paragraphs. Marked by exaggeration and inked in black and white, Morrissette’s cartoon foregrounds two witches with grotesque features, long robes and pointed hats. The warts, bushy eyebrows, hawk nose and elongated nails reinforce the repulsive nature of the witches and, by extension, portray the ugly face of neocapitalist industries. The cartoon invests in the trope, rhetoric and premodern cultural logic that witches are evil, powerful, supernatural beings to signify that big pharmaceutical companies of the present day have similar characteristics. In such a context, Morrisette’s verbo-visual imitation of the ‘weird sisters’ from Shakespeare’s Macbeth implies that they have a deeper significance in the overall context of the cartoon. The lightning and storm accompanying Macbeth’s witches and their role as a catalyst (to Macbeth’s ambition) signify that they are powerful enough to transform the ‘entire situation, both the human context and the natural setting’ (Tomarken 1984, 82). Similarly, sanitiser manufacturing companies are powerful enough to not only directly impact public health through their products but also influence the media and other related regulatory organisations to downplay the adverse effects of their products. In such a context, regulatory bodies need to lay out more stringent laws regarding the manufacturing and permissible product composition, much like ‘the law against sorcery passed in the reign of James I, whose Demonologie [is] mentioned as an important source of authorized belief ’ (italics in the original, 81). Though concerns regarding witches and witchcraft may seem juvenile in contemporary society, invocations, spells, enchantments, potions and the prophesies of the weird sisters ‘were serious concerns for Shakespeare’s audience’ (82). Morrisette’s invocation of the weird sisters as a metaphor for pharmaceutical companies similarly signifies that the addition of questionable substances in sanitisers is a source of concern in post-pandemic times. Statistically speaking, the global hand sanitiser industry grew 10.5% in 2021 alone and is ‘projected to reach $1.96 billion by 2026’ (Fortune Business Insights 2021, par. 1). In India, a ‘total of 152 new manufacturers started making sanitisers in March [2020], commanding 61 percent market and 46 percent value share’ (Dsouza 2020, par. 1). Consequently, companies selling hand sanitisers have greatly profited after the COVID-19 pandemic. That is, sanitisers were predominantly seen as a mere commercial commodity generating massive profits by manufacturing companies. The comic artist not only criticises the hastily put-together manufacturing units, lacking proper safety features through the makeshift fire pit but also expresses concern over the manufacturing process and composition of hand sanitisers through the image of a boiling pot/cauldron. In so doing, the cartoon condemns the moral framework allowing pharma companies to unethically concoct dubious products in the fashion of primitive alchemic potions. Given the current debate regarding harmful ingredients in sanitisers, Morrissette’s concerns ring true, especially when the product, supposed to Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research be ‘fair’ (protect us from COVID-19 virus), quickly turns ‘foul’ (causes various other diseases) (Shakespeare 2013, Act I, Sc. 1). Sanitisers from manufacturers such as Best Brands Consumer Products (The Mickey Mouse and Mandalorian Hand sanitisers), CorgioMed (Leafree Instant Hand sanitiser-Aloe Vera), Soluciones Cosméticas (Bersih brand sanitiser), 4E Global SAPI de CV (sold BLUMEN advanced sanitisers) and Eskbiochem (sold nine different methanol contaminated sanitisers), among others have been reported to contain toxic ingredients (U.S. Food and Drug Administration, (FDA) 2023). In fact, the FDA’s warning list of sanitisers includes nearly 200 products as of 17 September 2020 (Martyn 2020, par. 16). From the above, it can be deduced that contemporary sanitisers are as much a source of concern as the SARS-CoV-2 virus. Morrissette vividly conveys her apprehensions about the ingredients found in modern sanitisers by depicting a scene in which witches are shown adding animal excreta, teeming with germs, into a batch of sanitiser. Unlike Macbeth’s witches who use ingredients like the ‘toe of frog’, ‘tongue of dog’, ‘blindworm’s sting’ and ‘owlet’s wing’, among others used in traditional medicine, Morrissette’s witches use goat droppings which signify the gross and potentially toxic nature of these ingredients (Shakespeare 2013, Act I, Sc. 1). Interestingly, Morrissette’s caption (also the title of the cartoon) reads, ‘Just for the fun of it, let’s add some goat turds to this batch of hand sanitizer’ implying that this addition is part of an elaborate joke that may negatively impact potential users. Morrissette deliberately uses the word ‘fun’ to highlight the appalling trivialisation of life and the reckless attitude of the pharma behemoths. Moreover, ‘fun’ also implies that the goat turds are added to the mixture without any real purpose, which questions the validity of adding miscellaneous substances to