In an effort to contain swine flu, the French Health Ministry this week called for citizens to avoid "all direct contacts between people and particularly with sick people," which means no kissing or shaking hands. Quelle horreur, one might think, but the French seem ready to banish their tradition, called la bise, of bestowing pecks multiple times on both cheeks. Some businesses are instituting bise bans, and schools are instructing students to greet one another by raising a hand, like American Indians. Here in the United States, our own Centers for Disease Control and Prevention issued a guidance for college students last month instructing them to partake in "self -isolation" if they're suspected of being infected with the H1N1 virus that causes swine flu. The agency goes on to say:
If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact. Examples of close contact include kissing, sharing eating or drinking utensils, or having any other contact between persons likely to result in exposure to respiratory droplets.
This, of course, conjures an image in my mind of couples making out in surgical masks while swaying to the music at a frat party. Such silliness makes me wonder: Just how effective at stemming the spread of swine flu is all this advice?
I posed this question to swine flu expert Richard Wenzel, past president of the Infectious Diseases Society of America, who spoke to me yesterday from Mexico City (where he was investigating a resurgence of the infection, which broke out there and then subsided in late spring). Certainly, he says, it's smart for infected people to avoid close contact with others, but just how effective these measures are, no one knows. "There are sections in Mexico where 30 percent of the population is now infected," he tells me, despite the fact that much of the country donned face masks when the outbreak started there in April. "We've seen evidence of the virus not just in droplets from the nose and mouth but also in the stool."
That poses particular problems for pregnant women changing the dirty diapers of their infected toddlers. Pregnant women are at heightened risk of developing severe complications when infected with H1N1. In fact, those with infected family members are in a tough spot until the vaccine becomes available. In a previous blog post, one reader wrote a comment that she was pregnant and just found out her 3-year-old had swine flu: "I have been advised to avoid direct contact with him for one week from when he began taking the Tamiflu dose," she wrote. "I just would like guidance on how I could see him without endangering my unborn child and myself. It is very difficult to hear your child crying your name and you cannot go to him."
Wenzel, who's chair of the department of internal medicine at Virginia Commonwealth University, tells me that pregnant women who are in this situation should consider taking a prophylactic dose of an antiviral drug. "These drugs offer about 90 percent protection from H1N1," says Wenzel, "though as a treatment, their benefits are pretty modest, reducing the duration of symptoms by just a day."
In its guidance to pregnant women, the CDC says those who've been exposed to someone with H1N1 should consider taking the inhaled drug zanamivir (Relenza) as the first drug of choice because it's not absorbed as readily into the bloodstream and poses less risk to a developing fetus. Women with respiratory problems who can't take Relenza should consider oseltamivir (Tamiflu) as a "reasonable alternative." The agency emphasizes, though, that the rest of us shouldn't take these drugs as a preventive measure; the risk is that the virus will mutate into a drug-resistant strain.
There are other things that we can do to avoid getting infected with H1N1. Despite the bashing of la bise, kissing on the cheek probably isn't a common route of transmission, says Wenzel. Handshakes, though, are problematic, so if you must meet an extended hand at, say, a business meeting, sneak that travel-size bottle of hand sanitizer out of your purse and rub some on when no one's looking. The key is to not rub your nose, mouth, or eyes after you've just come in close contact with someone who's coughing, sneezing, or blowing his nose—that is, until you've washed or disinfected your hands. Hugging, Wenzel adds, is actually better than a handshake. And, yes, you should avoid sharing a beverage or mouth kiss with someone who might be infected.
Also, be aware that the H1N1 virus can live on objects, like a phone or computer mouse, for a few hours. So avoid sharing them with colleagues, or swab them down with alcohol wipes frequently. I use my own pen when signing credit card receipts instead of the one handled by dozens of other customers before me.
Sometimes, infection is simply unavoidable. About 7 to 8 percent of infected people, Wenzel says, "are what we call superspreaders—transmitting the virus to 10 or more people." These folks, he theorizes, exhale microscopic droplets that stay suspended in the air for hours like hot-air balloons, waiting for someone to walk by and breathe them in. No amount of hand washing will protect you from that.