I recently received a question from a fellow mom (thanks Kendra!) about ways, other than the vaccine, that we can protect ourselves from the flu. While the vaccine is the best defense we have, on a good year it’s at best 60% effective (see my flu vaccine post to see why). So if we can, we should really be doing other things to help keep the virus out of our systems.
But does that mean we should be bathing our kids in hand sanitizer every chance we get? If kids go to school or a daycare, they are exposed to many other little hands that have touched many other potentially contaminated hands, and toys that also may have touched little contaminated hands. How can we protect them? To the literature I went and I learned that there are actually some things you can do, aside from the flu vaccine, to combat the spread of the flu virus.
First, how is the flu transmitted?
Flu viruses, like most respiratory viruses, are transmitted through viral particles that are expelled when people sneeze or cough. Researchers at the University of Maryland showed in 2018 that even just breathing can spread the flu virus! In many cases, those viral particles will float through the air up to six feet away and into your nose or mouth. But the flu virus can also survive for up to 24 hours on hard surfaces! When they land on a doorknob or classroom desk and an unsuspecting person touches that doorknob or desk and then touches his/her mouth or nose, he/she can be infected with the virus.
Once the virus is in the body, it binds to the surfaces of cells in the respiratory tract, and releases its genetic information into those cells to make them virus-making factories.
Those cells will then make many copies of the virus that then go and infect other cells. Within 1-4 days, your immune system goes into hyperdrive, raising your body temperature (fever!) in attempt to kill the virus, and making lots of mucus to flush it out. When protecting against the flu virus, we need to protect against those two routes of transmission, or stop the virus from replicating in your respiratory tract. So how can we do it?
Option 1 – We’ll start with the obvious: hand-washing, but with what?
If you search the websites for medical organizations, all of them recommend hand washing to prevent the spread of the flu virus. The CDC recommends washing with soap and water. The Mayo Clinic suggest frequent hand washing, but they don’t say with what, for how long, or how frequently.
Should I use antibacterial soap or is regular soap good enough?
Over the last couple of decades, antibacterial soap has become the new craze. But does it really work better? Well let’s first talk about how the different types of soap work to protect against viruses and bacteria.
Regular soap works in a physical way, to remove bacteria and viruses so they can be wiped or washed away. That’s because bacteria and viruses bind to the oils on your skin. Soap molecules contain two parts – a water-loving and an oil-loving part. The oil-loving part binds up the oils on your skin, and the water-loving part allows the soap bound to the oil to mix and wash away, along with the viruses and bacteria that were attached.
Regular soap does not kill the viruses or bacteria. It just removes them, but if you wash your hands well, it does a good job of removing almost all of the viruses and bacteria on them. But make sure to clean your sink too! A recent study showed that your sink has more bacteria than your toilet!
Antibacterial soap, on the other hand, has an ingredient that actually kills bacteria. The most common ingredients in antibacterial soap are benzonium chloride and triclosan. Benzonium chloride kills bacteria by physically deforming their cell membranes, and triclosan targets an enzyme that the bacteria use to make those cell membranes.
It sounds better to have both a physical and a chemical method of getting rid of the bugs, doesn’t it? Well, actually, most research suggests that while soap itself can reduce the chance of contracting respiratory illnesses by 21% (and stomach bugs by over 30% – bonus!), an antibacterial soap didn’t do any better.
This might be because you have to leave the antibiotic soap on a surface (or skin) for at least two minutes to allow it to kill the bacteria, and many people may not do that.
If you’re a Grey’s Anatomy fan, there was a scene in one episode where Dr. Bailey explained that she washes her hands while singing the entire chorus of the song R-E-S-P-E-C-T, to effectively kill pathogens (ya gotta love Grey’s!). You can also wash your hands for as long as it takes to sing Happy Birthday twice, and that should be long enough to wash away bacteria and viruses on your hands. But by that time, the bacteria/viruses probably wash away before the chemicals can kill them.
Plus, antibacterial soaps DON’T kill viruses!
Even if you do wash long enough, viruses don’t have a negatively charged cell membrane that benzonium chloride usually binds to in bacteria, nor do they have the enzyme that triclosan attacks. So, while antibacterial soaps will wash viruses away just like regular soap does, they don’t kill the viruses like they kill the bacteria. And actually, antibacterial soaps may even be harmful! The effects of extended use of triclosan on skin has never been expressly tested, and using mild antibiotics for a long period of time can even contribute to antibiotic resistance (where the antibiotic no longer works on the bacteria).
But does washing your hands really help specifically against the flu viruses and how often should you wash your hands?
There have been many studies testing this, and in 2015 and 2019, some researchers compiled those studies and found that while hand washing does protect against other respiratory viruses, hand washing alone may not be enough to effectively prevent you from getting infected with the flu virus.
There were a few studies in there that found an effect of hand washing frequency. One study of 164 households showed that people who washed their hands at least three times per day were less likely to get influenza A, one of the viruses that causes the flu. Another study in 478 kids showed that kids who washed their hands five times per day or more were less likely to get the flu. So while the results are mixed, there’s no reason (other than dry hands maybe) to increase the frequency of your hand washes with plain soap during the flu season.