sanitisers to market them as unique products (Morrissette 2020). Though the artist portrays this action as a playful joke predicated on the essentially evil nature of the witches, in the case of neo-capitalist industries, this addition could easily be a deliberate act based on a profit-making mindset. In the context of the COVID-19 pandemic, the presence of undeclared methanol found in ‘lot 133 475 of Adam’s Polishes Hand Sanitizer’ implies that such an additions are undertaken by sanitizer manufacterers out of greed and prior knowledge of the toxicity of methanol (Knudson 2022, par. 2). Conversely, the cartoon highlights moral questions regarding corporate responsibility and public health. Notably, it questions the morality of those consciously poisoning an entire population and potentially causing various acute and chronic health conditions because of greed and material/monetary benefits. Put together, Morrissette’s cartoon is an extended metaphor that not only criticises sanitiser manufacturing companies who endanger public health by using toxic ingredients but also prompts the general populace to choose industry-manufactured products discerningly. Panic buying, stockpiling and profiteering off sanitisers Sketched as a children’s cartoon featuring a fox and a rabbit, Indian cartoonist Shivesh Shrivastava’s ‘Damru and Sanitizer’ (2021) (figure 2) was published by Champak (a children’s magazine in India) on 5 June 2021. The cartoon’s title not only alludes to the characters but also symbolises the importance of sanitisers during the COVID-19 pandemic. Shrivastava, a cartoonist affiliated with Champak, is well known for his character, Damru, a grey rabbit. The vibrantly coloured eight-panel comic employs a narrative technique reminiscent of the Indian classic Panchatantra, written around 200 BCE by Pandit Vishnu Sharma. Like Panchatantra, ‘Damru and Sanitizer’ uses anthropomorphic Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 animals to convey meaningful life lessons. Notably, the use of anthropomorphic characters falls squarely within the comic tradition. Since Shrivastava’s comic is meant for children, it is straightforward and action-oriented, conveying a compelling story while delivering a distinct and clear message. Here, the grey rabbit Damru starts working with a red fox called Roxy Fox, a clever character who happens to own a ‘sanitizer shop’, signalling the importance of sanitisers as an object of importance during the COVID-19 pandemic (figure 2). As the story unfolds, Roxy Fox, an archetype of greedy businessmen and corporations, unveils a plan to exploit the pandemic by inflating the prices of sanitisers to maximise profits. During the brief absence of Roxy Fox, Damru takes it upon himself to distribute all the available sanitisers and masks, demonstrating the significance of altruism and emphasising the importance of not stockpiling essential supplies in the time of crisis. Put together, Shrivastava’s cartoon criticises corona-capitalism, advises against hoarding and overpricing essential goods, and encourages people to be charitable. The cartoon begins with Roxy Fox establishing the ‘high demand’ for hand sanitisers and outlining its vital role in pandemic preparedness (figure 2). The limited supply of sanitisers on the market contributes to this demand, in addition to the fact that sanitisation is an essential precaution recommended by numerous public health and government organisations. In addition to these factors, the uncertainty surrounding the duration of lockdowns (which were often extended), and the rise of quarantine spaces and containment zones prompted individuals to err on the side of caution, resulting in panic buying and hoarding of essential commodities. Panic buying is a ‘socially undesirable, herd behaviour where large quantities of daily necessities and medical supplies are purchased from markets, which often results in stockout situations’ (Yuen et al. 2020, 1). Anticipating high demand and a potential sell-out, Roxy Fox intends to market his sanitisers at twice their regular price. With the shelves of his shop already filled with sanitisers, the fox still goes out to buy more sanitisers, aiming to stockpile sanitisers to sell later. While at an individual level, stockpiling is an ‘avenue for individuals to regulate their negative emotions’, offering ‘a sense of security, comfort, momentarily escape, and alleviate stress’, at a global level, stockpiling puts tremendous pressure on the economy as it is not equipped to provide months of essentials to every individual (Yuen et al. 2020, 2). Because sanitisers and toilet paper are in limited supply, they can ‘prevent individuals or more vulnerable groups (eg, elderly or poor), who are in greater need of the products, from accessing them’ (Agrim 2020). From a retail perspective, various individuals have raked in huge profits by stockpiling sanitisers and toilet paper and selling them at grossly inflated prices on online platforms. For instance, ‘an 8-ounce bottle of Purell that would normally cost $2.50 was briefly on sale for $90 before being removed by Amazon’ in early March 2020 (Huddleston Jr. 2020, par. 