Hard work, late nights, and the imminent election season, which unhappily coincides with the start of flu season, make a potent recipe for political candidates and staffers to catch a flu bug.
But it is the bread and butter of a political campaign -- connecting with people -- that truly puts a person like Sen. Barack Obama or Sen. John McCain at risk for illness.
"They are encountering so many people in such close quarters, often in enclosed spaces, for prolonged periods of time," said Dr. William Schaffner, chair of the Department of Preventative Medicine at Vanderbilt Medical School. "Getting close to people and shaking hands are risk factors for getting an infection."
Despite the cramped quarters during a presidential campaign that makes illnesses hard to avoid, experts say there are a few things candidates can do to stay flu-free as they work their way through election season.
The common admonition, Schaffner said, is to avoid those who are coughing, sneezing, have runny noses, and generally look ill. Three feet is all it takes for a healthy person to be able to inhale virus-laden water droplets spewed from the mouth or nose of an infected person.
But it is impossible to predict who will become ill or who has been ill recently. Influenza can be transmitted one day before and up to five days after being sick. Each year, 5 percent to 20 percent of the U.S. population gets the flu, according to the Centers for Disease Control and Prevention.
No Flu-Free Campaigns
And political candidates get around. On the average day, Sunlen Miller, an ABC News producer covering the Obama campaign, estimated that Obama shakes hands with about 500 people.
"If I were in the campaign... just assume that I am encountering viruses all the time," Schaffner said.
And it is nearly impossible for a contingent of assistants and press to avoid a virus while traveling together.
"We're packed in the back of the plane like sardines," Miller said. "People pass on these sicknesses."
Avoidance aside, frequent hand-washing is an effective way to get rid of germs and viruses before they are transmitted to the nose or mouth.
Good etiquette, such as working in a sequestered area and using a tissue or a handkerchief or the crook of the elbow to block a cough or a sneeze, can also prevent flu from spreading.
"Bend your head away from everyone else, raise your arm, and sneeze or cough into the crook of your elbow," Schaffner said. "Do not spray your respiratory secretions into the vicinity."
Among the controversies that dot the campaign trail, doctors say using natural cold and flu remedies, such as Echinacea or Vitamin C, is one of them.
"We're rather pessimistic about both of them because the data are decidedly mixed," Schaffner said. "The impact at best is going to be small, though you might wish to use them regardless."
And Schaffner cautions that those who choose to take large amounts of vitamin C should drink two extra glasses of water so that the excess vitamin can be excreted through urine, preventing it from crystallizing in the urinary tract.
Common Sense Cures
Staying hydrated, rested, and getting some exercise will keep you feeling well in general, Schaffner said, and better positioned to fight off an infection.
Most candidates do make a point to work physical activity into their schedules.
Chris Lee, the republican congressional candidate from the 26th Congressional district, which covers most of western New York, runs several miles a few times each week, according to Andrea Bozek, a campaign spokeswoman.
In addition, Schaffner said September is a good time to look into a flu vaccine because the virus can cause outbreaks as early as October, though the peak season is in January and February.
But staying in bed because of the flu may seem too large a sacrifice to make as political candidates and their teams make their final push for office.
"I'm afraid campaign workers tend to have the 'push on' mentality, probably until somebody else tells them to go to bed," said Ann Wadsworth, campaign spokes person for Alice Kryzan, the democratic Congressional candidate for the 26th Congressional district.
And campaign staff may have their own ideas about what works in the face of illness.
"Pizza," Wadsworth said. "Cold pizza is very good. The antioxidant properties in those tomatoes."
A shared flu can bring out camaraderie during a stressful campaign. Miller recalls being so ill she lost her voice after the Iowa caucus earlier this year. Obama had the same bug and offered her his own throat-soothing tea recipe made with honey and ginger.
At the very least, feeling under the weather can affect how energetic a candidate is onstage during public events. While the audience may not know that the candidate is feeling poorly, Miller said there is a difference.
"He might deliver lines less powerfully or mess up some lines," Miller said. "[People] react to his energy. It changes the mood of the room and of the event," Miller said.
But at this stage in the game, getting sick is simply not an option, whether you are Barack Obama or John McCain and running for the U.S. presidency or a local official running for a state office.
"We can only recommend that if you come down with something, please don't give it to anyone around you," Schaffner said. "But I have a feeling that recommendation may fall on deaf ears."
But both Wadsworth and Bozek agreed that the primary concern for a sick candidate who had to make public appearances was to try and minimize the chances of infecting anyone else.
"This is the season when the winter respiratory viruses start to make their way through the population," Schaffner said. A candidate may not want to present themselves, flushed and sniffling to an audience.
"They might say, 'Give us your messages but not your viruses,'" Schaffner said.