Handwashing: Making it stick

Your Health columnist Kim Painter wants to know in USA Today tomorrow if the spike in handwashing compliance after SARS hit Toronto in 2003 will be replicated with swine flu in 2009 – and will it last?

In summer 2003, researchers descended on airport bathrooms in the USA and Canada and discovered a dirty truth: More than 20% of restroom visitors left without washing their hands.

But there was one big exception: In Toronto, which had just endured a deadly outbreak of severe acute respiratory syndrome (SARS), fewer than 5% of people left dirty-handed. During that outbreak, public health officials had repeatedly urged people to protect themselves by washing their hands.

Doug Powell, a food scientist at Kansas State University, said if changing handwashing behavior was simple, "we wouldn’t have so many people getting sick each year."

The story summarizes handwashing compliance advice for businesses, schools and hospitals as:

•The voice of authority. Just as federal health officials enlisted Obama to endorse handwashing, Dan Dunlop, president of Jennings, a North Carolina marketing company that has designed handwashing promotions for hospitals, has enlisted hospital CEOs and medical chiefs to inspire handwashing in their troops. School principals, PTA presidents and restaurant managers could do likewise, he says.

•The audience. "With younger people, what seems to work is being blunt and gross," Powell says. Powell, who writes at barfblog.foodsafety.ksu.edu, tells his students that when they eat without washing their hands first, they may be eating feces. (But he uses another word.)

•Social pressure. In one unpublished study, Craig found that petting-zoo visitors who left a barn through a crowded exit washed their hands more often than those who left by a less-crowded door.

•Keeping supplies up. Powell says he hears often about bathrooms in schools, college dormitories and other germ hotspots that lack soap (or paper towel – dp).

Don’t drink infected pig blood

Reuters reported yesterday that new information from the World Health Organization suggested pigs sickened with H1N1 swine flu should not be consumed, despite earlier insistence that fully cooked pork is perfectly safe.

The story states,

"The WHO comments appear more cautious than those from the Food and Agriculture Organisation (FAO) and World Organisation for Animal Health (OIE), which said import bans are not required to safeguard public health because the disease is not food-borne and has not been identified in dead animal tissue.

The WHO however said it was possible for flu viruses to survive the freezing process and be present in thawed meat, as well as in blood."

Well, who in their right mind drinks raw pig blood thinking it won’t possibly make them sick?

I didn’t find any statements on the WHO website that mentioned the ability of viruses to survive freezing–or its pertinence to the consumption of fully cooked pork–but I discovered that the WHO, FAO, and OIE have reissued their joint statement from April 30 today to address misunderstanding of the consumption of meat from H1N1 infected pigs. The statement reads, in part,

"Authorities and consumers should ensure that meat from sick pigs or pigs found dead are not processed or used for human consumption under any circumstances."

Sick or dead animals should never be slaughtered, regardless of the cause of illness or death. This  reduces the risk for cross-contamination. The statement reassures,

"Heat treatments commonly used in cooking meat (e.g. 70°C/160°F core temperature) will readily inactivate any viruses potentially present in raw meat products.

Pork and pork products, handled in accordance with good hygienic practices recommended by the WHO, Codex Alimentarius Commission and the OIE, will not be a source of infection."

But I shouldn’t be spelling this stuff out–the WHO should. And they should address the bit about viruses surviving freezing and how that impacts food handlers.

Authorities should communicate the risks and how they’re being managed (or can be managed) in a way the public can understand and the media can’t mess up. It’s their responsibility to a concerned public.

US waits to react to flu discovery in Canadian pigs

As a backlog of state and federal lab test results reached the Centers for Disease Control and Prevention (CDC), the total number of confirmed cases of H1N1 in the US climbed to 244 in 34 states, the Associated Press reported this weekend.

The Globe and Mail reported numbers from the World Health Organization, stating, “Canada, for its part, has tallied 101 cases in seven provinces.”

When news broke that a Canadian swine herd was found suffering from a flu thought to be H1N1, the U.S. Department of Agriculture (USDA) issued a statement assuring that, “this detection does not change the situation here in the United States.”

The statement continued:

“Today’s discovery will not impact our borders or trading with Canada. As prescribed by the World Organization for Animal Health guidelines, any trade restrictions must be based on science so at this time, we are awaiting confirmatory test results before considering any action."

Additionally, while the CDC works on a H1N1 vaccine for humans, the USDA announced it is trying to develop a vaccine for swine. But that’s just standard protocol when a new virus appears.

It seems they’re taking no rash action until there’s evidence to suggest it’s necessary. That sounds like a wise use of resources to me.

