Airborne Germs and Handwringing

How to avoid colds

Just before the Christmas break, right as my annual winter festival cold kicked in and I was up to my neck in end of year deadlines, I posted a link to a press release in my Geeky Bits science extra column. That page is a repository of the less worthy, but hopefully interesting stuff I come across. Occasionally, I see an intriguing headline, give it a click, give the text a quick read through, add the item to the Bits, and thinking nothing more of it, just as one might with a del.icio.us or StumbleUpon post.

However, one regular Sciencebase reader, Churchill Fellow Grace Filby, was somewhat taken aback by my highlighting a timely press release from the London School of Hygiene and Tropical Medicine (University of London) – and described it as “a load of misguided nonsense”. Unfortunately, there is no online feedback or comments form on that LSHTM press release through which we could open a public debate on its content.

The press release was entitled – “If you don’t want to fall ill this Christmas, then share a festive kiss but don’t shake hands” – not the snappiest of titles but almost certainly one attempting to catch the wave of festive spirit seeing as it was released on December 19. However, both the title and the subheading of the press release (“The fight against all types of infections, from colds and flu to stomach bugs and MRSA, begins at home, with good hand hygiene, says first review of hand hygiene in the community.”) perhaps places too much emphasis on hand hygiene as opposed to the problem of airborne pathogens, believes Filby.

First off, Filby says that the press release “deflects the public’s attention away from a major source of germs which is the air we breathe…handwashing is only a part of it.” She adds that, “It is the germs arriving in the air that need disinfecting or freshening before the germs land on surfaces that could be touched by hands and passed to other people.” Even the British government appears to be acknowledging this to some degree, according to The Times on Christmas Eve in a bulleted item on how air disinfection units can kill MRSA, and C difficile.

The press release states: “But a report just published warns that we may be far more at risk of passing on an infection by shaking someone’s hand than in sharing a kiss.” As far as we can see, the full text of the original 38-page report cited in the release the word kiss or kissing occurs only once. It’s almost as if the press office hoped to catch media attention with the mistletoe and seasonal kissing theme regardless of the science reported in the report itself. Moreover, there is nothing much about handshakes or shaking hands either.

There are several other dubious details about handwashing: “but we believe that this targeted approach to home hygiene…” Is “believe” valid in a heavyweight scientific document of this sort, asks Filby.

The press release concludes that, “Handwashing with soap is probably the single most important thing you can do to protect yourselves and your loved ones from infection this Christmas.” Probably – that’s good, but we also need to deal with airborne germs. Whatever would Florence Nightingale have said? There are plenty of other risk factors out there and ways to reduce the chances of succumbing to winter bugs, such as walks in the fresh air, healthy eating, and more contentiously vitamin C or zinc supplements, although the jury is still out on the benefits of those.

Regardless, the main problem is that the press release ignores the primary source of respiratory infection which occurs from carrier to the next victim before pathogens ever fall onto a surface. In the case of many winter bugs, they spread quickly through sneezes or coughs when people don’t cover their noses and mouths.

Of course, Filby and I could put on our cynical hats at this point and come up with some kind of plausible explanation as to why hand hygiene as opposed to air hygiene is considered important. “Perhaps it is worth noting that funding for research on air hygiene wasn’t forthcoming whereas for hand hygiene there are plenty of interested parties – soap manufacturers, handwash products and water companies,” says Filby.

Hand hygiene is obviously part of the story and in the pre-Xmas rush for headlines one could forgive the LSHTM for highlighting it, but a broader perspective on all-round hygiene education and the promotion of other aspects of hygiene, as opposed to simple hand-wringing in the washroom, would have made more sense.

15 thoughts on “Airborne Germs and Handwringing

  1. You are splitting hairs sir. I did not claim that D is an anabolic steroid. Vitamin D most certainly is an immunosuppresive steroid and will block the VDR and stop transcription of antimicrobial substances.

    Judging by the depth of your statement I am sure you are quite aware of the fact that D3 is converted by the liver into 25-D, which functions as a steroid. 1,25-D, the activated form of vitamin D, functions as both a steroid and a hormone. It is produced inside various types of cells, including those of the immune system and the kidneys, as well as in response to sunlight.

    The problem with 25-D is that it binds the Vitamin D Receptor which decreases the activity of the receptor, causing the innate immune system to slow down and shut off.

    The point I am trying to make is that exogenous D is immunomodulatory and should be handled with great care and caution under medical supervision.

