Norovirus: Why washing your hands isn't enough

REUTERS/Lisi Niesner

Paramedics dressed in protective attire enter a German cruise ship quarantined in December after an outbreak suspected to be norovirus. A new strain is making people miserable around the world this year.

It gets in your food, in your laundry, it sticks to plates and it might even float into the air when you flush your toilet. A new strain of norovirus -- often called stomach flu -- is going around and it’s going to be very hard to avoid it, experts say.

Federal health officials say a new strain, called the Sydney strain, is now causing most of the misery across the United States and the world. The virus, sometimes known as Norwalk virus or winter vomiting disease, causes vomiting, diarrhea and that someone-just-hit-me-with-a-plank feeling.

There’s no real treatment for it except for waiting it out, no vaccine, and recent studies show it’s one of the hardest viruses to get rid of. Simple cleaning alone doesn’t always kill it, and it takes just a few particles of virus to sicken a person.

“It is pretty difficult to get rid of,” says Allison Aiello, who studies how viruses spread at the University of Michigan. “It is pretty stable. It lives quite some time on surfaces. It is hard to kill.”

For instance, a few recent studies show that a quick application of hand sanitizer won’t get rid of it, Aiello says. And most people don’t wash their hands properly, either -- it takes about 30 seconds of vigorous rubbing using hot water and soap to wash away the tiny bits of virus, and that means getting under the nails, too.

Perhaps worst of all, people start spreading norovirus before they actually feel sick, and they can spread it for as long as two weeks after they start getting better. 

“Imagine you have a food handler who uses the bathroom and they haven’t washed their hands thoroughly,” Aiello said in a telephone interview. “They can end up preparing a salad for the diners that evening and end up infecting a lot of people because the food isn’t cooked. You can’t really do anything about that.”

Raw shellfish is a notorious source of norovirus and other foodborne germs, but at least one recent study suggests norovirus may be even more insidious than that. In December, a team at Ohio State University found the virus stuck to plates that had been washed in restaurant-like conditions -- and they found sticky dairy products like cheese helped the virus stay there.

Hand-washed dishes are especially likely to carry the virus, the Centers for Disease Control and Prevention says in its website -- which could be one reason norovirus causes so many outbreaks on cruise ships. “You cannot get the water hot enough if you wash by hand,” says Aiello.

Norovirus is spread fecally -- in the poop -- and that means it can get into laundry. Studies show that fecal matter spreads even in ordinary laundry, so if someone is sick, it’s important to use very hot water and bleach to destroy virus that could be on any clothing, sheets or towels.

And regular cleaner won’t get the virus off surfaces. CDC recommends using bleach, including chlorine bleach or hydrogen peroxide.

Complicating the problem, most restaurant workers don’t get paid sick leave, so if they miss work, they don’t get paid. This means many workers come in sick, and they can spread the virus to hundreds of customers. Food handlers, dishwashers, even staff who bus and clear tables, all can spread the germ.

“If they have to go back to work there has to be complete and utter vigilance about washing your hands,” Aiello says.

In June, the Food Chain Workers Alliance issued a report showing that only 21 percent of workers surveyed could take a paid sick day off work. More than half said they come to work sick because they cannot take time off.

The problem extends to the home, too. There, Aiello said, several factors make it hard to keep one sick family member from infecting others.

“It could be the door handle. It could be the toilet tank cover. Some studies show it can be aerosolized. If you throw up and then flush the toilet, how much of the spray gets into the air?” she asked. One study last year showed how the virus spread on a plastic bag that had been in a bathroom where a norovirus patient threw up. 

Norovirus is the most common cause of acute gastroenteritis -- stomach upset -- in the United States. It makes 21 million people sick every year in the United States – 70,000 on average sick enough to go to the hospital. As many as 800 people die, mostly elderly patients who become dehydrated. It’s the the most common cause of foodborne-disease outbreaks, CDC says.

Dr. John Treanor of the University of Rochester Medical Center in New York is working on a vaccine against norovirus. But the same properties that make norovirus so hard to kill also make it hard to make a vaccine.

