Norovirus alert – how to avoid spreading it

For about 24 hours beginning last Wednesday evening I had what I thought at the time was a bout of food poisoning. It wasn’t, because my wife Cathy and then our houseguest Dave Täht got it. It was a form of extremely infectious gastroenteritis, almost certainly a new strain of norovirus that is running through the U.S. like wildfire right now. Here’s what you need to know to avoid getting it and giving it to others:

We think it was norovirus because the symptoms match its clinical profile perfectly. They are: vomiting, diarrhea, muscle pain. Duration is about 24 hours. It is difficult to convey how hard and fast this hits – you go from feeling fine to violent nausea in 20 minutes. I experienced the progression myself and watched it in two others.

1. If you experience fast-onset gastroenteritis that mimics food poisoning, it is quite likely to actually be norovirus.

2. This bug is extremely infectious and can be spread by skin contact, aerosol droplets, or virus on food-preparation sufaces.

3. Careful hygiene in the bathroom and frequent hand-washing before and after contact with other people is important to help you keep from getting it and passing it on. Sources differ on how effective conventional hand sanitizer fluid is against this bug, but it can’t hurt to use it.

4. If you get it, isolate yourself. Avoid contact with other people. Do not go out in public if you can possibly avoid it. Do not handle food that will be eaten by others; do not touch food-preparation surfaces or cookware or utensils that will be used by others.

5. It is not lethally dangerous (except to the very old, the very young, and people with compromised immune systems) and it doesn’t last long (about 24 hours).

6. Those will, however, probably be 24 of the most most miserable and disgusting hours of your life. The symptoms include violent vomiting and (sometimes uncontrollable) diarrhea. You do not want to have this.

7. Do not try to hold down the initial vomiting any longer than it takes you to get to somewhere sanitary to barf into. You will feel better after you have emptied your stomach. You may, in fact, feel almost normal – until the diarrhea hits.

8. You will be losing water rapidly via the vomiting and diarrhea; you will be more miserable, and recover more slowly, if you let yourself get dehydrated. Take small drinks of water at relatively frequent intervals.

9. Washing contaminated clothes, towels and surfaces with a light chlorine solution will kill the virus.

10. Important: Continue isolation until you have been without symptoms for a minimum of 48 hours! I cannot emphasize this point enough – failing this because I didn’t know I was infectious is probably how Cathy and Dave got it.

If we had known it was infectious when I got it, Cathy and Dave might have been spared a lot of unpleasantness. Play safe and don’t infect those near you.

43 thoughts on “Norovirus alert – how to avoid spreading it

  1. 5. It is not lethally dangerous (except to the very old, the very young, and people with compromised immune systems) and it doesn’t last long (about 24 hours). You’ll just wish it were.

  2. The references to 24-hours is a bit misleading. It can, and often does, last more than 24 hours. The core symptoms might wane in a day if you are lucky, but you can remain nauseated easily for over a day, and diarrhea may start later on day 2 and last until day 3-4. In other words, the ordeal needn’t be short-lived as the “24-hour” language insinuates.

    As to the window of contagiousness, you could have it and pass it 1-2 days before symptoms start, and can last for another week or so. Mild aftereffects can persist for a week after the core nausea-diarrhea subsides. In all, you could very well be a carrier for 1 – 1.5 weeks.

    If you can get to a doctor or ER and have them prescribe Zofran, you’ll be much happier. You’ll starve for a day or two because you won’t want to eat anything, but Zofran will keep you from throwing up, and the whole not-eating thing will keep the diarrhea down to minimum.

    BRAT diet is a useful thing to know – Banana, Rice, Applesauce, Toast. If you are going to eat wheat, then go for high glycemic foods – bagels sans cream cheese works for e.g. Banana’s can be your friend. Corn flakes + Soymilk will work as well. Avoid lacto-ovo foods.

  3. “Take small drinks of water at rekatiely frequent intervals.”

    Should probably be

    “Take small drinks of water at relatively frequent intervals.”

    Hand sanitizer is mostly an alcohol-glycol solution. The norovirus will dessicate in the presence of alcohol, but not have its protein sheathe oxidize enough to kill it. Less effective than just having a bottle of water with a bleach solution (about four times the bleach you’d use for laundry – 1 cup per gallon). Re-use an old hand sanitizer bottle for the solution, apply bleach, then apply hand lotion afterwards. (The hand lotion acts as a mild barrier to you spreading the virus by touch).

