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Featured topic and speakers
Is norovirus going around? How is norovirus spread? How long are you contagious with norovirus? What kills norovirus on surfaces? How to avoid norovirus when family has it?
Our guest is Joanna Bisgrove, MD, family physician at Rush University Medical Center and a member of the AMA Council on Science & Public Health. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Joanna Bisgrove, MD, family physician, Rush University Medical Center; member, AMA Council on Science & Public Health
Transcript
Dr. Bisgrove: Basically, the bacteria gets passed by contact with it. It is not spread through the air, like say, measles, which we've heard a lot about, or the flu. Also, the main thing norovirus has in common with measles and the flu is how contagious it is.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about norovirus, including where it spreads, how to prevent outbreaks and why it's been surging. Joining us today in our studio is Dr. Joanna Bisgrove. Dr. Bisgrove is a family physician at Rush University Medical Center right here in Chicago. She's also a member of the AMA Council on Science and Public Health. Couldn't have a better person to talk to you today. I'm Todd Unger, AMA's chief experience officer. Welcome, Dr. Bisgrove.
Dr. Bisgrove: Thank you so much, Todd. It's great to be here and great to be local.
Unger: Great to have you here, and great to have someone from Rush, one of our new health system partners here in Chicago. And I can see you've got the Cubs colors going.
Dr. Bisgrove: Yes, I am a die-hard Cubs fan, and many in the AMA know that. And this is one of my favorite professional suits to wear because it's the Cubs. It's spring, and my whole family is excited.
Unger: Well, that's fantastic. Well, thanks for joining us. I'm going to tell you what—talking about norovirus is about as close to norovirus as I want to get. And I got a lot of questions for you today. So we're going to get into that.
I think people out there are probably confused. There are so many things and reasons that people seem to get sick. But let's talk specifically, what is norovirus, how do you diagnosis this and what do you do about it?
Dr. Bisgrove: So norovirus is a virus, obviously. It is passed through what they call the fecal-oral route. Basically, it's a bacteria that's passed by contact with it. It is not spread through the air, like say, measles, which we've heard a lot about, or the flu. Also, the main thing norovirus has in common with measles and the flu is how contagious it is.
Beyond that, the similarities really end. The other two are spread by air, are vaccine preventable. Norovirus is a very, very different thing. It is spread by contact with surfaces. It's a little bugger that can live on surfaces for quite a long time and also be shed by people long after they've been sick.
So it is something that's like—keep washing your hands is so important to keep it from spreading, keeping surfaces clean. I don't know about most commonly spread, but it's very, very commonly spread in food setting just because people were not washing their hands, were not cleaning surfaces properly with the proper high-grade disinfectants. And so yeah, it is a tough and easily spread thing.
Unger: So you mentioned very contagious, all over surfaces, and it lasts a long time. You have some personal experience for just how long this lasts.
Dr. Bisgrove: Yes, I do. So when I was pregnant with my now 18-year-old, I was about 35, 36 weeks pregnant. And—we had friends coming over to help with setting up the crib. And the wife had been sick, and we thought she had norovirus.
And I'd asked, please stay home—don't come with. But she'd been feeling better for a couple of days. And the husband's like, oh, come along. I was not home. I was on call as a third year resident. So I came home after they left, went to the bathroom, settled in and went to sleep.
What I did not realize is that she had used that same one bathroom in our one bedroom apartment at the time to go to the bathroom as well. And I think it was a couple of hours—but still, she was still shedding even though didn't realize that. I didn't realize she had been there, so I didn't think to clean the seat.
I was sick within 24 hours. And when you're 35 weeks pregnant, sick—throwing up, vomiting, diarrhea, which are the common symptoms of norovirus, it's not fun. I mean, Katie, my oldest, was kicking away very happy. And I was so sore. I was like, please, child, I love you, but come on now.
We did go to labor and delivery. They checked me out. Baby looked fine, but they were like, yeah, this is probably norovirus. And then I got better, was feeling better. They said, you can go home. I barely avoided being admitted for observation for that.
Unger: That's a hard story to hear.
Dr. Bisgrove: Yeah, it's one I tell often because it explains a lot about how norovirus works and how sick you can get.
Unger: Now, you mentioned something just in that statement. They said it's probably norovirus. How do you know if you have norovirus, if you have some other kind of stomach bug, or something like listeria, which can have a real impact on different organs and things like that?