For one thing, it’s simple. Like all viruses, norovirus hijacks live cells, turning them into virus factories that kick out particles called virions. “There is only one protein they use to make virions,” Treanor says. “If you have that one protein, it will self-assemble.”

The virus is also surrounded by a case called a capsid, which makes it hard to kill. The viruses infect the epithelial cells which line the digestive tract, causing cramps, diarrhea and vomiting, but it’s not understood exactly why.

And the virus mutates. “You typically see a specific strain, and then that strain is replaced by a new strain,” Treanor said. In this case, a strain called New Orleans has been replaced by the Sydney strain. Like with influenza, people who may have had some immunity against one strain aren’t protected agaisnt the new one.

So until there is a vaccine, what can people do? “There really isn’t very much you can do,” says Treanor. “Clearly, washing your hands is important.”

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I just refer to a side of pasta with meat sauce as salad now lol.

  • 2 votes
Reply#82 - Mon Jan 28, 2013 6:23 PM EST

Why not give the school kids a vacation now? Having no school may cut down on these viruses spreading quite so quickly. When June arrives, have the kids in school then. Any worker who isn't healthy and apt to bring a bug into the work place, should stay home until completely well! If an employer doesn't provide sick days, agree to work extra hours once you are able to return to work. Ask friends, family to help you out financially if possible until you are back to work and able to repay them.

  • 1 vote
Reply#83 - Mon Jan 28, 2013 6:33 PM EST

I came down with this about 2 weeks ago, I cannot remember feeling that sick in 10 years, plan on being down for the count for 2 days and toilet visits about every 40 minutes...wouldn't wish this on on my worst enemy..

  • 6 votes
Reply#84 - Mon Jan 28, 2013 6:48 PM EST

Oh No please save us Nazi socialist freaks we can not live with he fear of a upset tummy. Please take my spoon it makes me fat and a burden on the Nazi state.

  • 1 vote
Reply#85 - Mon Jan 28, 2013 6:51 PM EST

T.S. Eliot paraphrase:

This is the way the world will end

This is the way the world will end

Not with a Bang

But repeated flushing.

  • 2 votes
Reply#86 - Mon Jan 28, 2013 6:53 PM EST

IMPORTANT TO REMEMBER.... If you ever catch a virus on your private parts, shave off one half of your pubic hairs, lite the other on fire (lighter fluid works fine), and when them nasty critters come out... stick them with an ice pick...PROBLEM SOLVE.

  • 3 votes
Reply#87 - Mon Jan 28, 2013 6:58 PM EST

Please Ms. Fox, if you're talking about a virus please don't refer to it as a germ.

  • 1 vote
Reply#88 - Mon Jan 28, 2013 7:04 PM EST

funny every year it is a new strain. wow Population control? If we get rid of the elderly we dont have to pay ssi or dr bills. medicare etc. mmmmmmmmmmmmmmmmmmmwow or it is just part of the brilliant universe trying to kill humans to evolve their self. Either way every year it is something new every day we are living in fear of this and fear of that. Well guess what people are so broken down now nothing is scary anymore. So one thing they really should be working on is a back up system that kicks in when your heart fails. Or cure for aging and for death. I am sure they can but however at the same time the population would have to be controlled one day it will happen if the human race survives long enough. If not we will be back on another planet.

    Reply#89 - Mon Jan 28, 2013 7:05 PM EST

    So who now gets all the money that is saved from the unused ssi and dr bills?

    • 1 vote
    #89.1 - Mon Feb 11, 2013 6:54 PM EST
    Reply

    Schools, McDonald's play centers, Grocery Stores, Malls, Gas Stations, Work, Courtrooms, movie theaters, restaurants, bingo halls...everywhere you go in the winter time you find an incubation center, a place where germs and viruses gather and spread to one another, when these viruses hit they spread like wild fires. You cannot get away from this unless you suit up in a biological suit, or an astronaut suit, or just deal with it. Getting the flu is a common thing, yes it is uncomfortable to go through, some are more deadly, but look at the light side. There are non. Wash your hands crawl under the covers for the next 8 weeks, like a bear that hibernates in the winter. I take 2 aspirin and a shot of Jack Daniels(just a shot) with a quarter slice of real lemon will knock the flue out of the house. It works for me. LMAO

