How To Outsmart The Stealthy Stomach Bug

woman in the fetal position on the bathroom floor

By Aayesha Siddiqui (@aayesha)
CommonHealth Contributor

“I threw up lunch for some reason,” my friend casually texted one recent afternoon.

It didn’t stop there: Hours later, he was bolting to the bathroom. “Diarrhea…the worst!” he moaned. His experience pales in comparison to that of my coworker’s friend who, while at a swanky New Year’s Eve party, fell victim to an unexpected and violent episode of vomiting. She recounted the horror: “The floor was wood — oak, as I recall — and scattered with gorgeous area rugs…The best I could do was aim for the floor between them.”

They’re not alone. Boston’s emergency departments have seen a recent increase in people with vomiting and diarrhea. The Boston Public Health Commission (BPHC) counted 287 emergency department cases just in the week between Christmas and New Year’s. New York is seeing a similar trend: the New York City Department of Health and Mental Hygiene reports that, over the two week holiday period in late December, there was a 50% increase in emergency department visits for vomiting and diarrhea compared to the fall months.

But let’s not panic just yet; this isn’t anything too out of the ordinary. Take a look at the BPHC graph below. You’ll notice that these emergency department cases of acute gastrointestinal illness (the medical name for all those trips to the bathroom) peak during the winter months:

So, what’s making so many gastrointestinal systems go haywire?

Well, there are lots of pathogens — viruses, bacteria, parasites — that could be the culprits, but there is one that stands out: norovirus. In fact, just in the last month, Minnesota, Iowa, and California have all had norovirus outbreaks.

According to the CDC, norovirus causes over 20 million cases of viral gastroenteritis every year. About a quarter of those cases come from contact with contaminated food (often due to insufficient hand washing before preparing food). With nausea, vomiting, and diarrhea as the most popular symptoms, 1 in 15 Americans will be spending far more time in the bathroom than they’d like.

Virus Particle Invasion

Norovirus is spread through what’s called the oral-fecal route: Billions — yes, billions — of viral particles are present in an infected person’s fecal matter (and vomit). If an infected person doesn’t wash her hands well after using the bathroom, those billions of virus particles make their way onto surfaces, counters, clothes, door handles, food, other people. If a healthy person comes in contact with these virus particles and manages to get them in her mouth (for example, by not washing her hands before she eats), then it’s her turn to start running to the bathroom.

How long between sharing a meal with a sick friend and your first stomach rumbles? Here’s a timeline of how norovirus plays out:

Timeline graphic: First, you come in contact with norovirus particles (through food, people, or surfaces). Then, 12-48 hours later, you get sick—mostly nausea, vomiting, diarrhea. You’re probably sick for 1-3 days. During this time, you’re highly contagious! Wash hands, bleach surfaces, and stay home from school/work! 2 weeks later, you still could be shedding viral particles. Keep washing those hands! After, you’re temporarily immune against the particular strain of norovirus you had. But there are many strains, so keep up the good hygiene!

That red box up there, the one that says you’re highly contagious — read it again. An infected person spews out billions of viral particles, but it only takes a few (as few as 20) of those particles to make a healthy person sick. This is one reason why norovirus is so easy to catch.

At The Masquerade Ball

Your body’s immune system is like the cadre of bodyguards stationed at the door.
What makes norovirus even more of a stealthy culprit is that there are so many different strains of the virus.

Think of your body as a big masquerade ball. Your body’s immune system is like the cadre of bodyguards stationed at the door. When you get one strain of norovirus — let’s say, a wizard dressed in green — your bodyguards learn to look out for that green-clad wizard. But another strain is dressed in purple, and another is wearing a hat, and another is carrying a staff and donning a cape.

The bodyguards haven’t been instructed to look out for all these different wizards, these different strains, so they may inadvertently allow one of those wizards into the masquerade ball. Soon, that different wizard, that strain of norovirus that only slightly varies from the one you had before, is working its magic on your stomach and intestines. That’s why, if you had viral gastroenteritis due to norovirus last year, you still could be at risk of getting sick once again.

Easy Fixes

So, what should you do?