Dr. Bisgrove: You are correct. Typically, it's a clinical diagnosis. So we make it by what the symptoms are, by being really, really ill, whether there's potential exposure to something—say, listeria. Listeria frequently found in deli meat. It's like, what's the exposure pattern?
Because a lot of times, with viruses, it's who were you near, what were the exposures, what was going on? We knew my friend hadn't had any deli meat. The symptoms were about 2 or 3 days for her, so we knew that, most likely, clinically speaking, it was norovirus.
Sometimes it could look like food poisoning—just that food poisoning also is very short. But if it lasts longer than 24 hours, like 2 to 3 days, most likely norovirus. Like I said, you can test frequently. People don't. They can in the hospital if it's absolutely needed. But most of the time, it is a clinical diagnosis.
Unger: So in rank order, food poisoning, shorter—norovirus, 2 to 3 days, exhaustion after that, and then maybe something like a listeria, depending on what you said. Do you have history associated with typical causes?
Dr. Bisgrove: Yeah, and usually, bacterial diarrhea lasts a lot longer. So we frequently tell people if you're still, after a week or two, having lots of problems, go and get tested because norovirus and other viruses frequently don't act like that, especially norovirus. It does not act like that. It is quick. It is obnoxious, but it's quick.
Unger: Well, I guess that's one upside.
Dr. Bisgrove: Yes.
Unger: I've heard about norovirus for a long time. I kind of think about it as like something that my friends with young children pick up, and then it runs through the whole family on its way out. But this winter, it just seems like everyone, including one of my daughters, has had norovirus. Am I imagining that it's kind of picked up or what?
Dr. Bisgrove: I haven't seen anything that is super high this year compared to last year. It's always what's in the news. It is always around from November to April at its most concentrated. Typically viruses, we think about them being winter viruses. But the reality is that they can happen any time of year.
What typically happens in winter that makes it easier for viruses to spread is that people are in closer contact. Like norovirus can hang out on a surface. People are in more likely to be in very, very specific areas that are away from cold weather where they're touching more surfaces more frequently.
And if the surfaces aren't getting cleaned, if you're not washing your hands for at least 20 seconds—for children, we often talk about singing happy birthday two times while you're washing your hands. Hand sanitizer doesn't work as well. It's really important to wash hands and use high grade disinfectants for surfaces.
Unger: Well, that's very, very good advice. Like so many different viruses out there, norovirus is a public health issue.
Dr. Bisgrove: Yes it is.
Unger: So how do you view this in terms of outbreaks, and what are some of the factors, other than you said close quarters, touching a lot of stuff, that are that are really factoring into this?
Dr. Bisgrove: I believe one of its most frequent, as I mentioned before, frequent areas for food settings, because people can be sick—food workers can be sick. But then they come back too soon, and surfaces aren't being cleaned. We frequently recommend, if you are sick, stay home for at least 48 hours after the symptoms are gone.
The norovirus can keep shedding for several days after that, but the most concentrated time of shedding after you're better is about 48 hours. So you are still really highly likely to spread it. That was like what happened in our situation. It hadn't been quite 48 hours. My friend was still shedding.
And it's really easy for it to get on a surface. If the surface is not cleaned, it doesn't take a lot of norovirus particles to get you sick. Again, very highly contagious. So it's cleaning surfaces, washing your hands, really wiping things down that help prevent it.
But yes, anything that causes outbreaks, where suddenly a whole lot of people get sick, is a public health concern. That's why we look at things like measles and flu, and norovirus. And norovirus comes every year and gets a lot of people sick. And depending on what's going on, it makes the news or doesn't make the news.
I know there was a massive outbreak last year in California. I haven't heard quite that much this year in the news or in the public health record. But there has also been a lot more going on, so it's a little harder for the norovirus information to break through.
Unger: So here's a question. I mean, if somebody was in a room with me that had norovirus, I would probably be in a hazmat suit. Say somebody walks into your office and you suspect, as a physician, that they have norovirus, are you taking any special precautions?
Dr. Bisgrove: We are. I let the staff know and we clean. We've got our high grade hospital disinfectant wipes, and they clean everything down. And usually, we give the room a break for a little bit if we can. But yeah, the first thing they do is they literally wipe everything down. I'm also wearing gloves.