    Norovirus, like influenza, relies on dry conditions to spread. This may be met with some measure of disbelief when you see how wet the stuff is coming out of you…but in moist conditions, norovirus’ protein sheathe opens up a bit and it dies faster from atmospheric oxygen.

    Wipe down surfaces that people touch with their hands. Same rules apply for influenza, and are mostly ignored. The path of transmission is “touch your nose/mouth/waste product, touch several other things, water in your touch dries out, norovirus goes dormant, next person touches that surface, touches their lips, and gets infected.”

    Norovirus can remain dormant on surfaces for a very long period of time. Lab samples under household conditions take 9 to 10 days to die off.

    I am reasonably confident that Dave and Cathy got infected not because you were still infectious, but because something you touched did not get cleaned with suitable ruthlessness.

  4. I can’t comment on this particular virus. However, I can comment on dehydration. It’s not pleasant. It’s also a really big problem in developing countries; with children particularly that get viruses (e.g. cholera) that cause these symptoms. Anyway, not only drink regularly and keep your fluid levels up, but also make sure your salt and sugar levels are kept up.
    Wikipedia (of course) has an article on Oral rehydration therapy where they explain the importance of sugar and salt. Wikipedia gives the following ratios:
    30 ml sugar: 2.5 ml salt : 1 liter water
    2 tbl. sugar : 0.5 tsp. salt : 1 quart water

    You probably won’t die if you are a healthy adult and you just happen to catch something nasty. But any children, get them to the doctor (or, if you can’t, but can read this, read up on the Internet for symptoms and solutions, and keep the kid’s fluid levels up).

  5. Dozens of us are experimenting with silver nano-particles in a colloidal solution and finding it to be highly effective against many pathogens, viral and bacterial. In vitro tests have shown silver ions or nano-particles (i.e. clusters of several complete atoms) to be active against for example HIV, SARS, and various bacteria. In my case, in past 3 months I was able to significantly reduce the viral load of a high strain (carcinogenic) HPV virus which I contracted in 2006, as evidenced by disappear of papillomas on my skin and the reduction of my lymphocytes confirmed via a blood test.

    The key to efficacy appears to be the oral consumption of a large dose, e.g. 1000ml on the onset of symptoms. Taking spoonfuls is ineffective and could stimulate silver resistant strains. Consume only the nano-particle form, because silver ions can cause Argyia and are less effective– their small size and unstable outer electron shell enables permanent lodging inside healthy (skin) cells bound with chloride or sulpher in the body. Silver is photo-sensitive, e.g. used in developing photographic film. Electron microscope images show the AgNPs near a pathogen and exploding it.

    Up to the recent past, all colloidal silver (CS) was the clear ionic form, which is evident when it is shipped in dark colored bottles, because the ions are not stable and will precipitate out of the solution under light. Kephra discovered that by running the electrolysis with heat and reducing with a carbohydrate, these Ag+ ions can be coaxed into the safer and more efficacious yellow-golden AgNPs solution. The color of light reflected is due to the size of the NPs.

    Several of us have rediscovered Lugol’s iodine or Sea Kelp tablets for improved immunity and systemic health. Apparently the entire volume of blood of the body is circulated through the thyroid every 17 minutes, and iodine in the thyroid weakens pathogens. Also we need significantly more than the RDA 150 mcg, because the excess from the thyroid is distributed to the human cells throughout the body. We can not realistically get this needed excess from iodized salt. And most foods are relatively low in iodine, with seaweed two or more orders-of-magnitude greater in concentration.

    When taking CS, start with smaller doses to test for the Herxheimer reaction.

  6. I’m not 100% sure if I took a stroll on the Norwalk, but I did catch a nasty gastroenteritis of some description in 2004 November around the same time it was making its rounds in Calgary. It didn’t last very long and wasn’t too bad. I do recall an earlier bout, it’d be about 1994, IIRC, that I’m pretty sure was the flu but was awful enough to almost match descriptions of cholera. I realize that one (well, I at least) need to be a little careful with oral rehydration. If you take too much at once, it’ll come straight back out without doing any good. The magic mean, for me at least, seemed to be about half a cup, give it about ten minutes to settle (unless your throat is dry, then it tends to settle faster) and then take more. Then you can ramp it up when you start feeling thirsty again…

    Perhaps I should point out that when you’re sick, you can be desperately dehydrated without feeling thirsty, and it is important to bear this in mind. If you’re not feeling thirsty, but you can’t sleep, feel tired, and most especially if you’re getting dizzy or pain from moving your head around (can feel as though your brain is shriveling up inside your head and bouncing around; I know that’s not what it really is), you are definitely dehydrated, even if you don’t feel thirsty.

