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1 in 4 Don't Cover Coughs and Sneezes

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  • 1 in 4 Don't Cover Coughs and Sneezes

    During the H1N1 flu (also known as swine flu) pandemic, public health campaigns urged individuals to practice good hygiene habits, but few heeded the advice, according to a new study.

    About one out of every four people that researchers observed in public settings failed to cover their mouth when they coughed or sneezed, and less than 5 percent of people covered their mouth using methods recommended by health officials.

    "This study showed a low prevalence of recommended respiratory hygiene behaviors suggesting that hygiene messages promoted in mass media campaigns have not been seen and/or have not been readily adopted by the public in this city," said Nick Wilson of Otago University Wellington in New Zealand, an author on the study.

    The study was conducted in New Zealand, which had a public health campaign during the pandemic similar to that in the United States and other countries around the world. However, the results do not necessarily apply to other areas, the researchers said.

    The study was presented today at the International Conference on Emerging Infectious Diseases in Atlanta, Ga.

    Watching you cough and sneeze

    One of the simplest actions recommended by the media campaigns was that individuals cover their mouths when they cough or sneeze, preferably with a tissue or the inside of their elbow, to avoid getting the virus on their hands and spreading it to nearby surfaces.

    To determine if people were heeding the advice of public health agencies, Wilson and his colleagues conducted an observational survey in three public areas in New Zealand's capital city of Wellington: a train station, a hospital and a shopping mall. Local public health authorities had already been conducting an educational campaign with posters and radio and newspaper advertisements recommending people cover their mouth when they cough or sneeze, using a tissue or their elbow.

    Using medical students as observers, they recorded the incidence of coughs and sneezes and the individual responses to these respiratory events.

    They observed 5.5 coughs and sneezes per observed-person-hour, of which 26.7 percent went uncovered and only 4.7 percent were covered by a tissue, handkerchief or elbow. The most common behavior, observed in 64.4 percent of cases, was to cover the mouth with the hands. Using a handkerchief or covering the mouth with the elbow were the least common behaviors.

    The gross truth

    Coughs and sneezes spew germs at rapid speed. About 3,000 droplets are expelled in a single cough, and some of them fly out of the mouth at speeds of up to 50 mph. Sneezing is worse ? as many as 40,000 droplets come out of the mouth, sometimes as fast as 200 mph.

    If a person is sick, the droplets in a single cough may contain as many as two hundred million virus particles. The number varies dramatically and changes over the course of an infection as the immune system clears out the virus. Generally, a sick person is most infectious as soon as the first symptoms appear and less infectious as his or her immune system clears the virus.

    Once airborne, viruses in these tiny droplets can survive for hours. Even if the droplets hit a surface, the viruses can survive and still spread disease if the droplets become airborne later. When a droplet lands on paper, its virus particles can survive for hours. On steel or plastic they can survive for days.

    Studies in the United States have found that only 24 percent of men and 39 percent of women say they always wash their hands after coughing or sneezing.

    Scientists study the ways we cough and sneeze to shed light on how viruses like influenza spread.
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