Swine Flu Outbreak

Be interesting to see what if any impact this swine flu issue has on the desire of some to increase urban density afterall some will argue that increased density will help diseases spread.

I posted this on another page of this website, but my letter may be even more applicable here in light of the recent out break: To wit:

I'm not a doctor, but I have a thought on the subject for what it's worth. Though my friends think I'm crazy, defying conventional scientific wisdom, I've been skeptical about how transmittable ariborne flu viruses are in open air, esp. outdoors. So this (paper on this site discussing the transmission of airborne flu in contaminated hospital rooms) paper caught my attention. Not to dismiss the flu aerosols, esp in closed areas like school classrooms for instance, but my attention is directed to the potential mode of transmission thru eating establishments, or whereever food is involved and people get together. Perhaps we are eating contaminated food,( or our fingers are picking up flu from surfaces, that goes to our food or directly to our mouths), more than we realize is the gist of my hypothesis here.

I believe I have experienced this first hand myself being sick with influenza (not food poisoning) on a few occassions. I noticed that in many situations were the occassion is to share a meal with others, a house, a restaurant, etc, there is often at least one person sick. Often it's the cook, the waitress bringing the plate of food, or if a potluck, or salad bar, any number of diners can transmit their germs to the community food. And perhaps they are unwary of their developing illness, being in the initial stages, but still very contagious.

I also observe patrons of eating establishments, and poor manners as it is, quite often people eat with their fingers, that is they have to smack the food off their fingers, then their fingers are everywhere else. I've seen them dunk their fingers in salad bars as well. I've witnessed a whole family, adults and kids, all with a cough, and all sticking their fingers in their mouths, and then their hands touch tables, chairs, etc. Perhaps the virus in addition, the virus can be present in several areas around the eating are from patrons sticking their fingers in their mouths, or coughing on surfaces, and unwary patrons come and pick up those germs to their hands and ultimately to their mouths while they eat.

I recently contacted a mild cold or flu, and I believe I can trace the source to a cook in one of the local fast foods. Last year I got a good dose of the flu and I believe I traced that to a potluck of about 30 people, and I was the last to serve myself from the food pot. Recently the cashier in the grocery store was sick I noticed, and thought that every bit of food that I buy may have some of her germs on it.

To conclude, I suspect that flu and cold transmission via areas of served food may be contaminated by either cooks, servers or patrons, and that perhaps this is a widely underestimated mode of transmision. If that can be of any help whatsoever so much the better. Mark Miller
April 27 2009

Maybe I'm wrong with my theory that flu spread can come thru food that has been contaminated with flu germs and that mode of transmission is widely underestimated?
Doing some more searching today, virtually every website I've viewed (including CDC spokespeople) state flatly that "flu can not be spread by eating food".
This is perplexing because in the same breadth practically, it is stated that flu can be spread by picking up germs with your fingers and then touching your eyes or mouth. How can this be? That is if a food caterer, who is sick with flu and/or carries flu germs, sneezes or coughs in the vicinity of your food, then it would seem that those germs, the aerosols (small and large) can settle on your meal and that as you eat that food, those germs are entering your body. Food must pass thru the mouth, so how can that statement above be true?
Maybe germs entering the stomach don't stand a chance in that kind of environment? Or or flu bugs in the stomach equally as virulent as the repiratory tract? I would like to be informed on this. Thanks.

MM, I expect that the advice about flu not being spread by food is meant to reassure people that eating, say, the meat of a pig that had swine flu is not a mode of virus transmission.

There's still a lot we don't know about how flu is transmitted, but aerosols are a likely suspect, and exposure via the mucous membranes in your eyes and nose a likely route.

Thanks Liz for the feedback. I returned to this site again since I just noticed a patron at a restaurant smacking all her fingers as she ate. I was thinking how effective a mode of transmittal of germs this would be in flu season, as all subsequent patrons would get her germs- whether it be on the same table, or chair, or money, or the help yourself areas, etc. Many of those patrons will also put their fingers in their mouths, or eyes, etc. But, you may be right that the mucous membranes are far more susceptible to aerosols, and that perhaps manual spread to the mouth or stomach (or eyes) are not so effective, and I am totally wrong about eating areas being the big source for flu spread.

That does leave the lingering question, however, of why healthy people visiting tight quarters with sick folks, where flu aerosols are overly abundant, don't get sick to the frequency that would be predicted. More will come out on this some day, for sure. Just my two cents worth, if that.

I was thinking of the horrible 1917 flu outbreak and wondering what the primary mode of transmission may have been that contributed to so many victims in the military.

Was it mainly from the tight quarters of the barracks with abundant flu aerosols? Or could it have been from the dining, 'mess' areas? Perhaps flu aerosols from coughing and sneezing landed all over the tables and food that was being served. Maybe ill cooks and food handlers were transmitting their germs to everyone who ate? Or maybe it was aerosols that were inhaled directly, or in contact with eyes?