    Finally, don’t mix caffeine and echinacea. I can’t give you a citation for this, I’ve only learned it very much the hard way. They combine into some sort of poison that will start producing flu-like symptoms in less than two hours. Separate the two by a minimum of eight hours. As soon as I realized this, and looked back over the previous instances I had sudden flu-like symptoms associated with other non-flu-like illnesses, I was certain this was the case. I figured it was probably attacking metabolic enzymes and took an anti-hangover course of massive amounts of natural fruit smoothies (got about twelve RDIs, 720mg or so of natural source ascorbate (Vitamin C), along with probably twenty or thirty other colorful antioxidants and vitamins) followed by natural source Vitamin B (about two hours later, Vitamin C tends to destroy the B vitamins, so don’t take them at the same time.) I was right as rain in eight hours, the sore throat I took the echinacea for was gone, as well as the flu-like symptoms of having chased the large Tim Hortons ice cap with the echinacea at the start of the bout.

    Also, I should point out, since most people don’t know this, you need about 2000mg of echinacea before you notice anything. My experiments have revealed it to be an antibiotic, with very little effect on norovirus (I tried it in 2004), but it’ll knock out strep throat (Strep-A to be exact; there are probably echinacea resistant strains out there by now, since both mainstream and medical specialists I talk to look at me like a YEC when I tell them this story) just like the pricy prescription I got from my doctor. The last time I got a sore throat (full blown nasty yellow loogie hardly breathe variety), I took echinacea like an antibiotic run, three 2000mg caplets a day (one every eight hours) until the $10 bottle of sixty ran out. That was five years ago and I haven’t had a sick day off since.

  7. When one begins to resemble a source flow…life can become optional.

    I have only felt that way once. The magical source suppression suppositories do wonders in such a condition.

    Good luck all. I just had my brush with this yesterday. Fortunately rather mild for me. I did not have the nausea, vomiting thing….just the other. Guess that makes me a doublet flow.

    Should we all go on a cruise?

  8. I was going to ask if it was too soon to make cruise ship jokes, but someone beat me to it.

    I’ve had something like that once, but it was just food poisoning and the acute effects only lasted a few hours. But the misery, and horror of not being able to decide which end to point towards the porcelain…. ugh. I hope everyone affected is feeling better.

    I’ve heard rumors a couple of times that norovirus was going around along with the usual colds and flu this year. A little distressed to have confirmation of the rumors, but thanks for the warning.

  9. One more tip: if you are unable to hold any fluids down, go have your sorry ass dragged over to the ER. You will feel one hell of a lot better once you get an IV in you.

  10. Except you can’t get in any vehicle without destroying the interior.
    My wife contracted it from me. She called me from the Lancaster train station needing a ride home and a CV change of clothes.
    Fast and furious.
    Well that explains why we didn’t see you tonight.

  11. @ Michael. on Sunday, February 24 2013 at 4:51 pm

    Cholera is a bacterial agent (not viral) and infections are deadly if untreated. Bacterial infections often produce toxins that increase the disease severity aside from the loss of fluids & electrolytes. Gastroenteritis can be caused by viruses, bacteria, protozoans, etc. and all agent types are more or less present globally.

  12. >Well that explains why we didn’t see you [come in for your regular Sunday night BBQ] tonight.

    Yeah, we like you too much to wage biological warfare on your customers. Ended up scarfing down a bunch of Chinese takeout instead (I picked it up, being the person least likely to be infectious at this point). Not that that was bad, the fire oil was excellent for my morale anyway.

    No martial-arts class for us tonight, either.

  13. Given the title, I thought this was going to be about how to avoid spreading the alert (rather than the virus). After hearing firsthand of the symptoms now, it seems appropriate to spread the alert far and wide.

    Glad you’re feeling better.

  14. As an EMT, we’re seeing a lot of people who are suffering from acute dehydration. Some general rules:

    Avoid consuming food or beverages which are diuretics such as alcohol or caffeine (or, in a special kind of stupid, alcohol to the point of a hangover the following morning with several cups of coffee to rehydrate).

