Doom and Bloom: Noroviruses

In this article, Dr. Alton at Doom and Bloom Medical talks about Norovirus symptoms, treatment, and prevention.

Many of us have heard of the “stomach flu” but not the actual virus that causes it: Norovirus. Norovirus has been in the news lately when a long-term outbreak occurred among more than 220 rafters and hikers in the Grand Canyon National Park from April to mid-June of this year. Less well known is 448 norovirus cases reported in the U.S. from Aug 2021 to March of this year. That was six times the number of cases reported during the same time the year before.

We personally an experience with the virus a few years ago when my wife sampled “The World’s Best Hot Dog” at a street stand in New York City while visiting our daughter. Believe me, it’s no fun, and considering that norovirus can be found everywhere from the Big Apple to the Grand Canyon, the family medic should know about it.

ABOUT NOROVIRUSES

The National Foundation for infectious diseases reports that noroviruses are the most common cause of acute stomach and intestinal infections in the United States, The U.S. reports 19 million to 21 million cases a year. Humans are, apparently,  the only hosts of the virus. It affects people of all ages, but it’s particularly dangerous in the elderly, the very young, and those with weakened immune systems. Except for this year, winter is the most common time for outbreaks.

The virus was formerly known as the Norwalk virus because the first known outbreak took place at an elementary school in Norwalk, Ohio. Scientists identified the virus in 1972 from stool samples and renamed it “norovirus.” Since then, it’s been identified everywhere from cruise ships to nursing homes.

Norovirus is very contagious (just 5-20 viral particles can cause illness) and is easily transmitted through contaminated food or water, close personal contact, and even by air droplets from vomit, contaminated kitchen counters, and even toilet flushes. Infection can be passed from person to person for a time even after apparent recovery.

Here’s how contagious the norovirus is: In one outbreak reported in 1998, 126 people were dining at a restaurant when one person vomited onto the floor. Despite a rapid cleanup, 52 customers fell ill within three days. More than 90% of the people who later dined at the same table reported symptoms. More than 70% of the diners at a nearby table got sick; at a table on the other side of the restaurant, the rate was still 25%.

Norovirus is a hardy microbe, and is known to survive for long periods outside a human host. It can live for weeks on countertops and up to twelve days on clothes. It can survive for months in still water. Disinfectants containing chlorine, however, like bleach will quickly eliminate it, as will sufficient heat.

SYMPTOMS OF “STOMACH FLU”

The symptoms of the stomach flu include nausea and vomiting, watery diarrhea, and (sometimes severe) abdominal pain, usually within 12 to 48 hours of exposure. Along with this, muscle aches, headache, and fever may be seen. Luckily, life-threatening illness is rare, with dehydration being the main danger in those infected with the virus. Symptoms may last several days before eventually subsiding.

Unlike some viruses, immunity to norovirus is only temporary. Antibodies against the virus at thought to last up to six months after recovery. Also, there are various types of noroviruses, getting one doesn’t protect you against others.

Outbreaks of norovirus infection often occur in closed spaces such as cruise ships, nursing homes, schools, camps, and prisons. Shellfish, such as oysters, and salad ingredients are the foods most often implicated in norovirus outbreaks (except, of course, “the World’s Best Hot Dog”).

TREATING NOROVIRUS

As is the case with most viruses, there is no known cure for norovirus infection. Antibiotics will not be effective, as they are meant to kill bacteria, not viruses. Treatment involves staying well-hydrated. Suspect dehydration if you see these signs and symptoms:

·        Dry mouth

·        Decrease in quantity or dark color of urine

·        Dizziness when standing up

·        Decreased elasticity of skin (it “tents” when pulled)

·        No tears when crying or unusual irritability in infants

Using antidiarrheal meds like loperamide (Imodium) and anti-vomiting drugs like Ondansetron (Zofran) may also help.

PREVENTING NOROVIRUS

A cure may not be available but prevention is another issue. To decrease the chance of norovirus infection:

·        Wash your hands frequently with soap and water (norovirus is relatively resistant to alcohol), especially after using the restroom or handling food. Be especially sure to do this for 2 weeks after becoming infected (yes, you can be contagious for that long).

·        Wash food before cooking; cook shellfish thoroughly.

·        Frequently disinfect contaminated surfaces with a bleach solution (the EPA recommends 5-25 drops of bleach per gallon).

·        Keep sick individuals away from food preparation areas.

·        Avoid close contact with others when you are sick, and don’t share utensils or other items.

·        Wear disposable gloves while handling soiled items.

·        Immediately remove and wash clothes that may be contaminated with vomit or feces. Machine dry if possible.

It may be difficult to completely eliminate the risk of norovirus infection, but careful attention to hand and food hygiene will go a long way towards avoiding the stomach flu.

Joe Alton MD

California Wildfire Housing Crisis

In what could be a preview of they type of crisis that may be seen in the event of a CSZ earthquake in Washington or Oregon, California is facing a humanitarian crisis in the wake of recent wild fires. Tens of thousands have been evacuated from their homes and 26,000 Paradise residents are now homeless. Norovirus has broken out in three different evacuation shelters. Zero Hedge has consolidated information from several sources in “Situation Growing Worse With Every Passing Day”: Cali Wildfire Sparks New Housing Crisis.

Making things worse, norovirus has broken out in at least three evacuation shelters, requiring isolation tents to try and contain its spread.

As the Sacramento Bee notes – “the situation is growing worse with each passing day.”

Enafaye Nine-Rowe, a member of Chico California Conservation Corps, and California Air National Guard Sgt. Manghirmalani walk past an isolation tent at East Ave Church in Chico on Friday. Daniel Kim dkim@sacbee.com

This is on an order of magnitude beyond what we thought was one of the worst disaster recoveries we would be faced with,” said Kelly Huston, deputy director of governor Jerry Brown’s Office of Emergency Services.

After the Camp Fire erased most of the town of Paradise, destroying more than 9,800 residences, emergency services officials are dealing with what some say is an escalating humanitarian crisis with no quick solutions. Some evacuees will be able to return to unburned homes. Most, now hunkered in hotels, staying with family and friends, or stuck in evacuation centers or unauthorized camps, have no home to return to, and are left wondering where their future lies. –Sacramento Bee

“Wallywood”

Many residents have turned to makeshift communities where sanitation and safety are top concerns. In particular, hundreds of evacuees have been squatting at a camp in a Walmart parking lot, “a ramshackle village some inhabitants call Wallywood, a sardonic mash-up of their location and reduced circumstances,” reports the Bee.