In the winter, Rush, we'll mask frequently. Everyone in clinical settings are required by Rush to mask. Rush is very, very big on infection prevention. And so yes, we are wearing masks. For my hearing loss, my patients wear clear masks, which is awesome, but they are still masked. But yeah, that we really have to just be careful, clean everything down, wear masks to prevent ourselves not from norovirus so much, but airborne viruses—try to reduce the risk of transmission there.
But even still, another quick story. My father asked me recently if they could go to lunch with some friends who had just been sick. And the other man possibly had norovirus. And I said, wait at least 48 hours just in case, because my dad's about to turn 85 this year. So we don't want him getting that sick.
Unger: So this is really good because we're going to shift into advice. So A, make sure, if somebody's been ill, give them that space—at least 48 hours.
Dr. Bisgrove: At least 48 hours, stay home. Work from home if you're able to work from home, but otherwise don't go in because then, one, if you're not fully better, you could just make things worse. But two, if you get all your coworkers sick or your friends sick, and they all have to stay home, you're kind of stuck. Like particularly at work, you suddenly send all your coworkers home because they got norovirus, and you have to do all the work now. So that's not good.
Unger: Many incentives not to—
Dr. Bisgrove: Yes, many incentives.
Unger: So we talked about that. We talked about handwashing, especially since—
Dr. Bisgrove: Happy birthday twice.
Unger: —hand sanitizer not as effective. Any other kinds of things? I'm a hand washer, and so I don't—I try to, A, not touch anything. And B, if I do, I wash my hands.
Dr. Bisgrove: That's a very good, safe way to go. But yeah, those are really the big things. Wash your hands, clean surfaces, stay home if you're sick. These are common public health measures to keep infection from spreading for most things—for most things that are contact related, such as norovirus.
Obviously, for different infectious diseases spread through the air that are vaccine preventable, we talk about vaccination to reduce the spread and reduce the illness. We talk about the importance of the masking. Norovirus, again, is different. It spreads through contact.
So wash your hands, clean your toilets. If your children are sick, yeah, wash your hands all the time. Have a whole big bunch of thick hand lotion on hand because your hands are going to get dried up for how much you need to wash them.
Unger: So even someone like me, who's taking extreme precautions all the time—I mean, you're kind of defenseless a little bit. It's just bad luck. Pick up a dish, whatever it is, in a restaurant. And let's say you get norovirus, what do you do to take care of yourself?
Dr. Bisgrove: It's mainly supportive care. Drink fluids like crazy as much as you can. If you're having a lot of diarrhea, it can be hard. As long as you're—if you're not feeling lightheaded, if you can urinate, like have urine, and the urine is not so dark and small amount that it's scary, then you're OK.
But if the urine starts looking really dark, really red, not coming out, if you're vomiting and can't keep fluids down, then you usually need to seek medical attention. That's when you need to go in and get checked out, because they may need to give you fluids through the IV, some anti-nausea meds just enough to help keep your body functioning properly until the illness passes.
Unger: And as you said, it's kind of like in that two-to-three-day range. If it's not dissipating by then, would you get in to see a physician?
Dr. Bisgrove: If it's not dissipating, most likely—it's two to three days. If it's not dissipating after like four, or five, or six days a week, and you have been able to stay hydrated and haven't ended up in the emergency room because of lightheadedness or other symptoms—chest pain, all sorts of things that necessitate a higher level of care than just helping at home—then yeah, usually, on the seven day mark, people often check in.
After 7 to 10, sometimes 14 days, we get a little more concerned about a bacterial infection, so something that's not norovirus. So we'll start sending stool cultures. We'll start asking a lot more questions Have you traveled, have you eaten raw sushi, or other raw foods? We start asking a lot more questions.
The norovirus can spread so quickly, but also, as we already talked about, norovirus can be very—it's usually very fast. So yeah, if people are taking care of themselves, we leave them alone. But if it keeps going, we're like, maybe this isn't norovirus, and we need to do other things.
Unger: So outside of that time frame, time to see your family physician and get that checked out.
Dr. Bisgrove: Yes—very least, make a call.
Unger: Well, thank you so much Dr. Bisgrove—for being here.
Dr. Bisgrove: Absolutely.
Unger: I know more about norovirus than maybe I ever wanted to. We really appreciate your advice and how to navigate this. Thanks so much for being here today.
Dr. Bisgrove: Absolutely.
Unger: If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts.
Thanks for joining us. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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