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Q&A: There are germs among us, and you can’t be too safe

While Ebola is making daily headlines, the average American is at far greater risk of contracting several infectious diseases. With cold and flu season starting, how do you keep you and your family free of illness?

The News Tribune interviewed Dr. Paul Pottinger for tips on disease prevention. Pottinger is an associate professor in the Division of Allergy and Infectious Diseases at the University of Washington School of Medicine and directs a program that educates and helps other doctors with optimizing antibiotic use.

The News Tribune met him in the lobby of the UW Medical Center in Seattle.

Reporter:You are shaking my hand, but you don’t know where it’s been.

Pottinger: All I need to know is that you have probably touched something I haven’t. So, that’s why I have this. (He pulls out a small bottle of alcohol-based hand sanitizer and rubs his hands with it.)

Reporter and doctor then head to a medical center deli to buy sandwiches. Dollar bills and coins are exchanged with cashier. Reporter and doctor sit down for interview.

Question: Let’s get Ebola out of the way. How prepared is UWMC and Harborview Medical Center for it?

Answer: This hospital is ready. Harborview is ready. We’re putting in a lot of time and effort to prepare for Ebola so everyone can relax. The general public has other things to worry about.

Q: You’re getting out the hand sanitizer again.

A: I traded money with the woman behind the counter. Money is a classic way to catch infections, as it goes from hand to hand.

Q: Hand washing. When should it be done?

A: After you’ve used the toilet and before you eat. I’m about to put this sandwich in my gullet. Whatever I’ve touched is about to go straight into my system. So with that money – the coins, the bills – I’m basically eating what came off of those. And that’s totally fine.

Q: How do you mean that?

A: Because we all have an immune system. We have a series of defenses against the germs out there. We can neutralize most of them.

Q: So, in the course of the day we are constantly ingesting and absorbing germs?

A: Constantly. But if you became focused on this, you’d never leave the house. There are some easy things to do to stay healthy.

Q: Do you get sick?

A: I’m pretty typical. I get one or two colds a year and one GI (gastrointestinal infection) – nausea, vomiting.

Q: What’s the biggest infectious disease risk for the typical American?

A: Influenza. There’s still so much we don’t know. It’s a germ that can change quickly. We need to stay ahead of it.

Q: Why do some people not get flu shots?

A: The biggest thing I hear is that it gives them the flu. The truth is they should have gotten it a few weeks earlier. Sore shoulder? Yes. Low-grade fever? Not uncommon. But that’s all good. It tells you that you are mounting an immunological response. There’s nothing alive in the injection. You can’t catch something from something that’s not alive.

The other reason I get is because they’ve never gotten the flu. Why should I get this shot?

First, it only takes one episode to ruin your whole week and, No. 2, people do get mild influenza infections but they perceive it to be a cold. But they can still spread that to others. And those folks can get critically ill. Something like 30,000 Americans will die this year from the influenza.

Q: When you leave the house, what do you avoid touching?

A: The “high-touch” surfaces – a door knob, mouse, keypad. By far the biggest high-touch surface is your cellphone. If it’s your own germs, it’s fine. But if you’re using a public keyboard – that and the bathroom toilet handle are probably the two most germy spots you can think of.

Q: What precautions do you take when traveling by air?

A: I’m not worried about the air quality. Although some germs you can get by breathing the air, that’s relatively uncommon. The reason people may get sick on a plane is because of what they touch: the armrest, the handle in the lav. I’m just careful with my hand hygiene before I eat and after I use the lav.

Q: That raises the question: Are we creating problems by overusing hand cleansers?

A: There’s a lot of confusion about that. Hand cleaners come in two families. There’s anti-bacterial chemicals and medications. The classic is called chlorhexidine. It’s our surgical scrub. That stuff does not belong at home. It’s in Dial anti-bacterial soap and other products you can buy. They have never been proven to be beneficial. Plain soap and water is always the way to go.

This, however (he holds up hand sanitizer), is different. This is ethyl, or isopropyl alcohol. The germs basically cannot get resistant to this because they are killed on contact. This stuff is fine – all day and all night.

Q: What’s the germiest spot in the home kitchen?

A: If I’m not mistaken, according to studies, the heaviest bacterial load in the whole kitchen is that (kitchen) sponge. Anything that’s wet. Life loves moisture. In my house the kitchen sponge has a one-week life span because of this issue.

Q: You feel a sneeze coming on. What do you do?

A: First, I like to give people warning. Then the best thing is use the crook of your elbow, sneeze into your sleeve. If you sneeze into your hand, you just made your hand contagious. Even if you have a hanky it’s hard to keep that off of your hand. If you sneeze into your elbow, very few people interact with their elbow.

Q: New scenario: You shake hands with someone and then realize that person is sick. You forgot your hand sanitizer, and there’s no bathroom in miles. Now, your hand is radioactive with disease. What do you do?