  • WASH YOUR HANDS. Whether you’re sick or healthy, use soap and running water and scrub vigorously. Be sure to wash for at least 20 seconds and dry thoroughly after. (And no, hand sanitizers will not do the trick. Old school handwashing is best.)
  • Disinfect surfaces. If you’re sick or caring for someone sick, use a bleach-based cleaner to disinfect any contaminated surfaces, especially in the bathroom and in the kitchen.
  • Keep to yourself. Stay home from school or work while you’re sick. This is especially important if you work at a long-term care facility, at a school or daycare center, or in food service. (More than half of foodborne illness in the U.S. is caused by norovirus.) It’s best to stay home for 2 to 3 days after your symptoms subside.
  • Drink a lot of water.  All that diarrhea and vomiting can lead to dehydration, with children and the elderly at the highest risk.

Epidemiology professor Wayne LaMorte of the Boston University School of Public Health reflects, “If you were to somehow quiz families who had a family member with nausea and vomiting, it would escape them to wash their hands or cleanse utensils. There’s a lack of knowledge with GI [gastrointestinal] disease.”

He goes on, “Prevention of these things is incredibly simple. The complicated part is getting people to comply with simple measures that should be taken all the time.”

Three days groaning in the bathroom, possibly infecting your whole family, vs. washing your hands and circumventing that whole mess? Simple indeed.

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  • Catherine Birch

    What`s wrong with using anti-emetics & anti diahrea meds while sick, at least then you won`t be chucking your filthy germs everywhere!

  • Ron Heart

    I was at my families house over the weekend for my nieces wedding. I was so embarrassed during rehearsal, when I got so sick I didn’t even make it to the bathroom,barely hitting the trash can. I was glad I could call and talk to a doctor. I was out of town and miles away from my primary. The called in in a prescription to a pharmacy down the road.

  • Whatever

    A shot of Jack Daniels every other day—try it.

  • Drbethleilani

    terric article.  thanks.

  • Antera55

    Great article Ms. Siddiqui. Public education on hand washing may sound redundant and basic, and as a Registered Nurse for the past 35 years, people still don’t know how to wash their hands properly.  I have literally stopped people from exiting a toilet stall in public bathrooms to remind them to wash their hands. This virus is so virulent and contagious. Great reading.

    • Anonymous

      Why don’t public bathroom doors push outwards so you don’t need to touch them to open them?  I see people wash their hands correctly, dry them, and then open the door without using a paper towel which has been touched by the vile people who don’t wash their hands. 

      • DKB

        Building codes should require that public bathrooms consist of a passageway without doors at all. When you enter the passageway you would find the toilets, then the sinks, then the drying area and walk back out without touching anything after the last step. It would be a one-way street from filth to cleanliness.

    • Sara Piazza

      I agree, Re: hand – washing, but usually, the things you have to touch in a public bathroom in order to wash your hands are dirtier than your own hands. Also, those electric hand-dryers, which are all we are offered in many public bathrooms, recirculate the germs. I saw a study where people’s hands were dirtier after using an electric dryer than before.

  • pamkas

    I’m curious – why don’t hand sanitizers work?  I keep one in my car to apply after being in public places like stores and supermarkets…thought I was getting rid of the germs.

    • Aaron
      Synopsis: sanitizers have been shown to reduce infections in hospital settings, but do not work in a manner that makes a difference outside those settings.

      • Sara Piazza

        Those hand-sanitizers are someone’s cash cow and support businesses that use our fear in order to market their products.

        I know that using antibacterial soaps has been shown to lower our resistance to some bacteria as well as killing off beneficial bacteria. Could this also be true of hand-sanitizers?

    • Aayesha Siddiqui

      Hi pamkas. Hand sanitizers usually contain 60+% alcohol (either ethanol or isopropanol). These are effective against a lot of bacteria as well as against enveloped viruses (viruses that have a coating), like the influenza virus. But they’re not as effective against non-enveloped (naked) viruses, like norovirus. For these naked viruses, the concentration of alcohol would need to be much higher to be effective (the best results are at a concentration of 95%). 

      In summary: it’s not such a bad idea to have that hand sanitizer in your car, but what would be best would be to use your hand sanitizer as an adjunct to thoroughly washing your hands.  

  • Concord Sid

           Public education of this nature is direly needed.  For the high risk individuals, it can lead to huge hospital bills.  Consider the high cost for Medicare and Medicaid, too.  The result of poor hygiene could develop to intricate social problems.

  • LisaN

    Well, the financial thing is hard to judge, CourtLuv08, except that you’re putting everyone else’s livelihood at risk when you come back too soon.  But really….you think keeping your good attendance record is justification for making others ill?  Maybe their kids and their elderly relatives, etc, etc.  Think ripple effect here.  All for your “good attendance record”?  Please have a look in the mirror and think about what you just said.