    • 2 votes
    Reply#90 - Mon Jan 28, 2013 7:17 PM EST

    There's no question that flu viruses mutate. Flue shots are never 100% because they're based on the past season's virus. However, I very, very rarely catch a cold or the flu. I think it's just because of some simple safeguards. I do get a flu shot every year. I avoid crowds during cold and flu season. I've trained myself to never touch my face or eyes when I've been on a cablecar or bus until I can wash my hands. I avoid coughers and snifflers, especially when its a child. And, usually will also put on glasses to protect my eyes when there are lots of sick people about. I wouldn't say I'm paranoid about catching the flu in general, BUT, I have to say that after reading what amounts to really a very few disease-ridden cruise ships, the stories are so miserable that I'll probably never go on a cruise. The thought of being in a tin can with hundreds of vomiting strangers is just too much for me.

    • 1 vote
    Reply#91 - Mon Jan 28, 2013 7:21 PM EST

    Aging sucks for sure, but there are two good things going for it. As one is exposed to more illness one develops better immunity and gets sick less often in general. The second and the best part: if your still aging, then your not dead! So get off your ass and head to the nearest watering hole with a pool table and have some fun!

    • 2 votes
    Reply#92 - Mon Jan 28, 2013 7:53 PM EST

    For the love of God, are you TRYING to give us OCDers panic attacks?!?! I already wash my hands and sanitize obsessively, I don't need this "you can run but you can't hide" garbage.

    • 2 votes
    Reply#93 - Mon Jan 28, 2013 8:27 PM EST

    Actually even though the virus is VERY easily spread,and getting sick from it is horrible and sometimes dangerous...the writer never should have made the statement that if you're seriously ill with this there's NOTHING you can do.That is pure sensationalism and BS.

    If someone has norovirus and is managing to stay hydrated then please do not go to a healthcare facility,as the risk of infecting other patients and the staff is too great.But if someone is becoming dehydrated and/or weak from this bug they SHOULD go to urgent care.IV fluid and anti-nausea medication together can kick the crap out of norovirus.

    • 3 votes
    #93.1 - Tue Jan 29, 2013 2:11 AM EST
    Reply

    I am 69 years old. Always get a flu shot. Wash hands frequently (30 seconds+). Replace all hand towels as soon as any of the 13 grandkids departs. And I average less than 1 simple cold a year - no flu.

    • 1 vote
    Reply#94 - Mon Jan 28, 2013 8:37 PM EST

    Doomed! I tell you, we are all doomed. Seems we have no control over this virus. Excuse me, I have to go to the bathroom...

    • 1 vote
    Reply#95 - Mon Jan 28, 2013 9:22 PM EST

    Remember to wash your hands (:

    • 1 vote
    #95.1 - Tue Jan 29, 2013 2:41 PM EST
    Reply

    Just what we need.. another vacine. What about the people who already had it, will they get it again? Or has their system built up any immunity to it?

    • 1 vote
    Reply#96 - Mon Jan 28, 2013 9:40 PM EST

    Just like the Flu, just because you get it once doesn't mean you will get it again...

    • 1 vote
    #96.1 - Mon Jan 28, 2013 9:56 PM EST
    Reply

    Bosses don't care if you're sick, it's all about the bottom line..MONEY. (Give THEM SICK LEAVE..)

    I know for a fact the school cafeteria manager in my state got mad when anyone called in, so several times they'd show up with a fever, and they had sick leave.

    • 3 votes
    Reply#97 - Mon Jan 28, 2013 9:48 PM EST

    The place I worked for didn't grant us "sick days" and they made sure that they gave you a rough time when you were to sick to come in. The boss's would harass you on the phone and some people would actually cave in to that treatment. I really hated that palce.

    • 1 vote
    #97.1 - Tue Jan 29, 2013 2:55 AM EST
    Reply

    Sorry Doctor but if you wash your hands you will avoid 99% of the problems. I fail to believe their statement that hand sanitizer and washing your hands fail to kill this virus--because we would all have it.

    Clean your hands and don't listen to this nonsense.

