Not in my elbow

Wednesday January 16, 2013

The flu season is upon us and it is grabbing headlines. Anytime a disease that kills 36,000 Americans a year gets publicity that is a good thing. Massachusetts is in panic mode. You know things are bad when a state gives away some sort of health care for free. That is what is happening in our neighbor to the south. Free flu shots for all.

It still amazes me that so many people do not think that the flu is a serious disease. What troubles me even more is that so many health care workers refuse to get flu shots. Is it out of self absorption, thinking they are young and healthy and can deal with the flu? Is it because they just don't understand how they could spread the flu to the sick and vulnerable people they come in contact with each day? I don't get it.

Just to dispel the myths about flu shots, you cannot get the flu from the shot. It is a dead virus and it works by stimulating your body to produce antibodies to fight against those particular strains of the flu in the vaccine. It takes about two weeks for your body to build up an adequate supply of flu-fighting antibodies, but if you are sick or if your immune system is compromised it could take longer.

When people say they won't get a flu shot because it made them sick in the past they are showing ignorance. The vaccine can stimulate a local painful reaction for a few days and some people may have a low-grade fever. If you get sick after the shot that means you were coming down with something and you didn't know it. Coincidences happen.

The flu will always be with us. The vaccine is the best form of prevention and there are others measures we can take to help stop the spread of the flu once it has moved into an area. The influenza virus is spread by direct contact, by contact with contaminated objects and by inhaling the virus.

Hand washing has received a lot of attention and it is one of the best measures to stop the spread of the virus. Then there is the issue of coughing and sneezing. Here is an interesting tidbit from the Infectious Diseases Journal of 2009: "Respiratory transmission depends upon the production of aerosols that contain virus particles. Speaking, singing, and normal breathing all produce aerosols, while coughing and sneezing lead to more forceful expulsion. While coughing may produce several hundred droplets, a good sneeze can generate up to 20,000. Aerosolized particles produced by these activities are of different sizes. The largest droplets fall to the ground within a few meters and will transmit an infection only to those in the immediate vicinity. Other droplets travel a distance determined by their size. Those droplets 1-4 microns in diameter are called ‘droplet nuclei'; these remain suspended in the air for very long periods and may not only travel long distances, but can reach the lower respiratory tract. Inhalation of droplets and droplet nuclei places virus in the upper respiratory tract, where it may initiate infection."

No one seems to know how long the flu virus can live outside the body but most experts believe it is about 48 hours. That is why I am not a big fan of coughing into your elbow, as so many people are doing these days. I think there are a lot better alternatives. The practice came about as a suggestion that would be less harmful than simply coughing without covering your mouth.

You can readily wash your hands if you cough into them, but you can't wash your clothing if you are spewing all kinds of respiratory droplets into them. During the late fall and winter, and especially during the flu season, it would not be too much of a burden for people to carry tissues or hand sanitizer or to simply be mindful to wash their hands after they cough into them. That way, potential viruses could be easily eliminated from the environment.

Coughing into your elbow makes you think that you have stopped the spread of the disease but those little villains are on your shirt or sweater and who knows how close you may come to a person during the course of a day. You raise your hand and elbow to shake hands with someone and you shake the virus particles loose as the person takes a deep breath. Who knows what happens next?

Cover your mouth, wash your hands frequently and carry tissue. If you are one of those people who cough into your elbow I will be keeping my distance.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at


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