Prevention & Recovery

How not to spread the flu

Author: Canadian Living

Prevention & Recovery

How not to spread the flu

How the influenza virus travels in droplets and enters mucous membranes
In everyday life, influenza virus particles travel in droplets larger than 5 microns in diameter, which are released or "shed" from infected persons when they sneeze, cough, or talk. These are large droplets.

This is an important detail, because large droplets do not travel very far. It is thought that they spread no farther than 1 metre, which is the basis of the "less than 1 metre" principle: the distance that people should stay apart to limit the risk of infection. Other types of infections, like tuberculosis and chicken pox, can travel in "aerosols," which means they can be suspended in smaller particles with the ability to travel farther.

To infect you, influenza must enter your body through mucous membranes: your eyes, your nose, or your mouth. The relatively large droplets containing influenza virus can directly infect you if you are less than 1 metre from an infected person. This may happen if an infected person sheds virus while coughing, sneezing, or talking and the virus particles enter your eyes, nose, or mouth. Droplets may also deposit themselves on an object; if you touch this object, you then bring the virus to your own mucous membranes by touching them.

Guard your mucous membranes: wash your hands
Handwashing is the single most powerful personal measure that can reduce your chance of contracting influenza during a pandemic.

This is what happens: People with influenza cough, clear their throats, talk, or sneeze on their hands. They open doors and push elevator buttons. They may not realize they're sick, because a person with influenza can be contagious and shedding virus particles one day before any symptoms appear. Influenza virus particles can survive on inanimate objects: up to 48 hours on hard surfaces, up to 12 hours on cloth or tissues. You open a door or push an elevator button in the wake of someone with influenza, you might rub a bit of dust from your eye or scratch your nose. Now, you may have infected yourself with influenza.

Page 1 of 4 – On page 2, find etiquette guidelines to follow around someone who's coughing or sneezing around you.

Excerpted from The Flu Pandemic and You: A Canadian Guide by Vincent Lam, M.D. and Colin Lee, M.D. Copyright 2006 Vincent Lam and Colin Lee. Reprinted by permission of Doubleday Canada.


During Phase 6 of a pandemic, it is probable that you will touch contaminated objects as you go about your daily life, and this might also occur in earlier phases, especially Phases 4 and 5. In this way, you could catch influenza from another person whom you never saw. It will not be possible for you to control who touches things before you do. What you can control is what comes in contact with your eyes, nose, and mouth.

Touching and handling an object is not sufficient to cause you to be infected with influenza. It is the act of bringing your contaminated hands in contact with your mucous membranes that allows your body to be infected with influenza.

Be sure to wash your hands thoroughly before touching your eyes, nose, or mouth at all times. Improved handwashing rates have been shown to decrease infection rates in hospitals and also in community settings. It is estimated that one out of three people do not wash their hands after using a toilet, so this is an especially important measure when you are out in public, especially if you are about to eat a meal or touch your face.

Cough and sneeze etiquette

At some point during a pandemic, you will need to cough or sneeze. Do so in such a way that if you are carrying influenza virus, you reduce the chance of spreading it. Cough and sneeze etiquette is sometimes referred to as respiratory hygiene. Not every cough that you have during a pandemic will be influenza.

You may be sneezing or coughing because of a cold or your allergies, but remember that you could at the same time be in the incubation period of influenza and be shedding virus anyway. Cough and sneeze etiquette is a worthwhile courtesy at all times, and even more relevant during an influenza pandemic.

Interacting with others
Turn away from the people around you. Don't cough or sneeze on people, and especially not in their faces. Ideally, cough or sneeze into a disposable paper tissue, holding it with your non-dominant hand (if you are right-handed, sneeze into a tissue in your left hand, and vice versa). Immediately throw the tissue away in a garbage can. Regard both hands as potentially contaminated, and wash them both thoroughly as soon as possible. Do not unnecessarily touch or handle any objects with either hand until you have done so.

Simple? Sounds like it. Easier said than done? Yes. Try it. Doing all these things in real life may be challenging. For instance, you may need to sneeze on the subway at rush hour. If you are in a crowded place and can't turn away from everyone, try to cover your nose and mouth as well as possible when you cough or sneeze. Or you may have run out of tissues. If so, cough or sneeze into your upper shirt sleeve. This piece of clothing is now certainly contaminated if you have influenza. After sneezing into your upper sleeve, don't push doors open with your shoulder.

Page 2 of 4 One page 3, learn what to do if you're coughed on or sneezed on.

Excerpted from The Flu Pandemic and You: A Canadian Guide by Vincent Lam, M.D. and Colin Lee, M.D. Copyright 2006 Vincent Lam and Colin Lee. Reprinted by permission of Doubleday Canada.


Using your non-dominant hand
There is no scientific literature to support using your non-dominant hand to address your sneeze, and then preferring your dominant hand if you need to handle objects before you're able to wash both hands. We just think it makes sense, because you're going to need to use one of your hands. Interestingly, in many cultures, such as in India, the left hand is seen as a contaminated hand and performs "dirty" daily activities; consequently, one never greets another person with that hand.