The World Health Organization is similarly waiting for evidence before sounding the alert to a pandemic. As reported by the New York Times,

“The World Health Organization announced an increase in the number of confirmed cases of swine flu on Saturday, but said there was no evidence of sustained spread in communities outside North America, which would fit the definition of a pandemic.”

“Dr. Michael J. Ryan, the director of the World Health Organization global alert and response team, said in a teleconference from Geneva, ‘We have to expect that Phase 6 (the level of a pandemic) will be reached. We have to hope that it is not.’”

The public should be made aware of existing risks and what’s being done to manage them. But, there is no good reason to waste resources pretending to manage imaginary risks.

Act on what you know and seek out what you don’t–for the good of the public.

Flu in Canadian swine

Someone finally found the H1N1 swine flu in pigs.

After I bashed them for allotting resources for hog surveillance when little evidence for such a need existed, the United Nation’s Food and Agriculture Organization is now applauding Canada for spotting the flu in a herd of Alberta swine.

However, a person—not other swine—sickened the pigs.

healthzone.ca reports that a carpenter at an Alberta hog farm went to work on April 14 after a visit to Mexico and may have brought the H1N1 flu with him. Within a couple weeks, about a tenth of the 2,200-hog operation showed signs of the flu.

The affected hogs were quarantined and all are recovering or have already recovered. Only one other person who has had contact with the pigs shares signs of illness.

Across Canada, however, canada.com reports that another 15 cases of H1N1 flu were confirmed last week, bringing the country’s total to 34. One case was a student at Beairsto Elementary School, which responded by closing for a week.

Additionally, the story reports,

“The federal government will launch a public awareness campaign Friday to inform Canadians about the swine flu as the number of cases in Canada climbed to 34 and the number of worldwide cases surpassed 270.”

I hope these messages for the public contain more information than “you can’t get the flu from food,” which is about all I’ve heard so far.

In a press release in the US, the director of science and technology for the National Pork Producers Council, Dr. Jennifer Greiner, was quoted as saying,

"People cannot get the flu from eating or handling pork. The flu is a respiratory illness, it’s not a food-borne illness."

Then can someone please explain to their country how to manage these respiratory risks?

Let’s talk more about what the risks are than what they aren’t.

Egypt kills pigs to stop a virus that moves person-to-person

Egypt began culling its roughly 300,000 pigs on Wednesday and, Reuters reported,

“The move is not expected to block the H1N1 virus from striking, as the illness is spread by people and not present in Egyptian swine. But acting against pigs, largely viewed as unclean in conservative Muslim Egypt, could help quell a panic.”

The next day, according to the Associated Press, the World Organization for Animal Health said, "there is no evidence of infection in pigs, nor of humans acquiring infection directly from pigs," and the World Health Organization announced, "Rather than calling this swine flu … we’re going to stick with the technical scientific name H1N1 influenza A."

These organizations recognized that Egyptians aren’t getting the whole story.

The World Health Organization has raised the alert on the H1N1 flu virus to phase 5, which assistant director-general Dr. Keiji Fukuda said is reserved for situations in which the likelihood of a pandemic “is very high or inevitable.” The move reflects the need for countries to take the virus seriously, and Egyptian leaders appear to be doing just that. However, costly culls that act against current evidence are sending inaccurate messages to the public about the risks present and the ways in which they can be effectively controlled.

Egyptian pig farmers are outraged. The remaining citizens feel a bit safer now. But they will all feel terribly betrayed when the H1N1 flu infiltrates their borders in the form of an infected human.

VP Biden says dumb things about swine flu

While on the road for several hours yesterday after visiting family, I finally settled on National Public Radio. I hear lots of good stuff on NPR when I’m in the mood for it. Just a few miles from home, I heard a story about some bad risk communication from an uninformed political figure. That’s always fun in my line of work…

According to the NPR story aired yesterday (heard by clicking Listen Now), when asked about the outbreak of swine flu on the Today show, U.S. vice president Joe Biden said he has told his family,

“I wouldn’t go anywhere in confined places now. It’s not that you’re going to Mexico – it’s that you’re in a confined aircraft and when one person sneezes, it goes all the way through the aircraft.”

Dr. Mark Gendreau, whose research has focused on flying and the spread of diseases, was quoted as saying that a sneeze would only travel about 3 feet. Only people two seats in front or two seats behind a sneezer on an airplane were in danger of contacting infected droplets.

Dr. Gendreau recommended washing hands often and using alcohol-based hand sanitizers to limit the spread of infection.

Biden also told the Today show that, if they had another form of transportation, he does not suggest that his family ride the subway.

