Toilet paper has been an issue since the start of the pandemic, but now toilets themselves are the concern. As stay-at-home restrictions are lifting, many are feeling a long pent-up urge to go out, but what's stopping some is concern about their urge to gowhile they're out.

As in, use the bathroom.

Loath to risk the germs in a public restroom, if they can even find one that's open, many are limiting their outings while others are getting creative.

Shu Sanatani, a pediatric cardiologist in Vancouver, Canada, never used to think twice before going for his usual two- to three-hour run. Now, every time he heads out, he becomes kind of obsessed.

"It's the anticipation of, 'What if I have to go to the bathroom?' " he said, mocking his usual panic. "Do I have to go to the bathroom? Uh oh, now I'm thinking about going to the bathroom, and now I feel like I have to go to the bathroom."

Recently, his worst fears came to be. He really did have to go. His route took him by countless businesses that were closed, before he finally found a car mechanic's shop that was open. But the staff wouldn't let him in.

"The panic grows as the third and fourth options exhaust themselves," he said.

He was considering just going outside, then thought better of it.

"I can't imagine it would be popular if someone saw me leaving my presumed viral sheddings somewhere in their petunias," he said with a laugh. So he changed his route and finally found a hospital that did let him in.

It was a relief to him. But for many people, the prospect of using a public restroom is hardly comforting.

Among those who cringe at the idea is Cheryl Bowlan, 69, who is moving from California to Portland, Ore., and will be driving the 12 hours with her husband. With all the planning and packing, she only recently realized she would have to use the public rest stops along the freeway. It left her just a little panicked.

"I woke up early one morning and all of a sudden, ding, it occurred to me. Ick! Nasty!!" she recalled. "There are hundreds of people going through there every day, and I didn't want to do that."

Experts say such fears are well-founded.

"It's miserable. Disgustingly miserable," said Dr. Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic in Rochester, Minn.

Just the fact that bathrooms tend to be highly trafficked and too cramped for social distancing makes them risky, he said. But on top of that, poor hand washing leaves doorknobs, faucets and other surfaces contaminated. And flushing the toilet can create a plume of vaporized germs up to 6 feet high, he said. While it's not yet proven the coronavirus can spread that way, it is known that other viruses can.

"It really is a nightmare," said Poland. With all that going on, he said, "you have a bioweapons factory in [there.]"

Some businesses are trying to adapt by installing touch-free doors, faucets and hand dryers, for example. Or they're switching to touch-free paper towel dispensers to avoid the possibility of hand dryers blowing coronavirus through the air — another potential, though not yet proven, risk.

Businesses are also cleaning and disinfecting more frequently and requiring face masks to enter. Some are even hiring bathroom monitors to control crowds and enforce distancing.

Steven Soifer, president of the American Restroom Association, which advocates for clean and safe public bathrooms, said many businesses are also installing dividers between urinals or closing down every other one.

"There's a new term out there," he said. "It's called 'social piss-tancing.' "

Soifer hopes the heightened awareness brought by COVID-19 will prompt what he sees as a long overdue overhaul of public restrooms. "We're advocating for more revolutionary toilet design with the single stall, fully enclosed water closets with toilet seats covers" that are typical in Europe, he said. "That would address many of the issues."

But that would take more money than many businesses would want to invest, and more time than many people can wait, including Cheryl Bowlan.

"It suddenly popped into my mind that I'll just do it in the car," she said.

Bowlan is one of a growing number of women who have bought a portable urinal called the Feminal. It's an ergonomically correct canister with a screw cap, designed by urology nurse Linda Asta. Once a niche product for outdoorsy types or bedridden patients, it's now a mass-market, high-demand item.

"All of a sudden sales have actually quadrupled in a month and a half," Asta said.

There are also a slew of other urinals and portable potties for men and women on the market too, as well as feminine funnels, including the Go Girl and the Shewee. Adyn Sonju, a partner at The Tinkle Belle, said her product allows women to "go wherever the men go" and has what she described as a built-in squeegee feature that eliminates the need for toilet paper.

"It's freeing to be able to go anywhere and know that you can just go when you need to go," Sonju said. "You just carry it with you like a portable restroom."

The SaniGirl is a disposable option whose year-over-year sales sales are on track to triple this spring, according to founder Susan Thompson. She thinks the product will not only "change women's lives as they venture back out and start to get their lives back," but also may well change bathroom behavior forever, given the public's newly heightened awareness of germs and the "shock" of the pandemic. She adds that some customers even use it in public restrooms so they don't have to sit or touch as many surfaces.

The portable products do carry their own risks if you don't hold them in place just right, so most manufacturers recommend practicing at home. You don't want your first try to be on the road or after a few drinks during a night out. But after a few (hopefully) dry runs at home, they say going on-the-go will be the safer way to go.

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