6). This is a case of what Canadian writer and social activist Naomi Klien calls ‘disaster capitalism’ when powerful people (such as multinational corporations, governments, or, for that matter, anyone in a position of power) capitalises on natural or manmade crises ‘to advance radical privatization combined with the privatization of the disaster response itself ’ (Naomi 2023, par. 5). In this dire scenario, Damru emerges as a moral guide, generously donating essential supplies, including sanitisers and masks. In contrast to the first four panels, where the shelves of the shop are packed with sanitisers, in the last four panels the shelves are completely bare. Accordingly, the once avaricious Roxy Fox, who initially sported a sly smile, is depicted in a tearful 5 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research Figure 2 Shrivastava, Shivesh. ‘Damru and Sanitizer’ Champak, 5 June 2021, https://www.champak.in/damru/damru-sanitiser. 6 Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research state in the final panel, while the Rabbit, initially displaying curiosity and shock, departs with a joyful grin. Damru instinctively comprehends the pivotal role of sanitisers and masks in disease prevention, unlike Roxy Fox, who views them solely as a means of profiteering. In the first four panels of the comics, Shrivastava critiques the practices of panic buying and hoarding, and in the last four panels, he implores the reader to embrace kindness and generosity. In so doing, Shrivastava visually articulates the importance of thinking ‘outside the coordinates of the stock market and profit and simply find[ing] another way to produce and allocate necessary resources’ (Žižek 2020, 90–91). In conclusion, ‘Damru and Sanitizer’ serves not only as a social commentary on unethical practices such as profiteering during the COVID-19 pandemic but also as a symbol of the sociocultural value and significance of sanitisers. Viral anxiety and sanitisers Cartoonist Dan McConnell’s cartoon titled ‘Hand Sanitizer’ (2020), curated in Cartoonstock deftly portrays pandemic-related anxiety regarding the invisible SARS-CoV-2 virus and obsessive hand sanitising practices. A former inker at Marvel Comics, McConnell has prolifically published in Reader’s Digest, MAD, Weekly Humourist, Humour Outcast, and Airmail and is the artist behind the cartoon strip Apple Andy. Published on 30 June 2020, the present cartoon depicts a masked man in an indoor setting sanitising his hands from a preinstalled public hand sanitiser booth. Interestingly, it is the second sanitiser booth labelled ‘HAND (After touching Hand Sanitizer) SANITIZER’ that draws the reader’s attention (McConnell 2020). The thematic force is evident in the contrast McConnell provides between the comic absurdity of sanitising the sanitisers and the brutality of actual pandemic fears. Given the interaction between an object and a subject and how such interactions impact and shape human experiences and perspectives, it is not surprising that in the wake of the COVID-19 pandemic, sanitisers (as objects) have played a crucial role in shaping our day-to-day activities, influencing our perspectives and eliciting a range of psychological reactions. Put differently, McConnell’s cartoon visually enunciates contamination fear, anxiety and obsessive-compulsive behaviour prevalent during the COVID-19 pandemic through an elaborate decontamination ritual. Illustrated in grey and white, McConnell’s cartoon concretises the collective consciousness of a population plagued by ‘unmanageable fears and thoughts that compel repetitive, ritualized behaviors that are performed in an attempt to drive out the obsessive thought’ (Rosenberg 2017, par.3). While for some, following precautionary measures during COVID put their concerns to rest, for others, especially germophobes (an individual with an extreme fear of germs) and people with anxiety disorders (such as obsessive compulsive disorder) led to compulsive behaviour aimed at managing intense feelings of anxiety and fear. Through the image of the second sanitiser booth, the present comic animates how contamination fear disrupts, affects and at times dominates one’s life. In the absence of the second sanitiser booth, the cartoon can be read merely as an advocacy for masking and sanitising. Therefore, it is the second sanitiser booth that not only assumes a specific and amplified expression but also imparts narrative force to the cartoon. Furthermore, the lone man in the cartoon symbolises the common man/general populace who is at once sanitising his hands but also plagued by anxiety because ‘surfaces that were once invisible and innocuous have now become charged with a sense of being sites of disease,’ (Trigg 2022, 107). The Joshi IA, Venkatesan S. Med Humanit 2024;0:1–8. doi:10.1136/medhum-2023-012733 protagonist’s psycho-emotional state is not explicitly verbalised or visually depicted as implied through the second sanitiser booth. However, the contrast between the anxious fears of the masked man and the low risk of catching the virus through the sanitising dispenser sets the overall tone/mood of the cartoon. Since