A: That’s a good way to think of it. Basically, you don’t want to touch your face. Every time that happens it’s an opportunity to get sick. (The face) is where the mucus membranes are and where germs are so happy to get into your system.

Q: Let’s talk about long-held notions. Does getting physically cold get you sick?

A: Colds are caused by viruses. Your environmental exposure should not affect that. In the tropics you can still get a cold.

Q: There’s no cure for the common cold, but are there proven treatments?

A: Yes, zinc. Those zinc lozenges or syrup. That’s proven in a number of studies to reduce the duration of a cold by a day.

Q: What about those over-the-counter products like Airborne?

A: It’s just vitamin C.

Q: If you get sick, when can you safely rejoin society?

A: The criteria for reintegrating into society should be no fever for at least a day and you should have control of your secretions. If you’re still sneezing and dribbling, then everything you touch is going to have billions and jazillions (of germs) and they’re going to make somebody else sick.

Q: Is there any science to support the “three-second rule,” when they drop food on the floor or if they just can’t stand the thought of losing a good chicken leg?

A: Different studies come to different conclusions. If it’s the bathroom floor at Grand Central Station, I would leave it where it lay. If it’s your own kitchen and there are no strangers coming in and it’s clean, it’s probably OK.

Q : But transfer of germs happens the split second it hits the floor?

A: Oh, yes. It'll have germs on it. If you take a bite of that, you’re eating germs. But that’s fine. We eat germs every day. We couldn’t live without them. There’s more of them in and on us than there are cells of us. And that’s OK. Unless they’re bad germs. Or you have a poor immune system. In my house the three-second rule is totally fine.

Q: Is wearing a surgical mask in public effective at preventing disease transmission?

A: I don’t think there’s any medical benefit to paper or cloth masks in terms of reducing infection risk. Most germs do not fly into your mouth or nose. And if they’re small enough to do that, they would just go right around those masks.

I worry that the masks are irritating and make people touch their faces more – which, ironically, makes things worse.

Q: Let’s talk about vaccinations. Beyond childhood vaccinations, what should adults be getting?

A: Adults should work with their primary care doctors to make sure they’re up to date. Pneumococcus, pertussis, tetanus. (Aside from international travelers) most folks just need seasonal flu.

And if you’re afraid of needles, we have a spray. We have egg-free versions, mercury-free. According to the (Centers for Disease Control and Prevention), everybody over the age of 6 months should have a flu shot every year. That’s almost without exception.

Q: There’s a theory that if kids get sick at an early age, like in day care, they'll develop a stronger immune system and have fewer health problems. What’s your take on that?

A: It’s sometimes called the hygiene hypothesis of infectious diseases. (The ideas is) we have these very advanced, well-tuned immune systems looking for something to do. And if there’s nothing to do, they turn on themselves. The link to that hygiene hypothesis is very weak scientifically. It sounds a little too easy to be true, and it probably is.

Q: Beyond the current crisis of Ebola, what are the long-term, systemic worries in infectious disease?

A: I'll tell you what keeps me up at night: Bacteria that are resistant to the antibiotics that should treat them. That’s my job. But I think that’s what we as a society should be worried about. It has implications for every person.

Q: What are the issues with bacteria?

A: They are an important family of germs because they can cause a whole range of sicknesses. Not only respiratory but skin, GI and soft tissue problems. Any part of the body can get these infections. And we have this whole class of drugs – the antibiotics – that should be able to treat them. Well, they evolved. Charles Darwin was right. The more you put a selective pressure on a population, the sooner it evolves to survive.

Q: How are they used?

A: In the United States we use them two ways: for people and for animals. I’m part of a group that says we should stop using antibiotics in animals. At least in the so-called prevention of disease and for growth enhancement.

Q: What are the issues with the use of antibiotics for people?

A: What I worry about is people who are getting sick and seeing their doctor for antibiotics when they don’t need it.

Q: But any doctor with five minutes of medical school knows antibiotics don’t treat viruses. Why are they prescribing them?

A: On occasion you'll have bacterial sinusitis where they need antibiotics. And sometimes there’s diagnostic uncertainty. There could be a bacterial component. But 95 percent of the time the patient has a viral process and bacterial infection is not the issue and you don’t need antibiotics.

Q: But these patients are still going home with antibiotics.

A: Because health care is a business. If you have taken time off from work, driven through the rain, paid for parking and seen that doctor, you want to get something for that investment.

The patient will say, “Give me antibiotics. I have to get back to work. I’ve got to get ahead of this.” That’s a hard emotional thing for us doctors to cope with.

We want our patients to be happy. If they’re happy, they'll come back. They'll get their diabetes under control, lose weight, quit smoking. I want a healthy patient. But if they get upset with me because I won’t give them antibiotics, I'll never see them again.

Q: How, as a doctor, can you break the cycle?

A: Think about what it must take to have that same conversation, that same fight with patients. I did primary care for four years when I was training. I can tell you: It’s exhausting.

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