In response, New York Mayor Michael Bloomberg, who often rides the subway to work, said,

“I feel perfectly safe on the subway and taking the subway does not present any more risks than anything else.”

The text version of the NPR story now available online states that,

“[T]he vice president’s office [later] issued a statement translating Biden-speak into bureaucratese: Biden was merely restating the same advice the Obama administration is giving everyone, to avoid unnecessary travel. The statement also reiterated the now-familiar admonition to cover your face when you cough.”

That’s not what I heard.

Obama says – dude, wash hands to contain swine flu

When asked about swine flu – oh, sorry, the H1N1 flu – U.S. President Barack Obama said during his prime-time 100-day press commencement conference that handwashing and staying at home if sick were key to controlling any potential spread of flu.

As we’ve said, proper handwashing with the proper tools — soap, water and paper towel — can significantly reduce the number of foodborne and other illnesses, even the emerging swine flu.

The steps in proper handwashing, as concluded from the preponderance of available evidence, are:

• wet hands with vigorously flowing water;

• use enough soap to build a good lather;

• scrub hands vigorously, creating friction and reaching all areas of the fingers and hands for at least 10 seconds to loosen pathogens on the fingers and hands;

• rinse hands with thorough amounts of water while continuing to rub hands; and

• dry hands vigorously with paper towel.

If any of the tools for handwashing are missing, let someone know.

However, even with reminders and access to the proper tools, not everyone will practice good hygiene. Those signs that say, ‘Employees Must Wash Hands’ don’t always work. We’re working in settings like high schools and hospitals to figure out the best way to not only tell people to wash their hands, but to use new media and messages to really compel individuals to wash their hands.

A video is available at:

and a poster at

Swine flu outbreak affecting pork industry

The Associated Press reported yesterday in USA Today that Mexican authorities believe as many as 149 people have died from the current outbreak of swine flu.

Also in USA Today, Matt Krantz reported that,

“Shares of pork producers Smithfield Foods (SFD), Tyson Foods (TSN) and Bob Evans Farms (BOBE) dropped 12.4%, 8.9% and 6.4% respectively as investors wondered if consumers might cut back on pork consumption due to confusion about how the virus spreads.”

Currently, there is no evidence that swine in the US or Canada are infected. Even if some infected hogs surface, the World Health Organization and the Centers for Disease Control and Prevention have stated that well-cooked pork cannot transmit swine flu. However, that doesn’t stop consumers from being concerned.

So, what are pork producers and processors doing to market the safety of their products? This is a great opportunity to show off their antemortem (live hog) and postmortem (hog carcass) disease monitoring programs.

Smithfield Foods, Inc. seized the moment and told investors in a statement Sunday that, “it has found no clinical signs or symptoms of the presence of swine influenza in the company’s swine herd or its employees at its joint ventures in Mexico,” and, “its joint ventures in Mexico routinely administer influenza virus vaccination to their swine herds and conduct monthly tests for the presence of swine influenza.”

Tyson Foods, which does not operate any pork processing facilities in the affected areas, only referred to the CDC statement that the flu is not affecting pigs, and stated, “Our pork products are safe.” I doubt that brings much comfort to confused consumers who are actively trying to protect themselves. Show us some real evidence that your products are safe.

I haven’t seen anything from Bob Evans Farms. Maybe they don’t even know there’s an outbreak…

Consumers demonstrate their vote of confidence in products each time they make a purchase. Producers that speak up about risks and how they’re being managed are likely to receive more votes than those that don’t.

Swine flu? I’ll have the oregano oil?

People will pay to protect themselves — or at least for the positive perception they are protecting themselves. Industry is all too happy to oblige with a variety of products of questionable value.

When faced with outbreaks of foodborne illness on fresh produce, sales of veggie washes go up. Salmonella in the kitchen? Bring on the antibacterial sanitizers. Now with swine flu dominating the headlines, twitterscape and Jon Stewart (see below) USA Today reports today that marketers are out in force — particularly on the Internet — with items ranging from 99-cent face masks to potions such as oregano oil that fetch $70 a bottle to third-party overnight shipments of Tamiflu for $135 per prescription.

Some major marketers are seeing an uptick in sales of items such as masks, latex gloves, anti-bacterial soaps and hand sanitizers. Consumer gurus aren’t surprised that so many treatments and protective devices related to swine flu — legitimate or not — are getting plenty of traction from retailers and marketers.

Jerald Jellison, a social psychologist said,

"When we’re faced with a potential threat, we tend to imagine the worst," says. That’s what marketers are capitalizing on. In a state of high need, with our rational powers diminished, we’ll take almost any action.”

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