Option 2: Leave-on hand sanitizers?
Those hand sanitizers that you don’t wash off should, in theory, be effective killers of viruses and bacteria, since they contain anywhere from 60-80% alcohol. Plus, you leave them on, so they should have more than enough time to kill the bugs. Well, results are conflicting, but some studies suggest that they might help.
In one study, researchers spread the influenza A virus (H1N1) on the hands of 30 volunteers, and then instructed them to use alcohol-based hand sanitizers. The sanitizers substantially reduced the amount of the virus on the participants’ hands, but didn’t completely eliminate them.
But, if you use hand sanitizers in combination with other methods, you might just see results! In 2011, schools in Pittsburgh, PA implemented a program called “WHACK the flu”, where over 3,000 students were asked to:
This intervention, and the use of hand sanitizer in particular, reduced the rate of flu infections among these children by 52%!
Option 3: Wearing medical grade facemasks
I know, just the idea of wearing a face mask throughout the day probably makes you think I’m crazy to even suggest it. And the idea that a kid will keep a face mask on is even more laughable. But, the fact remains that flu is mainly transmitted through the air or by touching your face, which is probably why hand washing and hand sanitizers alone don’t do a great job of preventing infection with the flu on their own. A face mask blocks both the inhalation of particles, and keeps you from touching your nose and mouth.
Many scientific studies show that a face mask one of the most effective ways (aside from vaccination) to stop yourself and your kids from catching the flu, and if you already have it, it’s a good way to keep from transmitting it as well. That’s why many doctors will give you a mask if you come in for symptoms that even resemble the flu when you’re sitting in their waiting rooms.
Can we possibly get our kids to wear these routinely? It could be possible if we see a little change in our societal practices overall. After all, we’ve been seeing facemasks more frequently in some Asian countries in response to flu epidemics and air pollution.
Frankly, I think it could be easy to get kids excited about face masks using simple marketing. If MC Hammer was able to make it cool for a whole generation of kids to wear big baggy balloon pants (and boy did I want them!), face masks shouldn’t be that hard.
You can even buy cute or fun or even scary surgical masks like these on Amazon!
Ok, I do realize that the likelihood of getting kids to wear masks to school with enough frequency to have major preventative effects is not likely. But where it could help is in situations when you and/or they are in very close quarters with a lot of people – think bus and plane rides where all the other passengers seem to be hacking or blowing noses. Maybe wearing a mask means you won’t bring the flu home from your cross-country business trip to infect the rest of your family.
Option 4 – Gargling with Listerine
If you don’t want to wear face masks, there are other things you can do. Remember that once the flu virus gets into the respiratory tract, it takes some time for it to replicate and cause a full-blown flu infection. If you can kill the virus before it can replicate, you can potentially prevent an infection.
Gargling does a good job of clearing out a portion of your throat, and Listerine contains several ingredients that are very effective at killing viruses. In fact, when scientists mixed some flu virus with Listerine, 100% of the flu virus was killed! Some websites tout gargling twice per day with either salt water or Listerine to ward off colds and the flu.
This won’t remove the flu virus from all of your respiratory tract, but it also can’t hurt, and there have been studies showing that gargling with Listerine can stop you from transmitting viruses in your saliva. So, whether you choose to gargle with it every day (a good idea for fighting gum disease!) or just when you start feeling that tickle in your throat, it certainly couldn’t hurt, and may even help to ward off a flu infection.
Option 5 – Gargling with…tea??
My mother always used to make me tea when I got sick. I always thought that I was drinking it because of the soothing warmth on my throat. But it turns out that tea can not only make you feel better while you’re sick, it can protect you from the infection in the first place!
Tea contains an exciting ingredient called catechins which can kill viruses, the flu virus in particular, both in a petrie dish and in living people.
A analysis of 5 studies conducted in Japan revealed that gargling with tea or catechins provides a significant protective effect against the flu!
Not into gargling? Well simply consuming green tea, or tablets containing green tea have been shown to help prevent flu infections in healthcare workers, and also reduce the severity and length of the flu. Note that the studies on green tea (both gargling and consuming it) are still in their infancy, so don’t forgo the vaccine for a green tea regimen just yet! It couldn’t hurt to add a cup of green tea to your daily regimen this season, though.
Option 5 – Eat your Wheaties (or whatever sugary cereal the kids probably like better)
To fight infection, our immune systems need to work properly, and research shows that the immune system needs not only energy, but also the right balance of micro- and macro-nutrients. As parents, we are facing many challenges in this realm.
We are, ourselves, exhausted most of the time from feeding babies or chasing toddlers or worrying over cranky teenagers, and we are often time-limited when it comes to meals. Case in point, tonight I had cake for dinner, partly because I was busy getting dinner together for the kids while helping with homework, etc., and partly because…well, I’m a stressed adult and cake made me happy. (Don’t tell the kids!).
Kids, of course, often have some rather limited food tastes. I don’t believe for a second that my 7-year old’s diet of chicken nuggets, more chicken nuggets, and the occasional chicken finger could possibly be satisfying her nutritional needs, let alone keeping her immune system in top notch condition.