This is in light of recent observations about healthy visitors not getting sick by visits to rooms that should seemingly be chock full of flu aerosols. Were the soldiers getting mainly getting sick by the aerosols of the tight quarters of barracks or messhalls, or were they mainly getting sick from physical contact with the viruses?

Just a little followup with more observations. Three toddlers the other day at the grocery store, at least one is coughing with a cold. They are all playing unsupervised in the cheese/dairy area, forgot what, grabbing, and touching and coughing on products. You come along later, grab those items, germs are on your hands, near the food you will be consuming, plus on the checker's hands who will be touching many more items of other customers.

At a restaurant, three people seated in the table next to us, one with a cold coughs, but as she does this, she points our direction. Some of it was deflected on her elbow, I hope. I look up to three tables away, Another patron is eating at atable, his hand straight up in the air, smacking all his fingers clean, then eat more and repeat process. Though he did not appear to be sick, you don't really know, but multiply this by millions of occurences across the land, and there will be perhaps thousands doing this behavior who are contagious.

Several more, just forgot what they were, but similar mode, and this is just me, one person, occassionally making casual observations. Add a couple of couging grocery store clerks, and deli sandwich makers to the list, though this year was not bad at all for flu.

Now, maybe the inhaled aerosols are the most contagious, but then again, why do we make such a big deal out of washing hands? If washing hands is very important, then why are eating establishments, and all the related aspects of food handling and service not ever mentioned as a potential source of flu transfer? I mean you see warnings about keyboards or restroom doors, but nothing, never a word about the potential flu transmission where food is involved, Curious.

Still, after reading my posts I'm not sure I made it clear that I do think flu aerosols spread flu, but my emphasis is on the surfaces where they land (vs inhalation), as I think they must be extremely abundant in eating establishments. So we get contaminated from flu aerosols settling on counters, plates food, as well as patrons spreading their saliva to virtually every surface imaginable.

I recommend observation! People breathe on your food (ie spread flu aerosols when they are contagious), cough on it, touch it, wipe their noses, smack their fingers (often all ten, multiple times), spread their saliva laden fingers to ALL surfaces, dunk their fingers in community food like buffets or salad bars (get a taste of the pudding for instance), etc, Watch kids at the grocery store- parents allow them to 'play' with all the food items. The counter clerk can be sick, the waiter or waitress or cook in the cafeteria or restaurant is sick. They need to work, sick nonetheless, They cough in their sleeves. Their germs are everywhere. That's how it happens imho.

More first-hand restaurant observations lately: Just noticed a patrons at a nearby tables with their fingers in their mouths and then touching the tables and many other surfaces. Not a big leap of faith to imagine some sinus discharge could be there too, and not a bit jump to conclude that a sick person with the flu or any other virus could be spreading germs to the surfaces. It takes very rigorous effort to get all the germs cleaned away, so it's very likely that subsequent patrons bring those germs to their mouths, noses or eyes very easily. I still wonder about the 1917-18 flu pandemic. Could it be that the tight quarters explanation has as much to do with the dining hall atmosphere (as I imagine table manners were probably about the same then) as much as airborne transmission, if not more so?

More developments: I just became aware of a paper by Lowen, Mubareka, Steel, Palese whose guinea pig tests concluded that airborne transmission of flu was temperature and relative humidity dependent, indicating colder and dryer conditions spread flu more effectively.
So, it could be the room full of sick patients where doctors were visiting, yet puzzlingly not catching the flu, perhaps was warm and humid?
Furthermore, it's surmised that airborne flu is spread more so in temperate climates (dryer/colder) than tropical, whereas in the later, direct contact mode of flu transmission is more prevalent.
Not dismissing airborne flu transmission whatsoever, I'm still taking this five steps further:
1) direct contact transmission is likley ongoing regardless of temperature, or RH, ie non-seasonal dependent
2)direct contact transmission is at least an important mode of flu transmission, since many flu outbreaks have occured where Temp and RH minimize the effects of airborne flu
3) direct contact transmission works as a component when atmospheric conditions favor airborne transmission, that is aersols settle on surfaces, people contact those surfaces, thus both modes re-inforce each other
4) direct contact can occur anywhere, of course, but it seems to me dining areas (including tea/coffee donut areas, cafes, restaurants, salad bars, bbqs, potlucks, etc) are by far the greatest potential source of direct contact. And that is because cooks and personelle will often work sick regardless, patrons will dine regardless, and personal habits, such as dipping fingers, licking fingers,wiping noses and eyes, and then touching all surfaces, or coughing or sneazing on all surfaces, and unsuspecting patrons will inturn do the same,Handrails, keyboards, doorknobs, etc, etc, have an effect, but the dining areas, it seems to me are the overwhelming venue for direct contact transmission.
5) Sticking my neck out with an hypothesis: it's possible that addressing in great detail and care around these dining areas ( defined as whereever people congregate, or visit in numbers to dine, drink, eat snacks, etc), and emphasizing extreme hygeine, may go a long way to avoid another flu pandemic,
Also, of interest and perhaps relevance regarding the 1918/ 1919 flu pandemic,to paraphrase a report: in March 4 of 1918 the company cook Fort Riley, Kansas reported sick. By noon on 11 March 1918, over 100 soldiers were in the hospital. Within days, 522 men at the camp had reported sick.