    • 3 votes
    Reply#98 - Mon Jan 28, 2013 9:56 PM EST

    According to the CDC, the foods most commonly implicated in norovirus outbreaks have been leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%). Infected food handlers have been the source of 53% of outbreaks and may have contributed to 82% of outbreaks.

    • 1 vote
    Reply#99 - Mon Jan 28, 2013 9:59 PM EST

    Its only a matter of time before we have a zombie virus. :)

    • 2 votes
    Reply#100 - Mon Jan 28, 2013 10:06 PM EST

    I was thinking the same thing

    • 1 vote
    #100.1 - Tue Jan 29, 2013 2:37 PM EST
    Reply

    It's easy to guard against Norovirus and the Flu. Just rest your hands in a large pot of boiling water for at least ten minutes when you get home and then gargle with Nitric Acid. It works every time! If you come across someone that is infected with the virus just shout "stay the HELL away from me" at the top of your lungs and run away...

    Just sayin...

    • 1 vote
    Reply#101 - Mon Jan 28, 2013 11:31 PM EST

    Mother Nature always wins.

    • 1 vote
    Reply#102 - Mon Jan 28, 2013 11:45 PM EST

    I believe these stories are mostly scare tactics. Our local coin wash hot water boiler broke down at least 2---3 years ago so hundreds of people are washing their clothes in cold water. So how to prove any correlation to wash clothes with very hot water as this article relates? They do not have the money to fix it. The health dept. has never closed down their facility.

    I never use hot water and just take a cold shower. I shut my hot water heater off over 10 years ago. My well water came back testing positive for c. bacteria. My guess is that water would have to be very hot to kill all bacteria. Though I got asthma through genetics and sinus condition during the winter I rarely get a cold or flu, perhaps upwards of 35 years now. And I got C. O. P. D. from being around my fathers second hand cigarette smoke while growing up who was three and one half packs a day. I got scar tissue throughout my lungs. At best I have 20----25 percent lung function left.

    People are getting sick because their immune system is already compromised making them prone to these bacteria and viruses. These are caused by the "anti-nutrients." What do you microcephalic mentality people think low birth weight and neural tube defects (spina bifida) is all about? Next time you go to the grocery store during check out look and see what people have got in their carts. And the adults feed it to their children since they are toddlers.........we function as a "WHOLE" not in separate parts so people can not simply run to their dentists to fix their dental decay.

    When they were doing autopsies on our military during the Korean and Viet Nam wars they found many had arteries already three-quarters stenosed. This correlates to massive loss of brain cells from occluded blood flow. The subjects were still in their late teens and early twenties..........

    • 1 vote
    Reply#103 - Tue Jan 29, 2013 1:07 AM EST

    They do not have the $ to fix? Can anyone imagine how much more $ they are saving on the gas bill?

    • 1 vote
    #103.1 - Mon Feb 11, 2013 7:14 PM EST
    Reply

    I came down with it late Christmas night. Ugh. Profuse vomiting for several hours, then In bed with no appetite and that wiped out, hit-by-a-plank feeling for the better part of four days. Adding misery to misery, and probably because my immune system was already taxed, I caught one of the upper respiratory things on Jan 2, which hung on for two and a half weeks. Luckily, I work from home, so I pretty much just quarantined myself and rested as much as possible. Wash those hands like mad, folks! It's still a nasty bug season out there!

    • 2 votes
    Reply#104 - Tue Jan 29, 2013 1:37 AM EST

    I came down with this virus the day after Christmas. The first 12 hours I was cursing my mother for giving me birth, it was that bad. My wife came down with it the next day and in 37 years of marriage, I don't think I have ever seen her that sick. The first 12 hours of this virus was the worst, after that it was a matter of trying to get some nourishment back into the system. After 4 or 5 days we were both back to normal. Trust me, this virus is nothing to fool around with, do anything & everything you can think of to avoid it, I sure wish that I would have.

      Reply#105 - Tue Jan 29, 2013 2:49 AM EST

      This phuckin country deserves a good epidemic ..

      • 1 vote
      Reply#106 - Tue Jan 29, 2013 3:37 AM EST

      It will probably start with your mother.

        #106.1 - Tue Jan 29, 2013 7:49 AM EST
        Reply
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