    If you are a diabetic, check your blood sugar more often than usual.

    If you are unable to keep something down, phone your local Urgent Care facility and see if they can provide IV therapy and Zofran. Urgent Care visits are almost always less expensive than ER visits, and in my neck of the woods, faster, too.

  15. Noravirus is one of the more infectious bugs. It only takes 10 virus particles to trigger an infection. Washing hands thoroughly with soap and warm water followed by an alcohol (or bleach) based disinfectant wipe is mandatory before eating. Surfaces can be wiped down with a bleach solution and left to dry (much like how to deal with salmonella). I’ve seen the results of this stuff at a summer camp a few years ago. The kids would be walking around just fine, then suddenly barf on the ground. They then spent a day hanging out near the toilet. Unpleasant indeed.

    I’m glad you recovered.

  16. >almost certainly a new strain of norovirus that is running through the U.S. like wildfire right now.

    I’ve not been hearing anything about a hard-hitting 24-hour bug down here in TX. Is this actually a US-wide thing or is it more regional?

  17. Had this back in December–first came the flu, then a day or two later…Well, you know.

    I had dysentary in Baghdad once or twice. This wasn’t *quite* as bad. But then here I had a bathroom 10 steps away. There it was 100 yards.

    One thing about staying hydrated or getting re-hydrated. Your body absorbs water better when there is a bit of carbohydrate in it. Get the powdered version of a sports drink (Gatorade etc.) and mix it weak if you don’t want all the sugar. The sucrose plus the little bit of salts will help get the water into your system and keep it there a little longer.

    Also eating very wet fruits (oranges, watermelon, rock melon/cantaloupe) helps because the water is pulled out of the fiber throughout the intestines. Also the fiber helps a bit.

  18. esr: “10. Important: Continue isolation until you have been without symptoms for a minimum of 48 hours!”

    However, the CDC is more pessimistic:
    “People with norovirus illness are contagious from the moment they begin feeling sick until at least 3 days after they recover. But, some people may be contagious for even longer.”

    http://www.cdc.gov/features/norovirus/

  19. “I’ve not been hearing anything about a hard-hitting 24-hour bug down here in TX. Is this actually a US-wide thing or is it more regional?”

    May have already been here. Seems like I had that some months ago.

  20. >I’ve not been hearing anything about a hard-hitting 24-hour bug down here in TX. Is this actually a US-wide thing or is it more regional?

    Over the whole country, but in patches. On my G+ feed I’ve seen reports from D.C., Oregon, Michigan, and Arizona at least. CDC describes it as nationwide.

  21. Over the whole country, but in patches. On my G+ feed I’ve seen reports from D.C., Oregon, Michigan, and Arizona at least. CDC describes it as nationwide.

    You’re actually late to the party. It hit Massachusetts at the beginning of January.

  22. In addition to the points in Eric’s original post: Keep in mind that immunity against Norovirus only lasts for a few weeks. So if you got yours as a member of some sizable and stable group — a fellow gym member, say — you are running the risk of ring infections. You might pass it on to another gym member who passes it on to another gym member [. . .] who passes it right back to you.

    Actually, Tom Lehrer puts it.much better than myself.

  23. Just think of it as a detox cleanse. You know what people pay at spas for that kind of thing?

  24. Just think of it as a detox cleanse. You know what people pay at spas for that kind of thing?

    Actually the reverse: just think of a detox cleanse as making yourself sick.

    See also: Isagenix.

  25. @esr:
    >Over the whole country, but in patches. On my G+ feed I’ve seen reports from D.C., Oregon, Michigan, and Arizona at least. CDC describes it as nationwide.

    Now, it is possible that I may be less conscious of stomach bugs going around because I very rarely get them anymore: I used to get them regularly as a kid, but since I turned 18 or so I’ve rarely been sick with anything but respiratory bugs. I could probably count the number of times I’ve been sick to my stomach since then on one hand.

  26. Pedialyte or it’s generic mixed with Gatorade is a nifty way to stay hydrated, and it can help with the ‘there must be a hole in my stomach I am so hungry’ sensation these kinds of illnesses can cause.

