10 Ways to Avoid Swine Flu in Public

Swine flu is making its rounds around the country — including your neighborhood — and recently, President Obama declared the situation a national emergency.

"Just being out in the world means you'll encounter individuals who are shedding the virus," says William Schaffner, MD, president-elect of the National Foundation for Infectious Diseases and chair of the department of preventive medicine at the Vanderbilt Medical Center in Nashville. And you can't always tell who's infected. H1N1 is shed, "or excreted, to use a tackier term," says Dr. Schaffner, in its highest concentrations the day before an individual gets really sick, mostly by traveling on the droplets that are spewed when someone coughs or sneezes. The volume of shed virus begins to diminish thereafter, he says, but a person can still pass the germ along until 24 hours after symptoms disappear and his or her fever goes away.

So if you're sick, it's important to stay home until symptoms improve. And if there's a serious outbreak in your community, you might want to consider cutting out trips that aren't really necessary. But if you know how to handle yourself at the grocery store, on the bus, or even at the World Series, you can do little things to lower your risk of catching H1N1 without turning into a complete hermit. (If you can get a flu shot, do that too.)

The H1N1 vaccination has gained more attention than any other flu vaccine program. So should you go for the shot, or take your chances without it?

Even as H1N1 circulates, life goes on. Here are ways to lower your risk of catching the illness in common public settings:

#1: In Movie Theaters
The average big-screen movie theater has between 200 and 300 seats, and with today's megaplexes including as many as 26 theaters per venue, that could mean upwards of 8,000 people in one building on a crowded Saturday night, many of whom may be actively shedding the virus without knowing it.

Strategy: Reschedule. First, ask yourself if seeing a blockbuster on opening night is worth the risk of H1N1. "During a season such as this, perhaps it's better to rent a movie rather than going to a theater," says Dr. Schaffner. Should you decide that you can't stand another minute at home, head to the theater when you know crowds will be lightest. At the very least, you can maintain the optimum three to six feet — that's the distance needed to prevent swine-flu transmission — between you and other potentially sick moviegoers. And wash your hands for a full 15 seconds when you head to the bathroom, or take a hand sanitizer with you. Most people avoid or minimize hand washing in the rush to return to their seats so they don't miss anything.

Stop the spread of flu in just seconds.

#2: On An Airplane
Unfortunately, if you wind up sitting next to an H1N1 patient, options are limited, says David Ellington, MD, director of the American Academy of Family Physicians. "Your major defense [against H1N1] is avoidance, and if you're sitting right next to someone who's coughing and hacking all over you, that's a very tough situation."

Strategy: Change seats.You can turn your head away from your seatmates so you're not directly inhaling their breath and the droplets from their coughing. But if you're lucky enough to be on an airplane that has a few empty seats, you can ask to move. If you can get at least six feet away from the offending individual, you stand a better chance. Wearing a flu mask during your flight may or may not shield you — outside of home or hospital, research on their effectiveness in real world situations is lacking. If you decide to go that route, you need to keep it tight on your face and wear it consistently to gain protection. Better yet, ask the cougher in question to wear the mask. Yeah, we know, good luck with that. But in home settings at least, research shows the infection is less likely to spread if the sick person wears a surgical-type mask.

#3: While Grocery Shopping
According to the Centers for Disease Control and Prevention, the H1N1 virus can live on surfaces for two to eight hours. So it would stand to reason that all those manhandled grocery carts would be prime vectors for spreading swine flu. Tests on those shopping carts have turned up everything from fecal bacteria from diapered baby bottoms to E. coli and Salmonella from raw meat, so it isn't a stretch to assume that they could be swine-flu carriers as well.

Strategy: Wash and wipe. Your best defense is to keep your hands away from your face (and your children's faces) while you're at the store, and wash your hands immediately after getting home. (Keep your shopping list in your hands and you may be less likely to touch your face.) Alternatively, you can store a washcloth soaked in a weak solution of bleach and water inside a sandwich bag, and use that to wipe down the handle of your grocery cart. Note that some stores provide sanitizing wipes, but those may contain antibacterial solutions, not antiviral disinfectants, in which case they are useless against the flu virus (and toxic, to boot).

Bleach or disinfectant for your home? There are lots of ways to wipe out swine-flu microbes, but some of them could be unhealthy.

#4: At a Restaurant
"Most of the transmission [of H1N1] occurs before the person gets sick," says Dr. Schaffner, which means that any seemingly healthy chef, waiter, or fellow diner could be spreading swine flu without realizing it.

Strategy: Dine in. Given all the unknowns and potential run-ins with sick employees or diners, and tables that may have been set with swine-flu-contaminated hands, you're better off eating at home if there's an outbreak of swine flu in your area and you haven't been vaccinated. Use this winter to learn how to cook — we've got hundreds of ideas in our Rodale Recipe Finder. Plus, you'll cut out all the added sugar, fat, and salt. Worried that too many evenings in will make you crazy? Form a supper club with friends, so you can take turns dining at each other's homes (club members must vow to practice good flu-prevention tactics, and take themselves out of the rotation if family members come down with the virus). And when you just have to have that restaurant experience, choose a day and time when there are fewer diners. Wash hands diligently, so you don't bring anything home besides leftovers.

