<http://www.newsweek.com/id/215435>Hand-Washing Won't Stop H1N1
It's become conventional wisdom that simple soap and water can
protect against the flu, but the science suggests otherwise.

http://www.newsweek.com/id/215435

In a speech to schoolchildren last week that had 
some conservative opponents up in arms,
President Obama delivered at least one line that 
seemed incontestable: "I hope you'll all wash
your hands a lot, and stay home from school when 
you don't feel well, so we can keep people
from getting the flu this fall and winter." The 
Disney corporation is now 
marketing <http://www.gethealthyhands.com/>Musical
Hand Wash Timers featuring characters like the 
Little Mermaid, and encouraging parents to
"take precaution against swine flu" by teaching 
children to wash their hands correctly. "Studies
prove that regular hand-washing dramatically 
reduces the spread of infection," says the Disney
Web page, which links to the Centers for Disease 
Control and Prevention's Web site.

Thanks in part to this and other campaigns run by 
the <http://www.flu.gov/>CDC, it has become 
conventional wisdom
that hand-washing is the best way to protect 
yourself from the H1N1 strain of influenza. But 
while hand-washing has been shown to be a great 
defense against the common cold and other 
respiratory diseases, it might not actually be 
that helpful against the influenza virus, 
including the H1N1 strain.

That's because there is virtually no evidence 
that people can catch the influenza virus from 
germs
that they pick up on their hands, according to 
Arthur Reingold, head of epidemiology at the 
University of California, Berkeley, and 
codirector of the CDC-funded California Emerging
Infections Program. Instead, humans are most 
likely to catch influenza by breathing in 
microscopic particles exhaled by infected people.

Reingold and other epidemiologists don't discount 
hand-washing as an important tool in public 
health: there is plenty of evidence that it 
prevents other nasty bugs, including the common 
cold,
many respiratory infections, and viruses that 
cause diarrhea. But Reingold is bothered by the 
lack
of science supporting the CDC's message, and he 
worries that the emphasis on a simple measure
like hand-washing creates a false sense of 
security from H1N1 and tamps down the discussion 
of more difficult preventive measures. He said as 
much in an e-mail to the CDC this May. "I 
wouldn't care
so much that we might be getting folks to improve 
handwashing . . . with what is likely to be 
incorrect information about its ability to 
prevent influenza" if the media and the court of 
public opinion weren't so quick to embrace it as 
the only solution at the expense of things like 
surgical masks, wrote Reingold in his letter to 
the CDC. While Reingold admits he doesn't know if 
masks would reduce transmission of the virus, he 
hypothesizes that they're more likely to be 
helpful containing exposure to the airborne virus 
than hand-washing, and should not be so easily
discounted. (Other experts are skeptical of face 
masks because it's difficult to ensure proper use,
or that people will wear them in the first place.)

Dr. Anne Schuchat, director of the CDC's National 
Center for Immunization and Respiratory Diseases, 
says the CDC's emphasis on hand-washing is guided 
by the "science that supports hand-washing 
against respiratory infections in general." In 
particular, she cites a study conducted in 
Pakistan that showed that hand hygiene measures 
cut the rate of pneumonia in half. One of the 
unique features of swine flu-the fact that it 
causes diarrhea-also suggests to some that it 
could be transmitted on the hands like other 
diarrhea-causing diseases that do not belong to 
the influenza family. Schuchat stresses that the 
best way to protect yourself will be to get the 
vaccine once it becomes available in October, but 
adds that the CDC continues to believe that 
"contact precautions are useful with this flu."

But the ferrets and guinea pigs tell a different 
story, says Dr. Michael Osterholm, of the 
National Institutes of Health-supported Minnesota 
Center of Excellence for Influenza Research and 
Surveillance, and head of the University of 
Minnesota's Center for Infectious Disease Research
and Policy. Researchers in the Netherlands used 
ferrets to study the transmission of H1N1 and
found that the disease was efficiently 
transmitted by small airborne particles. An 
earlier study examining a different flu strain in 
guinea pigs found that the animals did not pick 
up the virus from contaminated cages. That 
suggests that you're not really safer from the 
flu virus if you scrub your hands, paws, or cages 
because the virus travels through the air. While 
there's not enough evidence
to conclusively say the flu works the same way 
for humans, the current research suggests that 
the H1N1 flu travels mostly by air, not via 
hand-to-hand contact-and therefore won't be 
prevented through hand-washing.

"We don't want to create a crisis in confidence," 
Osterholm says, "but we have to be honest: the 
evidence doesn't show that hand-washing prevents 
the spread of the influenza virus."

Nevertheless, hand-washing is still your best 
defense against getting sick generally this 
fall-colds and other respiratory diseases are no 
fun, even if they don't sound as scary as swine 
flu. For that
and other flu viruses, don't seek solutions at 
the sink: your best chance of avoiding H1N1 this 
fall
is to get the vaccine once it becomes available.

© 2009
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