Could it be the cook was a super-carrier at the dining hall? Hard to make any definitive conclusions with this, yet interesting nonetheless.

Okay, here is perhaps a good test of my idea of dining areas being big culprits (vectors I think it's called) in cold/flu transmission.

I just went travelling about the state for a few days, and have returned as I write. This last Friday night ( Tues morning now) , 3 1/2 days ago, we ate out at a nice restaurant, in a tourist town. Trying to eat healthfully while travelling, I often avoid the prepared meals,, which tend to be poor in nutrition and full of empty calories. So, I chose the salad and soup bar. It was about 7:30 pm so many people had already used it. Perhaps a big mistake! I noticed a few of the patrons were sick, and at least one waitress also had congestion and nasty coughs. At least she used her sleeve to suppress her cough. And then I notice a lady and her daughter next to us also eating from the salad bar, I describe her as a soccer mom type. She had arrived before us and had obviously served herself from the salad bar too. She, I noticed, was sick too, runny nose and cough, plus I noticed her smacking her fingers on her return trip from the soup bar. Obviously, what comes to mind is her saliva has been transmitted to the surfaces at the salad and soup bar (counter tops, serving spoons, etc) or her contaminated aerosols have descended on those surfaces including the food.

So, three and one half days later, I am still not sick! If there was any environment to substantiate my hypothesis, this was it!

So maybe I am all wrong, the dining hall surfaces patrons touched and foods (where I suspect aerosols landed) are not infectious, maybe I got exceptionally lucky, or perhaps the germs are still incubating in me? If I do get sick, it's either where I ate, or the aerosols that just happened to be lingering in the air on the hiking trails (not!).

I do hope my idea about all this is wrong, dead wrong! Give it a few days.

Well, I did get that same illness, but it came on about a month later. So, it was either a long incubation period or more likely something I got it elsewhere. It was 15 days start to finish, though most of it was just a nuisance.- not the flu per se.

I maintain still that many in the health care industry should take heed and go to a wide variety of dining places, restaurants, salad bars, potlucks,etc, and observe the employees who insist on working while sick and the patrons who stick their fingers in their mouths repeatedly as they eat.

At one recent fine restaurant we visited, I noticed the lady at the next table who obviously got some sauce on her hands. All ten of her fingers were flared out, and she smacked everyone of them clean. This happened numerous times during her meal, You'd think we're living in a Third World country.

The likelihood she was sick and contagious is minimal, but extrapolate this behavior across the whole country especially in flu season, and this unsanitary behavior must be happening millions of times. Take a small percentage who actaully are sick with flu virus and contagious ( they might not even know it), and their saliva is on the table, the check stand, the salad bar, the door, etc etc. , and perhaps even your dinner plate or utensils if the cook or the servants are sick too,

The rudimentary cleaning of the table top between meals after those patrons leave generally is very likely to still leave their flu-contaminated saliva on the table, as well as numerous other areas. The next patron comes along, perhaps you, and their saliva is ready to be on your fingers too, which in turn may inadvertently end up on your food, your fingers and eventually in your mouth, your nose or your eyes.

Then you get sick too. My opinion fwiw.

Just a quick followup- Sitting at a community internet computer in a motel, and while on the web, hear this bad hacking to the left. Yep, another person is at the dining area, breakfast bar, serving herself and hacking away. Contagious still? Don't know, but I can assure you that whoever also serves themselves a meal, or coffee to drink, etc, will be assured to contact her germs. Oh, here she is again, setting the newspaper on the table next to me. Now I grab the paper and a muffin, and those germs are on my fingers and eventually in my mouth, eyes, whatever.
And of course, since the last post, zillions of diners observed smacking fingers in public places, their germs going everywhere. Eating with fingers in the mouths, believe it or not, is actually an aspect of popular culture now

Germ evolution probably thrived on this symbiotic relationship. Think about, it, flu viruses (as well as all other micro organisms in people) probably adapted this way over the eons. I suspect if man could figure out a way to dine and eat in more sanitary ways, (ie not cough all over the food areas, keep fingers out of mouths, nose, eyes, etc) , flu epidemics might be lessened greatly if not avoided altogether..

If dining areas and poor hygenic habits in those areas can be traced as a serious mode of transmission of flu germs, should the medical community also suspect this very same mode of direct contact transmission may be applicable to the Ebola virus? Assuming saliva or nasal fluids from Ebola infected individuals are transmitable, then I would think extreme sanitation measures are paramount for anyone in dining areas, If an infected person sneezes on the table, plates counters, etc, of if that person eats with his or her fingers into the mouth (a substantial portion of the population in the US does this), or wipes the eyes or nose with fingers or hands, then anywhere and everywhere in a dining area may be a potential contamination hazard, it seems,.