Ideally, after sneezing you shouldn't handle anything but should immediately throw away the tissue and wash both hands fastidiously. In a perfect world, bathrooms would be everywhere, they wouldn't have doors, and all sinks would be motion-activated. Since this isn't the case, and the ideal of not touching anything after you sneeze until you thoroughly wash your hands isn't always going to be possible, we recommend using your dominant and non-dominant hands, as well as your shirt sleeve in the fashion we describe above. Keeping hand sanitizer in your pocket or purse will also help mitigate the unavailability of bathrooms.

Being coughed on or sneezed on
At some point during an influenza pandemic, someone may cough or sneeze near you, or perhaps on you. During Phase 6, this is the pandemic influenza equivalent of having unprotected sex. Avoid it. It would be better if it hadn't happened, but once it has, it's good to know how you might mitigate your risk of contracting influenza and your potential for spreading it further. There is no formal scientific literature in this area, so what follows is our carefully considered opinion based on the best knowledge that exists.

Be polite
Don't flip out. Don't panic, and don't become hostile toward the person who just coughed or sneezed on you. There's no point. Once it's happened, it's happened. Perhaps the sneezer just has allergies. But you may also have been exposed to influenza. If you have just been exposed but no virus has entered your mucous membranes, you may not yet have contracted influenza.

You could ask the person if he is ill, but this is optional. The answer shouldn't change what you do. Our opinion is that during Phase 6 of a pandemic, you should treat any situation in which someone directly coughs or sneezes on you the same way. If the cough or sneeze reached your hands or belongings, wash them carefully.

Be especially sure to give your hands a thorough washing before you touch your own eyes, nose, or mouth. What if someone has coughed or sneezed in your face? First, wash your hands. Then wash your face thoroughly. You may choose to rinse your eyes and mouth. Be sure to wash your hands carefully before touching your face, because if your hands are contaminated, there's no point introducing contamination to your face in your attempt to clean it.

Page 3 of 4 – Find out how the "1 metre rule" prevents you from spreading the cold on page 4.

Excerpted from The Flu Pandemic and You: A Canadian Guide by Vincent Lam, M.D. and Colin Lee, M.D. Copyright 2006 Vincent Lam and Colin Lee. Reprinted by permission of Doubleday Canada.


Teaching others
You may consider, in a civilized and non-confrontational manner, advising the cougher or sneezer to employ cough and sneeze etiquette in the future. Finally, if you have been coughed or sneezed upon, be additionally careful in your own subsequent habits. In this way, if you have been infected, you can hopefully reduce the risk of transmitting the infection to others. Remember, even if you contract influenza, you have a high chance of surviving.

Don't shake hands, don't kiss people, don't share snacks
During Phase 6 of a pandemic, greet and interact with people in ways that do not involve direct physical contact. Consider this during Phases 4 and 5. Avoid eating food that someone else has recently handled. When you greet someone, just say hello, or bow slightly if you feel that a touch of formality is in order. During Phase 6 of a pandemic, it's really not sensible to shake the hands of everyone you meet, or to greet all your friends with a peck on each cheek.

This is not an exhaustive list of activities to avoid, so you will need to consider situations individually. For example, eating at buffets is not a good idea, since lots of people use the same serving utensils and take food from common platters. Religious ceremonies that involve drinking from a common cup or eating parts of a commonly handled piece of food should possibly be replaced simply by worshipping without physical contact. Maybe you should avoid contact sports. However, tai chi would pose no problem, nor would cycling or running.

Things to avoid during certain phases of a pandemic
Consider the principles we discussed above, take note of activities that involve touching other people, many people handling common objects, or putting food that others have touched in your mouth. If these actions are not essential, don't do them during Phase 6 of a pandemic. Consider avoiding them in Phases 4 and 5, and stay tuned because your local public health authorities may have a timely recommendation on this topic during Phases 4 and 5. They're not directly relevant to pandemic influenza in Phases 1, 2, and 3, although following this advice might reduce your chance of getting a cold or a case of seasonal influenza.

During Phases 4, 5, and 6 of a pandemic, if there are certain things that you feel are essential, such as communion or other religious activities, your religious institution may think about how to do these things in a way that reduces the risk of transmitting infection.

Social distancing and the "1 metre rule"
During Phase 6 of a pandemic, try to stay more than 1 metre away from other people. Whether this will be relevant during Phases 4 and 5 will depend on your local situation. The transfer of contaminated droplets directly from one person to another without physical contact occurs through coughing, sneezing, and talking when there is less than 1 metre between people. Keep yourself posted on local public health advice.

When going about your day during Phase 6, avoid non-essential activities that would put you in close quarters with others. Certain essential tasks may require that you are less than 1 metre from other people. For example, if you are a health care worker, caring for sick people will necessitate that you are closer to others.

If you are a police officer, you may have direct contact with people in order to enforce the law. Such essential workers, with unavoidable potential risk exposures, will probably have specific risk-reduction measures for those tasks, such as the wearing of masks, gloves, or goggles.

Otherwise, during Phase 6 avoid crowded bars, busy markets, theatres, sports events, public transit, and basically any non-essential situation in which you will end up being close to other people. If there are essential activities in your life that you can't cut out, think about whether you can do these things differently to minimize the number of times you will be less than 1 metre from another person and to avoid large gatherings of closely packed people.

Page 4 of 4
Share X
Prevention & Recovery

How not to spread the flu