#5: In the Doctor's Office
Most likely, if you're at the doctor's office, you're sick already, but those who are there for non-swine-flu-related health problems can ask to be placed in a separate waiting room, or even wait outside, if weather permits. Dr. Ellington, who also runs a private practice in Virginia, says that his office has set up a designated H1N1 waiting room to protect other patients, and also asks coughing patients to put on masks. "What the benefit of that is, we don't know scientifically," he says, but the intent is to cut down on the spread of droplets that contain the virus.

Strategy: Watch your hands. There are lots of surfaces you have to touch between entering the office — the doorknob — to checking in for your appointment — the pen — to waiting to be called back — books, magazines, and chair armrests, just to name a few. Ultimately, "your major defense is washing your hands and trying not to rub your nose and eyes," says Dr. Ellington. Pack a small bottle of hand sanitizer that contains at least 60 percent alcohol, and use it liberally. Bring your own books and magazines — at least they won't be from 2006 — and toys for your kids. Sign in with your own pen. If your doctor doesn't have segregated waiting rooms for swine flu patients, maintain six feet of space between you and the other people in the waiting room.

#6. At the Gym
Moderate exercise can do wonders to boost your immunity. While a crowded gym may not be the best place to be during an outbreak, it's not good to give up exercise, either.

Strategy: Clean, then sweat. Switch to outdoor exercise as much as you can, and make sure your fitness center carries sanitation wipes so you can wipe down equipment before and after use (check that they're antiviral, not just antibacterial). If they don't, bring your own alcohol-based hand sanitizer with you, and then apply lotion when you get home so your skin doesn't dry out.

#7. At Sporting Events
We're in the thick of the NFL season, and hockey is about to start. Your local colleges and high school teams are likely keeping busy, too. Despite the crowds, outdoor sports venues are less likely to expose you to flu germs than you might think. "Yes, there are lots of people in a football stadium, but they're outside, breezes are blowing, and they're not in an enclosed space," explains Dr. Schaffner.

Strategy: Practice viral blocking. Still, if someone is hacking near you, it's best to move, or watch the game from a standing-room only spot. If it's cold, wear a scarf — it can double as a neck warmer and a face shield, if someone starts sneezing around you, suggests Pat Rosenbaum, RN, CIC, spokesperson for the Association for Professionals in Infection Control and Epidemiology.

#8. On Public Transportation
You've probably seen it before. Someone on the bus or train is sick as a dog, hoodie up, face smooshed against the window, sneezing all over the place.

Strategy: Board with a Kleenex. "If it's a good, juicy sneeze or cough, turn your head," says Rosenbaum. "If you have a Kleenex, put it up to your nose and mouth for a second, that's another way to try and block it." She also says don't be afraid to ask someone challenged in the respiratory-etiquette department to cover his or her mouth. Holding your breath when someone near you sneezes isn't likely to help much, unfortunately. "If you hold your breathe for a few seconds and then inhale, you'll inhale strongly," she says, urging people to adopt three generic principles in any situation to prevent the spread of flu: Practice good hand hygiene, keep your hands away from your face, and try to stay three to six feet away from people.

#9. College Campus
Schools are breeding grounds for germs, and close living quarters on college campuses make it tough to protect yourself if your roommate gets sick.

Strategy: Lighten your social calendar. Since H1N1 is transmitted through droplets, try to make sure your bed is at least six feet away from your sniffling roomie's. And check with your campus health-service provider — some schools offer sick buildings where H1N1-infected students can stay. Avoid drinking a lot of alcohol (it can weaken your immune system), and steer clear of crowded campus parties if there's an outbreak at your school. Use Facebook, or whatever social-networking tool has replaced it among college hipsters, to keep in touch with your buds. And if your campus is offering any remote learning options as a flu-control measure, take advantage.

Eat these foods to protect yourself from a flu attack and to boost your immune system.

#10. The Workplace
Cubicles do provide some protection against sniffling coworkers. "But you have to wonder why they're at work in the first place," says Dr. Schaffner.

Strategy: Eat like a loner. If someone at work is clearly ill, talk to your supervisor and ask for the coughing coworker to be sent home. It will keep healthy workers safe and keep productivity running smoothly at the office. If people are still showing up to work sick, consider packing your own lunch and eating solo at your workspace until the outbreak eases. If many are sick at the office, you can also ask your boss if you can work from home until the outbreak subsides. Perhaps unimportant meetings can be put on hold (increasing productivity as a side benefit!).

If layoffs have hit your company hard, opt to use bathrooms located in areas with fewer workers, to lower your chances of running into a sniffling colleague. And make sure you wash your hands to stop the spread of flu in 15 seconds.
More Links:
How To Keep Swine Flu Out Of Your House
Should You Workout If You Have A Cold Or The Flu?
How To Set Up a Swine Flu Sick Room
How To Prep Your Lungs From Swine Flu