  • Trenalg

    There is nothing new here in this article.  We could have been spared, should have been spared, the photo and the gory details in the article.  We’ve ALL been told A MILLION TIMES to wash our hands and keep kitchens, bathrooms, etc., sanitary, and to avoid others if possible when we’re sick or they’re sick.  This is COMMON KNOWLEDGE and is by now also COMMON SENSE.  What was the point of this article?  Just to distract us all with more worry and stress??

    • Desiree Abraham

      I know you complain that this is nothing new, but teaching in a school in the South, hand-washing & hygiene is not the top priority in curriculum with No Child Left Behind.  Not only do I see children not wash their hands after using the toilet but at restaurants, their parents as well.  It is disgusting but when you have so many adults who refuse to read and hygiene is not a top priority on TV programming, you need articles like this to reinforce bodily cleanliness for the health of the masses.

      • Whatever

        Why does it matter in what region you teach? Knocking the South are we? I travel in my profession FROM the South to many nasty locales. You’d better believe that I wash my hands often.

  • Anonymous

    Drinking water is very poor advice.
    Drinking Electrolytes is advisable and water has none, (unless supplemented).
    You are better off drinking a 50% solution of water and something like gatorade, that way you will stay hydrated at the cellular level.

    • guest

      Gatorade has a high sugar content which will actually upset your stomach more.  Stick with Pedialyte or a drink called Electrolyte.

      • Anonymous

        G2 is sugarless.

        • gmom22

          sugar substitutes can irritate the intestines and even cause upset stomach in some healthy people – probably not a good idea when you are already sick…

      • krisp8888

        Last time I had the stomach flu I could not keep down anything. Pedialyte or Electrolyte included. Gatorade ended up working best.

  • Shaeoriley

    CourtLuv: I feel for you.  This situation is so frustrating–theoretically and in practice.  This is why American companies need to get on board with the idea that productivity actually increases when employees are given paid sick leave.  One sick person being out for a few days means that EVERYONE else can stay healthy and on the job.  Meanwhile, the ill employee feels positively toward his or her job and is motivated to keep it–i.e. does a better job overall!  Jobs with companies that ‘care back’ is truly at the foundation of a strong economy. 

  • Fred

    Isn’t this the same virus reported on and so prevalent on cruise ships years ago? 

  • Brandon

    Anyone have a poster about this that I can place on the mirror in our restroom at work? It’s amazing to me how many people use the urinal/toilet and then head straight for the door. How do we get through to THESE folks?

  • Anonymous

    As much as I’d love to stay home for 1-3 days AFTER my symptoms go away, I can’t afford to: financially or in terms of KEEPING my good attendance record. The best I can do is just advise my co-workers to wipe everything down after me.
    Are you all UNAWARE of how many companies do not provide paid sick time off, let alone have any sympathy for people when they are sick?

    • Trolls Union Local 47

      I get your point about loss of wages. But when you go to work and infect your coworkers, you lower the productivity of the business as a whole, and potentially cause others to lose pay. And asking others to wipe down after, if not your attempt at being funny, is unworkable and irresponsible. If you consider for a moment that perhaps you became sick because one of your coworkers infected you, you’ll have your answer of what you should do when you’re sick.

      • realist

        Maybe I’ll let you talk to my boss if that happens. Truthfully, human frailty gets the least amount of sympathy by corporations.

      • oh my

        I had a job where they wouldn’t let me go home sick at all 95% of the time. I could be vomiting violently all day and they would tell me “try to make sure no one’s looking” “just puke in the trash can”. The saddest part is that jobs like this pay their employees least so part of you is always glad when they tell you you can’t leave… Other jobs I’ve had would send me home for being sick, then write me up for not getting a doctor’s note and it’s like “You pay me $9 and hour, and you’re going to make me go home and expect me to have the money to see a doctor?” Christ, people.

    • carson297

      Yeah, some companies just don’t think about the bottom line in this way.  Often their the food industry, which makes the problem even worse.  Norovirus in double cheese burger.  That’s gross.

    • Germ-a-Phobe

      YOU are the EXACT reason more people get sick and even die (those with suppressed immune systems) Don’t be selfish and stay home! Think of those around you that may not come out of it ok!

  • Smittty729

    Had something similar a couple of months back. Don’t know if it was Norovirus, but woke up one morning, and between 07:00 and 10:00 hours, had 10 bouts of diarrhea, and had vomited 17 times.

    Couldn’t keep myself hydrated, as every time I drank anything, I immediately threw it back up! Off to the ED I went!