Enter daily vitamin supplements and believe it or not, cereal! While most cereals out there are, quite frankly, sugar bombs, the one good thing about them is that they are fortified with many essential vitamins and nutrients. There is actually a study out there showing that cereal intake may reduce the incidence of upper respiratory tract infections! Only a small portion of the illnesses in the study were caused by the flu virus, but it makes sense that a proper nutrient balance would result in a good immune response if the flu virus does happen to come your way. Of course, if you can get your kids to eat fish and veggies, even better.
Option 6: What about those “Immune boosting” supplements in the supermarket?
Take a quick trip down the cold medicine aisle in your food store, and you’ll come across a wide array of products that claim to boost the immune system to protect you from getting sick. The premise of how these work is loosely based on this idea that maximal immune function depends on proper nutrition, but the supplements themselves focus on only a couple of key micronutrients:
Zycam is a supplement that delivers a high dose of zinc. The company claims that the zinc coats the respiratory tract and inhibits the cold virus from invading and replicating. It is now pretty well-established that zinc does play an important role in the immune system. It specifically protects the respiratory tract against invaision and inflammation, and and there are studies showing that zinc supplementation in the diet can protect against respiratory infections.
What is not known is whether a few high doses of zinc right at the time you are infected are enough to really mobilize those immune responses fast enough. A group of studies suggested that Zycam may decrease the severity of colds by a day or two, but it is not yet known whether Zycam protects against the flu virus. It is possible that zinc could deliver some protection, but be careful with this. Too much zinc is toxic, so you don’t want to be adding too much zinc to the diet, or popping too many Zycam tablets.
Airborne is a supplement that delivers a very high dose of vitamin C to help you combat the flu. The idea is to take it when you know you may be exposed to people with the flu, like during a plane flight, for example. Vitamin C is, in fact, a critical player in the immune response to the flu virus, and vitamin C deficiency can increase the chances of having complications associated with the flu. Studies show that long-term supplementation with vitamin C effectively protected against infection with the flu, and even short-term treatment boosted the immune response to the flu vaccine in elderly patients.
In one convincing study, patients exposed to respiratory viruses were treated with high doses of vitamin C every hour for 9 hours after symptoms started, and they saw an 85% reduction in symptoms! Some of these patients were infected with the flu virus.
But again, be careful with this. Taking too high of a dose for an extended period of time can make you sick.
There may just be something behind the marketing of these “immune boost” companies, and in most cases, taking some of these for a couple of days when you think you’ve been exposed to the flu shouldn’t pose much of a risk if the package directions and age limits are followed. But care should be taken when using large doses of any supplement, and there aren’t enough tests out there yet to determine whether these really do work for the flu virus, specifically.
Option 7 – Get outside and get moving!
When the cold weather hits, the cozy couch with a warm blanket and a cup of cider may call to you, but sitting inside may be exactly what increases the risk of contracting the flu during the Fall and Winter months! There are now well-documented effects of exercise on the immune system. Moderate exercise can boost your immunity against all kinds of bugs, and studies also show that exercising can boost your antibody response against the flu virus.
In addition to that, exercise also reduces your stress levels, and stress inhibits your immune system, making you more prone to developing infections. Studies also show that spending a short amount of time outdoors is enough to reduce stress as well!
Finally, when your kids are hunkered down inside playing video games instead of playing outside, they are in closer quarters where the flu virus can be more easily spread, not to mention those game consoles that are teeming with viral particles from hands that are carrying whatever they touched at school that day. Contrary to common belief, going out into the cold is not likely to make you sick. Staying inside in the warmth is more likely to do that. So bundle your kids up and take them for a hike to help avoid the flu this year.
Option 8 – If all else fails, to the doc for Tamiflu!
Sometimes, we try everything we can, but suddenly, the fever hits and you know that you are in for it. Luckily, there is a last ditch effort you can take to help stop the replication of the flu virus in your respiratory tract – an antiviral medicine called Tamiflu. The trick with Tamiflu is that you have to take it within 1-2 days of when your symptoms start, and there is controversy about whether the effects warrant the cost. Tamiflu does not stop you from getting the flu. It only reduces the amount of time that you suffer with symptoms, sometimes by only a day or two.
If you know you have been exposed, however, you can head to the doc and get some Tamiflu to prevent an infection. Studies show that taking Tamiflu after exposure can reduce the incidence of infection by up to 55%! While less advertised, Relenza is another antiviral drug that can be taken either before symptoms start or within 2 days of symptom onset.
What’s the take-home?
There is no one good way to prevent flu exposure and/or infection for you and your family, but most scientists agree that a combination approach is best. Getting your flu vaccine is your best defense.To that, add a good hand washing routine with regular soap, put some hand sanitizer at different locations around your house for easy access, drink a daily cup of tea, eat well-balanced meals, try to avoid people who are showing flu symptoms, try not to touch your nose and mouth, and get outside for some exercise. All of those steps together could help you to avoid a nasty flu infection this year. Wishing you all good health this flu season!
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