  27. Yes, I had diarrhea last week (not norovirus i’m pretty sure) and I imediately went and bought a big bottle of pedialyte (it’s the right ratio, sterile etc versus doing my own). Why isn’t there an adult version available? It’s not like only babies get diarrhea.

  28. I suppose the point i really want to make is that if I hadn’t had babies i’d never know pedialyte existed (it is only on the baby aisle).

  29. >Um, norovirus *is* food poisoning, right?

    Interesting. I never learned to use that term for anything that is human-to-human infectious. I wonder if this is a recent CDC redefinition?

  30. Also there’s this stuff called “vitalyte” that is much like powdered gatorade, but is lower in surgar and sodium and higher in potassium.

  31. @esr:
    >Interesting. I never learned to use that term for anything that is human-to-human infectious. I wonder if this is a recent CDC redefinition?

    I’ve never heard (or at least I was only half listening if I ever did hear) any official definition of food poisoning, but in my mind it says how you got the disease and what the symptoms are more than it includes or excludes any particular pathogen, though I suppose you’re more likely to assume you got it from someone you know than from something you ate if you turn up with something transmissible by both methods.

    And it’s not necessarily a sharp line anyway: You vomit into a bowl while your other end is occupied with the toilet. Somebody then cleans that bowl out (but not quite well enough) and uses it for food preparation. The entire household comes down with what you had. Is it food poisoning or human-to-human transmission?

  32. This has been the worst winter for people getting sick that I can remember. Flu, laryngitis, norovirus…. Any theories, or just bad luck?

  33. Nancy,

    I blame global warming. We’ve seen a lot of wild temperature fluctuations recently, that is part of a greater pattern of extreme weather events that climatologists have linked to global warming.

    I’m kidding of course. But I’m just coming out of my second random encounter with norovirus this season; thankfully, my stomach appears to have gained a level or two and I could fight it off with far fewer symptoms than previously.

  34. I have a few tidbits to share:

    Noroviruses are interesting. A fairly large portion of the population are immune to them. The virus never grows in enough quantity to make them sick. This does not prevent these people from being vectors though. The small number of viruses needed to produce an infection keeps them contagieus for a long time even though they have no symptoms themselves.

    An interesting ethymology is use of the Arabic word “Yallah” in Swedish UN slang. It was minted in the early 1960s by Swedes in UN service in the Sinai. Yallah means “hurry up” or “to be in a hurry”. When I was in Un sevice in Cyprus in 1982 and in Lebanon in 1988 the word was very much in use. There was “Yallah”, which was when you just made it to the toilet, “Big Yallah”, when you made it half way to the toilet and finally “Super-Yallah”, when you barely had time to think about going to the toilet. There were strict instructions about how to deal with gastic infections in order to avoid infecting the rest of the camp. Hand wash before entering the dining hall, a special Yallah-toilet for the infected ones and iodine handwash for disinfection after all toilet visits. While we often had isolated cases of gastrointestinal problems, we never had any major breakouts, despite living under very crowded conditions.

    Another tidbit is advice from the chief physician at the Swedish National Center for the Treatment of Tropical Diseases. His advice for dealing with gastrointestinal bacteria infections was to consume hot tea to replace fluids. If you are vomiting, try it by the teaspoon to start with. When you have stopped vomiting, you start on the cure. This is consuming half a cup of boiled mashed carrots and half a cup of blueberry compote every half hour for 2 hours. Then wait for about 4 hours before starting to consume light normal food. You can buy the carrots and blueberries ready made in the form of baby food in many places. What this does is that it forms a plug of cellulose in your intestine, which prevents the bacteria from travelling upstream. The new food you are putting into the system has enough of your normal gut flora to outnumber the bad bugs. I’ve used this on many occasions to great effect.

    Finally, the use of capsules with gut bacteria is very effective against mild bacterial infections. You’ll find them in halath food stores in the US and in pharmacies in Europe. I have often fully recovered from diarrhea in about 4 hours when out travelling in the world. I’m extra sensitive, so without intervention I will usually be out of circulation for several days.

    Fortunately I seem to be immune to the noroviruses.

  35. @Scott >Um, norovirus *is* food poisoning, right?

    @ esr
    > Interesting. I never learned to use that term for anything that is human-to-human infectious. I wonder if this is a recent CDC redefinition?

    I thought most food poisonings were caused by bacterial infection spread through consumption of contaminated food. Norovirus is, by definition, caused by a virus, and it can be spread by means other than food.

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