Flu Prevention: Why Are Adults Still Sneezing into Their Hands?

Your average kindergartner knows the proper way to prevent germs from spreading. So why won't adults get with the program?

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Nothing quite gets under the skin like a young child pointing out the negative impact of your incandescent lightbulbs and idling car, but in the midst of a virulent flu season and the worst whooping-cough outbreak in 60 years, it’s worth listening to the righteous army of lilliputian surgeon generals. These tiny troopers are the advance guard against phlegm; they know how to stop germs in their tracks. Hand-sanitizer breaks are routine in elementary schools, and when there isn’t time to grab a Kleenex, children use a strategically placed elbow across the mouth instead. 

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Walk into any pre-K or elementary classroom in the U.S. and you’ll be surprised to see that kids don’t cough or sneeze into their hands anymore. It’s simply not done, and it’s easy to see why. Coughing or sneezing directly into a hand that subsequently touches food, money or other people is clearly a recipe for contagion. The real wonder is that people failed for so many years to spot this simple truth. A typical sneeze can travel 100 m.p.h. and spew countless germs into the air. One study found that viruses can survive much longer on objects like dollar bills than originally thought, particularly when found in high concentrations like those from a single sneeze.

The nation’s health experts have been recommending for years that people not sneeze or cough into their hands but cover their mouth or nose with a tissue instead (which they are advised to quickly dispose of and follow with 20 seconds of vigorous hand washing). Four years ago, Health and Human Services Secretary Kathleen Sebelius called out a reporter during a briefing to rebuke him for improper sneezing etiquette, demonstrating the proper technique with her elbow. Sesame Street has taught millions of children the hygienic way to sneeze and cough.

So why haven’t American adults been getting with the program? Boston is the center of medical excellence, with more physicians per capita in Massachusetts than in any other state and some of the world’s finest medical schools. Yet with a flu epidemic under way, adults can still be seen all over the city spraying their potentially contagious droplets on subway seats and restaurant menus. Hospitals are beginning to require masks for people who show up sick to ERs. Seasonal flu kills thousands each year, according to the CDC, and leaves many hundreds of thousands more temporarily incapacitated and unable to work, yet adults who disregard the basics of virus prevention seem to have the hubris to believe they aren’t susceptible to illness and thus can’t harm others. (The flu vaccine, while highly recommended, is only 62% effective at reducing symptoms, say health officials.)

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Or they may simply be misinformed. As infant mortality dropped in the early part of the 20th century and childhood vaccines began to eliminate many life-threatening diseases, people grew increasingly cavalier about germs, and a whole culture of nursing care and commonsense prevention was lost. (How many people still wash their hands every single time they eat?)

Parents have long refined the art of “Do as I say, not as I do,” but in this case it may be more than just routine hypocrisy. Is it simply too hard to teach an old dog new tricks? Kathleen Sebelius certainly has her work cut out for her, and we may very well need more public-service announcements targeting older adults. But if 5-year-olds can learn how to sneeze properly, surely we can expect their elders to master it too.