    Also – and I am sure you are already aware of this – The VDR is the primary nuclear receptor for the innate immune system so shutting it off with D will have consequences.

    Thank You for your reply Mr. Bradley

  2. No problem Mark. On a point of order though, just because something has the word steroid in its name does not mean it is a steroid in the strict sense, and certainly does not mean there is a direct link between that compound and the anabolic steroids abused by athletes and others. Indeed, the fact that vitamin D is called a seco-steroid actually means that it is not a steroid, i.e. it does not have the molecular skeleton of the archetypal sterol molecule on which the more commonly known steroids, such as testosterone are based. The seco part means it is split and so it is a chain of chemical groups (including rings) rather than a multiply fused ring system like testosterone.

  3. David – I was commenting on Mr. Mc Coll, Mr. Singletons statements and persons in general that think supplementing with steroids is a good idea. I forgot to mention – Vitamin D is not a Vitamin – Yes it is called a Vitamin but it’s really a seco-steroid and hormone. My apologies for the mixup.
    Mark

  4. Vitamin D stops gene transcription of the VDR nuclear receptor in humans. It is not a nutrient – It is a seco-steroid. That’s your business if you want to take steroids but lets be clear about it.

  5. PEOPLE FORGET HISTORY – HOW TRUE

    Grace “Sunshine” Filby gets some heavy endorsement! See below. This excerpt from
    http://www.amazingphage.info/page6.htm#11271

    “Many thanks for your letter. You are absolutely right about sunlight: people forget history – they seem to have forgotten that airing beds in the morning is a great way of reducing infection too.

    Thank you for writing.
    With kind regards,
    Yours sincerely,

    Lord McColl

    PROFESSOR THE LORD MCCOLL
    CBE MS FRCS FACS
    House of Lords London SW1A 0PW”

  6. I am firmly of the opinion that we humans are always (gestation to death) struggling with “malnutrition” in its broadest sense. This becomes even more true when we get past the life-span that nature so obviously intended. (You can define – I am 70 and know!) The vitamin D discussion would be fine if we could be sure that no other vital factors impinge on the expression of L-form bacteria – or any other lurking agent, come to that. I suggest that trying to pin down SIMPLE cause and effect in a massively interactive system like the human organism, is as impossible as knowing both location and momentum of a sub-atomic particle. A touch of Taoism required: as you approach certainty, you are inexorably more in error. In the end, what counts is “what works”. I am currently cheating a lot of “diseases of old age” by trial and error with supplements. I remain out of the clutches of my doctor but could meet a cheerful, active death at any moment from “side effects”. See you on the other side – I’ll be the one with the healthy glow.

  7. Of course, there are others who comment regularly on this site about vitamin D, who would point out that the last thing you need depending on your ailment is sunshine and more vitamin D as it increases inflammation and helps breed L-form bacteria.

  8. Grace Filby (a very sunny lady) has made clear, many a time, that we need sunshine in our lives. The problem that is air gets trapped and shared in our stygian “places of healing”. Get the bugs out in the open and give ’em a dose of Sun! As Corporal Jones would say: “They don’t like it up ’em!”

  9. While living in Japan I noticed — to my surprise — that when a person was sick he/she used face masks. I think research on the relative effectiveness of either method (using masks/washing hands) would be much more accurate on Japan, where one can reasonably expect everyone else to use both methods.

  10. It is indeed…it’s almost certain that air hygiene gets no or negligible research funding from industry whereas there will undoubtedly be dozens of studies backed by the manufacturers of antibacterial handwashes and related products such as those gels everyone is supposed to use in hospitals. Incidentally, my daughter’s primary school class had a demonstration using a fluorescent marker and a UV light of just how poor those things are at keeping one’s hands “clean”.

  11. It is odd that one means of transmission is given more of an airing (sorry, but I couldn’t help myself) than t’other.

    Being even more cynical — and probably a little conspiratorial into the bargain — might we not find a hidden sponsorship from some major soap products company?

  12. There wasn’t room to mention the fact that my winter cold turned into a nice hacking cough (my wife has had a tickly cough for weeks) and over the New Year I seem to have picked up a stomach virus that caused debilitating stomach cramps although no serious effluent, so probably not norovirus. Speaking of which though, noroviruses are all over the news this week in the UK and yet no bulletin ever suggests that someone infected should not go into work until they’ve been 24 hours with no symptoms…

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