Mass Transit: Subways and Buses a Breeding Ground to Catch Cold and Flu?

As more people opt to take buses and trains, some warn of cold and flu spread.

Sept. 18. 2008—, 2008 -- Higher gas prices are driving more people to take public transportation -- and as a result could drive up the number of cold and flu cases this season.

The American Public Transportation Association announced that in the second quarter of 2008, more Americans opted to ride public buses and trains rather than take their own cars -- 140 million more trips than the same time last year.

However, as more and more commuters pack into trains and buses, the chances that they will be placed in close proximity to someone who is already infected with a cold or flu virus are significantly higher.

So what can we do as passengers to avoid the cold and flu, otherwise known as the "crowding disease"?

When You're Next to Someone With the Cold or Flu

We have all been in this situation before: The person you're sitting next to is constantly coughing and sneezing. It is pretty obvious that they are sick, and you start to get that creepy sensation as if some of their illness has seeped into your system. How does one escape from this scenario to avoid getting sick?

"Get somewhere and sit somewhere else," advises Dr. Howard Markel, professor of the history of medicine and of pediatrics and communicable diseases at the University of Michigan Medical School. "If someone is coughing, I would avail myself that opportunity. Our mothers were right when they said, 'Don't let anyone cough on you.'"

More often than not, however, trains and buses are so packed that it's difficult to remove yourself from such situations. So, what do you do when you find yourself trapped?

"Breathe shallowly," Markel recommends. "Try not to let them cough on you." In that way, he explains, transmission of germs can be reduced.

If you are seated next to a child who is hacking up a storm, you should get up even faster.

"Children do not have good respiratory etiquette," says Markel. One might say that this is an understatement; children have the tendency to drool, and mostly do not cover their mouths when sneezing or coughing.

In addition to this, once adults have children, they double their risk of getting the cold and flu, according to Charles Gerba, professor of environmental microbiology at the University of Arizona. And children tend to touch themselves with their hands about 40 times per hour, about twice as often as adults do.

Also, washing your hands after you get off the subway or train is probably a good idea. Good old soap and water can eliminate any of the germs you may have collected while riding alongside someone with the cold or flu.

Strategic Sitting: Best Places to Park Yourself?

There is little evidence to suggest that some surfaces on public transportation are germier than others. According to Gerba, there haven't been many studies done on germs and public transportation.

However, there are some facts to keep in mind.

The metal poles and straps that passengers hold on to are often contaminated with microbes and bacteria.

"Stainless steel is a good transfer surface," Gerba points out, adding that about 50 percent of the germs on those poles are picked up by human hands, making them great carriers of the cold and flu virus.

You can also try and be aware of your surroundings and scope out where people are sitting. That way, you can possibly reduce your exposure to the virus.

"Go to the least used part of the bus," Gerba suggests. "The back of the bus seems like the least used part."

And sitting next to an open window is not necessarily the best place on the bus.

With regard to airborne germs, good ventilation "may dilute it a little," says Markel. However, there are no conclusive studies that directly suggest the window seat on the bus is a flu-free sanctuary.

Standard Cold and Flu Preventive Measures Important

Several studies have shown that viruses tend to be transmitted from the hands to mouth, to eyes and other body parts that are touched. According to Gerba, adults touch themselves with their hands about 18 times per hour -- which makes frequent hand-washing all the more important.

"The best thing you can do is hand hygiene," said Gerba. "The rails and poles you hold on to -- that tends to be germy."

If a sink is not within reach, carrying around an antimicrobial hand gel that is alcohol-based can be a good alternative to soap and water.

"I would emphasize using any antimicrobial hand gel -- I take that on airlines," recommends Dr. Mark Dykewicz, professor of internal medicine at St. Louis University School of Medicine.

Other measures normally associated with cold and flu prevention apply on public transit as well. This includes eating well and exercising, general good health practices and getting the flu shot every year.

"In general, if people would go and get their flu shots, that might help stop some of the transmission," says Dr. Phyllis Kozarsky, expert consultant in the Division of Global Migration and Quarantine at the U.S. Centers for Disease Control and Prevention.

And if you have the flu, Kozarsky says, it behooves you to respect your fellow travelers by simply staying home.

"Unfortunately, we're often in crowded places -- crowded shopping malls before Christmas, schools, not just on public transportation." says Kozarsky. "It's important to be courteous. When you yourself have a fever or cold, it's best to stay at home. [Also], keep your kids at home if they're sick."

No Love From the Gloves

Usually during the cold winter months, we don heavy coats, scarves and gloves to shield us from the blistering weather. But wearing these items while traveling does not necessarily keep us safe from cold and flu viruses. Kozarsky says that what you do with gloves afterward is key.

"You're sitting on the bus, touching the handles, the bars, touching and rubbing your eyes and your face with your gloves," says Kozarsky, adding that in most cases, people are not washing or disposing of their gloves after wearing them.

"They give people an artificial sense that they're helping themselves," Kozarsky remarks. "Hand-washing is more preferable."

Scarves that cover your face also do not act similarly to surgical masks proven to effectively keep germs at bay. Although it may seem like they act as barriers, the microbes can pass through the holes within the knit scarf or fabric.

"I don't know any data that suggest scarves are protective," Kozarsky acknowledges.

If, however, you really want to ward yourself from the cold and flu effectively, you can emulate what laboratory scientists wear as protection -- although you may get funny looks from other passengers.

"The first lines of defense -- the air and touch -- are the backbone of public health prevention," says Dr. Neil Kao, chair of the Allergic Diseases and Asthma Center in Greenville, S.C. "If you get a mask, wear gloves, you have a 99 percent chance of preventing yourself from getting the cold or flu."