man’s situatedness in the external environment allows them to ‘reach out to things, maneuver out of the way, adjust ourselves, and communicate with others—all without having to think about it in the abstract’, man takes these actions for granted (106). However, the pandemic has prompted human beings to be acutely conscious of their actions and the (in) animate entities around them, as reflected in McConnell’s cartoon. Consequently, the cartoon also highlights how everyday objects/surfaces have turned strange, sinister—even harmful— and are therefore viewed with fear, suspicion and anxiety. in such a manner objects, whether ordinary everyday objects or pandemic necessities such as masks and sanitisers, determine and exert power over human subjects. Contrary to anthropocentric beliefs, the COVID-19 pandemic has highlighted how human life, agency and existence is determined by their relation to living (animals, birds, even viruses) and non-living (objects) beings. McConnell’s cartoon covertly portrays such dynamics by depicting how humans rely on inanimate objects to protect themselves from a submicroscopic microbe. In conclusion, McConnell’s ‘Hand Sanitizer’ not only presents nuanced issues centred around the neo-normal lived experiences of contamination fear and obsessive hand washing/sanitising, but also offers insight into the broader relational structures of which man is but a mere part. Coda Beyond their role as a tool for immunisation, sanitisers have emerged as symbols encapsulating global fragility, individual vulnerability and a sense of radical otherness in the aftermath of the COVID-19 pandemic. At the level of their physical significance as objects, sanitisers have altered the fundamental relationships between animate and inanimate objects owing to contamination fear and viral consciousness. Drawing on OOO, this article illustrated how sanitisers surpassed their utilitarian function, evolving into influential objects, that, on occasion, shape and govern our existence. On a sociocultural level, however, issues pertaining to sanitisers have gained a more immediate resonance as concerns regarding the effectiveness of sanitisers, the presence of toxic ingredients, fear of contamination, hoarding, panic buying and the exorbitant pricing of sanitising products dominated pandemic discourses. Honing a visual mode of understanding through comics offers a powerful, richer and more nuanced iconography of the various aforementioned concerns related to sanitisers and sanitising practices during COVID. Notably, Munroe astutely points out that the use of sanitiser is only a precaution and does not guarantee complete immunisation against COVID-19. On the other hand, Morrissette examines the addition of toxic substances in sanitisers, thereby prompting a necessary examination of potential health risks associated with these widely used products. Shrivastava, in a more lighthearted manner, skillfully addresses the societal concerns of panic buying, stockpiling and inflated prices of essential commodities like sanitisers during the COVID-19 pandemic, shedding light on the interconnected issues of consumer behaviour and economic pressures. Finally, McConnell conveys how sanitising rituals and contamination fear have negatively impacted the psychological and emotional well-being of individuals. These 7 Med Humanities: first published as 10.1136/medhum-2023-012733 on 23 February 2024. Downloaded from http://mh.bmj.com/ on February 24, 2024 by guest. Protected by copyright. Original research graphic texts urge individuals to reflect not only on the challenges posed by COVID-19 but also the enduring impact these seemingly mundane objects have on our daily lives. In essence, this article not only brings to relief the materiality and ontological significance of the sanitisers as ‘objects’ but also contributes to a broader conversation about the complex web of concerns associated with their use, including their appropriation within the contemporary capitalist culture. Contributors Both authors have contributed equally to the article. IAJ, guarantor. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not applicable. Ethics approval Not applicable. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data sharing is not applicable as no data sets were generated and/or analysed for this study. Not Applicable. ORCID iDs Ishani Anwesha Joshi http://orcid.org/0000-0001-5850-8788 Sathyaraj Venkatesan http://orcid.org/0000-0003-2138-1263 NOTE 1. Randall Munroe is the author of What If?, Thing Explainer, How To: Absurd Scientific Advice for Common Real-World Problems, and What If? 2. BIBLIOGRAPHY Agrim, A. 2020. “History of Hand Sanitisers, Supply Chains and Something on Distilleries.” Investment Promotion and Facilitation Agency. Available from: https://www. investindia.gov.in/team-india-blogs/history-hand-sanitisers-supply-chains-andsomething-distilleries Baronian, M.-A. 2020. “Textile-Objects and Alterity: Notes on the Pandemic Mask.” In Pandemic Media: Preliminary Notes Toward an Inventory, edited by P. D. Keidl, 213–18. Lüneburg, Germany: Meson Press. 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