Let's talk about wee. We may also touch on poo. It's not something we would normally talk about, unless with our doctor, but current circumstances remain some way from normal, in that we are slowly re-emerging from lockdown, super-keen to see our loved ones, have been given the go-ahead to travel a bit, but - and here's the issue - what if we need to go to the loo?
There aren't any. What may seem like a simple lack reflects something quite complex, in terms of health, wellbeing and the environment. We can't all pee in bushes. Even if we were able-bodied enough to urinate outdoors - unlike men, women must squat - if everyone did it, the results would be unhygienic, socially unacceptable, and kill the bushes. Beaches, parks, areas of beauty would smell horrible. Plus, it's undignified, unless you are wild camping somewhere remote. Anywhere else is not an option.
So what can you do? Does this mean people who need to pee frequently - which is loads of us - have to stay home? It's been deemed okay to use the bathroom when you visit people's homes - hand washing remains key - but what if this isn't an option? Does it mean you have to stay home, not because of Covid, but because of lack of public facilities? Or if you want to venture out, does this mean you have to make friends with a urinating device like a Shewee, or purchase a mini chemical toilet to keep in your car? Do any of us really want to do that?
"Toilets are a vital piece of infrastructure," says Raymond Martin, from the Toilet Association of Ireland. "They are essential for social inclusion, equality, dignity, health and wellbeing, and public decency. We should not have to revert to going in the bushes. Toilets need to be reopened and kept open and we need a new way of cleaning them."
Especially as new research from China, published earlier this month in the journal Physics of Fluids, shows how coronavirus can not only be present in poo, but also in the air after the loo has been flushed - possibly lingering long enough to infect the next cubicle user. Yikes.
"Before Covid, toilets were cleaned first thing in the morning and last thing before being locked up for the night. Now, they will need to be cleaned every hour to make sure that they are safe.
"The big problem is that councils have very little funding for toilets - they come under 'discretionary services', and there's no specific legislation, or dedicated staff. Public toilets are looked after by general staff, but they need their own cleaning teams in places with large crowds. There is no Ministry for Toilets - they fall under leisure, amenities, commercial buildings. "We are expecting a 50pc rise in staycations this summer, which will put an additional strain on public toilets. We need to get them open, keep them open, have more staff who are better trained, and regarded as essential workers.
"It has a huge impact on people being able to go out as lockdown eases. Pregnant women, old people, children, people with Crohns or colitis or bladder issues - they all need access. As do lorry drivers, who are key workers, on long journeys who are being forced to urinate in bottles and defecate in cardboard boxes.
"We've had reports of people defecating in gardens, bushes, sand dunes, shop doorways. This is an urgent public health issue, it's hugely important and needs emergency funding right now."
Galway GP Dr Brian Higgins believes that the lack of public loos is discriminatory. "Lots of people have bladder issues - urinary incontinence is incredibly common in both men and women, and not just amongst the elderly and infirm," he says.
"Not having access to toilets discriminates against pregnant women, women who have recently had children, anyone who has had bladder surgery, men who have had prostate cancer, and older people, because our pelvic floor weakens as we age.
"The main problem when our bladder is full beyond capacity is that we run the risk of having an accident, and so people for whom that risk is higher might stay home rather than venturing out. This can lead to social isolation. And if you delay defecation, that can lead to constipation, before you ever consider people who suffer from conditions like Crohns or colitis.
"Regarding portable loos or Shewees, people shouldn't have to do that. And public toilets, when they are open, are not properly maintained. This disproportionately discriminate against the disadvantaged, who may not be admitted to use toilets in cafés if they are not customers. We need better public toilet facilities, rather than relying on restaurants and cafés. Most bathrooms have wipeable surfaces. So if there were disposable wipes at the entrance of each loo, people could wipe down before and after use."
Apart from discomfort and inconvenience, holding on when you need to pee is not great for your body. "A healthy bladder can hold between 300-600ml, but holding urine on a regular basis is not good," says Aoibhín McGreal, Clinical Specialist Physiotherapist in pelvic floor dysfunction at the Beacon Hospital. "Every now and then is not harmful, but regularly it can weaken the detrusor muscle. You can help your bladder by limiting your caffeine intake, or training it by waiting until it's full before emptying, and if you have ongoing issues, physiotherapy can help.
"The people who will be most impacted in relation to lack of access to public loos are those who can't hold on at all - those with bladder urgency, frequency or incontinence, which is one in three women, and one in 10 men. One in five women have bowel urgency, particularly after giving birth. What are people who can't hold on going to do? Nobody should have to use a device - there needs to be access to toilets.
"This is a public health concern, with implications for physical and mental health, because it impedes the two things vital for both - exercise and social contact."
And as well as a lack of facilities - in the UK, it's one loo per 12,500 people, and in Ireland there are no available figures, as public loos do not come under HSE jurisdiction - the quality of our facilities is not good. "They are mank," says Dr Higgins. Which is why Irish people tend to be squeamish around using them - a 2014 survey by Initial Washrooms found that 62pc of us would rather hold on.
So, as restaurants and cafés slowly reopen, perhaps we can use theirs - but this is a complicated social manoeuvre, involving the obligation to buy stuff, unlike popping into a public loo. In Dublin, the council opened several new facilities in the city centre, after local businesses campaigned - one local café owner started a petition and fundraiser to install festival-type portaloos, to highlight the dire need.
Opening restaurant and café loos to the public will need to follow stringent hygiene protocols. The Fáilte Ireland guidelines for cafés and restaurant owners reopening post-Covid, says Adrian Cummins of the Restaurant Association of Ireland, include queueing systems, limited numbers of users to ensure physical distancing, clear markings to minimise contact, the use of alternate sinks where possible, and toilets to be cleaned and disinfected at least twice a day.
However, whether you are using the loo in a private home, a public facility, or a privately owned public space like a café, the same things remain crucial - hand washing, and maintaining your physical distance. The HSE offers these guidelines for when you visit someone's home, but none for visiting public loos: "If visitors can keep 2 metres apart from you and each other, face coverings are not needed. If it's not possible for people to keep 2 metres apart, everyone should wear a face covering. Clean your hands regularly and invite your visitors to clean their hands when they arrive. Do not wear disposable gloves instead of washing your hands. The virus gets on them in the same way it gets on your hands. Also, your hands can get contaminated when you take them off. After your visitors leave it is good practice to clean surfaces they have been in contact with. Use your usual household cleaning agents and detergents."
Going forward, Covid may mean the provision of more and better public loos, as a health necessity. We may see the end of the urinal, and more use of self-closing loo seats, foot-operated flushes, sensor activated taps and soap, cubicles with sinks and baby change facilities. Basically, the kind of facilities you get at airports - but for everyone. It's a fairly basic human right, having somewhere clean and private to go.
Health & Living