Table of Contents:



I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse


References 1-3,199

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Areas missed during handwashing

The causal link between contaminated hands and infectious disease transmission in general is considered to be one of the best-documented phenomena in clinical science.2648 Eighty percent of all infectious diseases are transmitted by touch—from the common cold to “flesh-eating” bacteria and Ebola. The director of Clinical Microbiology at New York University considers proper hand washing as serious a public health issue as smoking cessation.2649 Proper hand washing certainly seemed to work during the SARS epidemic. Those at high risk who washed their hands were found to be ten times less likely to contract the disease.2650 The oily envelope stolen from our cells makes the influenza virus especially sensitive to being washed away by the detergent quality of ordinary hand soap. As we learn in medical school, while soap may not kill a virus, the “solution to pollution is dilution.” Hand washing is meant to decrease viral counts below an infectious threshold. According to the influenza program officer of the National Institute of Allergy and Infectious Diseases, without a vaccine the “single most important step people can take to help prevent getting the flu is to wash their hands.”2651

People don’t wash their hands as often as they should—or even as often as they think they do. Ninety-five percent say they wash their hands after using a public toilet, yet the American Society for Microbiology published a survey of almost 8,000 people across five U.S. cities and found the true number to be only about two-thirds. Chicago topped the list at 83%; in New York City, the actual number fell to less than half.2652

Doctors are no exception. Though 100,000 Americans die every year from infections they contracted in the hospital2653 and though hand washing is considered the single most important measure to prevent such infections,2654 studies have shown that less than half of doctors follow proper hand-washing protocols in the hospital. A sample of doctors working in—of all places—a pediatric intensive care unit were asked how much they thought they washed their hands. The average self-estimate of their own hand-washing rate was 73%, with individual responses ranging from 50% to 95%. These doctors were singled out and followed. Their actual hand washing rate? Less than 10%.2655

From an editorial in the New England Journal of Medicine: “It seems a terrible indictment of doctors that practices and protocols must be developed to take the place of something as simple…as hand washing. Perhaps an even bigger concern for current medical practice, and one which should lead us all to do some soul searching, is that careful and caring doctors can be extraordinarily self-delusional about their behavior.”2656 The top excuses doctors use for not washing hands are: being too busy and dry skin.2657

When doctors do wash their hands, studies show that they only wash for an average of nine seconds.2658 Proper hand washing, according to the director of clinical microbiology at Mount Sinai, involves lathering with plenty of soap for 20 to 30 seconds (about the time it takes to sing the “alphabet song” three times at a fast tempo), rinsing, and then repeating for another 20 to 30 seconds.2659 CDC guidelines are similar, with additional reminders to wash between fingers and under the nails, and to soap into the creases around knuckles.2660 According to the World Bank Health Services Department, there is no evidence to suggest that hot (or even warm) water is better for hand washing. On the contrary, the colder the water is, the less skin damage is done by the detergents in the soap after repeated hand washing. Washing with warm or tepid water may be more comfortable, but one need not find hot water to wash effectively.2661

Most Americans profess to washing after changing a diaper or before handling food, but most don’t even claim to wash after coughing or sneezing.2662 At a minimum, experts advise, hands should be washed after every cough, every sneeze, and every time we shake hands with anyone. These simple recommendations may decrease the number of colds we get every year, the number of work days we miss, and the number of days we are laid up in bed. During a pandemic, they may even save your life.2663