Swine Flu Loves a Crowd

THURSDAY, Sept. 17 (HealthDay News) -- With the H1N1 swine flu virus lurking in every nook and cranny, all Americans should be on guard this coming flu season.

But experts say those living and working in crowded locales -- schools, colleges, prisons, cruise ships, airplanes, military barracks -- need to be extra careful.

"Any crowded place carries a heightened risk," said Dr. Melinda Moore, a senior health researcher at the Rand Corp., in Arlington, Va. "It really has to do with people being in close quarters and having disease-transmitting behaviors such as coughing and sneezing."

"The virus is mainly spread the respiratory route, and it's also on inanimate objects like doors and knobs and handles and desktops and telephones," added Dr. Stuart Beeber, attending pediatrician at Northern Westchester Hospital Center, in Mount Kisco, N.Y. "It's mainly in close quarters where a lot of people are together, such as in classrooms or offices, potentially even movie theaters."

The danger of transmission lies not only in the fact that hordes of people are together for long periods of time, but that those hordes may not be practicing good hygiene.

"Any environment in which people are crowded together with compromised hygiene carries a heightened risk," said Dr. Dean Blumberg, an associate professor of pediatric infectious diseases at the University of California, Davis, Children's Hospital. "It's when people don't have access to hand washing or shower facilities."

Younger children are not naturally very hygienic, Blumberg pointed out.

College students may also engage in behaviors that are friendly to the spread of the H1N1 virus, such as kissing and sharing drinks. If those drinks are alcoholic, judgment may be affected, resulting in even more unsafe behaviors. Smoking can also compromise the respiratory system, making you more vulnerable to infection, Blumberg said.

The added problem in jails and prisons is that stepped-up hygiene needs to be balanced with safety and, in some cases, could actually compromise safety, Blumberg said. For example, "alcohol-based hand gels can be dangerous in that environment," he said.

Budget cuts may even be contributing to a hygiene crisis. The current fiscal problems plaguing California affect all school facilities, including those related to hygiene, Blumberg said.

"The people involved may not be quite as interested in disease prevention compliance as they are with other things, but that doesn't make it any less important," Moore said.

The first line of protection is what experts call "respiratory etiquette." Coughing and sneezing into your elbow or handkerchief doesn't require any special facilities. And, as often as you can, wash your hands or cleanse them with hand foam or alcohol gel. "You may also want to wipe down surfaces that you are in frequent contact with, like door knobs," Beeber said.

These are also messages the airline and cruise-ship industry are emphasizing more than usual right now, although, for the most part, it's business as usual for travelers.

According to Erik Elvejord, a spokesman for Holland America Line, based in Seattle, the cruise ship industry is already bound by strict public health standards, including not letting sick passengers board a ship and isolating sick passengers who are already on board. Ships do have some flu-testing equipment on board as well as antivirals, he said. Passengers also receive notes on their pillow reminding them to wash their hands, and containers of hand sanitizer are placed all around the ships, although these measures are not new, Elvejord added. "We've kind of been doing what we've been doing all along," he said.

Although one passenger on a recent commercial airline flight was told by the flight crew that blankets were no longer available in economy class because of swine flu concerns, David Castelveter, a spokesman for the Air Transport Association (ATA), said he has "not seen that wholesale."

For the most part, the airline industry is also proceeding with travel-as-usual. "We [already] have pretty sophisticated filtering systems," he said.

Debunking one persistent myth, Castelveter stressed that cabin air is not recirculated, but comes in the side, moves in a circular motion, then exits the plane into the great beyond. The worst danger comes from the person sitting next to you -- not in front or behind, Castelveter said. "The person who sneezes in row 3 will have no impact on someone sitting in row 11," he said.

Airlines are being more diligent in passing out hand-washing messages, and both water and antibacterial soap are available on most airplanes.

The ATA is also communicating regularly with CDC officials and will follow any recommendations they make, such as screening passengers before boarding an aircraft. So far, nothing has changed, Castelveter said.

As always, people who are sick should stay away from others. "The buzz word is social isolation, so children who have flu-like symptoms should stay home from school and workers who have flu-like symptoms should stay home from work until they have been fever-free for 24 hours without any drugs," Beeber said.

More information

There's much more on H1N1 flu at the U.S. Centers for Disease Control and Prevention.

SOURCES: Melinda Moore, M.D., senior health researcher, Rand Corp., Arlington, Va.; Dean Blumberg, M.D., associate professor, pediatric infectious diseases, University of California, Davis, Children's Hospital; Stuart Beeber, M.D., attending pediatrician, Northern Westchester Hospital, Mount Kisco, N.Y., and senior physician, Chappaqua Pediatrics, Chappaqua, N.Y.; Erik Elvejord, spokesman, Holland America Line, Seattle; David Castelveter, vice president, communications, Air Transport Association