🎙Notes on Norovirus Ep 252

Announcer: 0:00
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts Hosted by cardiologist and top medical researcher, Dr Michael Koren.
Michael J. Koren, MD: 0:11
Hello, I'm Dr Michael Koren, the executive editor of MedEvidence, and I have a great opportunity this is really going to be fun I'm very excited about this to work with a colleague and Dr. Victoria H, who is an adolescent specialist but also somebody that works in the emergency room, and she brought this issue to my attention, which is that here in North Florida we're having this epidemic almost of diarrhea and vomiting that's due to a norovirus. Vicwas was going to educate us about this and talk about some work we're doing in the clinical research space to maybe reduce the implications of this problem. So, V, just introduce yourself for the audience and tell people who you are and what you do day to day.
Victoria Helow, MD: 0:55
So I'm Victoria Helow and and I do, in fact, do clinical research as well as work in the emergency room, seeing primarily pediatric and adolescent patients, and, as Dr Koren said recently, it's really been horrible to see these patients in the ER and wish we could do something more than we can right now for them.
Michael J. Koren, MD: 1:15
All right, so let's start with the basics for the audience. So what is norovirus?
Victoria Helow, MD: 1:19
Norovirus is a virus that is extremely contagious and one of the more difficult ones to kill. Even COVID is easier to kill, really. Yeah, you can use the hand sanitizers and wipe it down and get rid of that virus, but this one's a little tougher.
Michael J. Koren, MD: 1:35
Now, is this the same thing as what I learned about in medical school called Norwalk virus?
Victoria Helow, MD: 1:39
Norwalk virus, Exactly the same old fashioned and it's still around. And we're how old? And we went to school when? And this virus is still around.
Michael J. Koren, MD: 1:48
Thank you for keeping me up to date here. I don't want to use the old terminology.
Victoria Helow, MD: 1:52
Yes, it is. The new terminology is norovirus and still causes the same disease.
Michael J. Koren, MD: 1:57
So describe what happens to people when they get norovirus.
Victoria Helow, MD: 2:00
Well, we always know when they're coming in the ER. Just because they present with the nausea and just as they vomit, they also have their diarrhea. So, unfortunately, it's both it's messy and it's miserable.
Michael J. Koren, MD: 2:11
Okay, yeah, hard to keep clean underwear.
Victoria Helow, MD: 2:14
Hard to keep clean underwear. It's really we know when the season is here and this is the month. November to April is the most common time to have it
Michael J. Koren, MD: 2:22
And and that's what we learned in medical school. It was a winter disease
Michael J. Koren, MD: 2:25
.
Victoria Helow, MD: 2:25
Yes.
Michael J. Koren, MD: 2:25
I guess because people are in more close contact with each other.
Victoria Helow, MD: 2:28
Probably in close contact and then, just because of being in the close contact, something as simple as vomiting near somebody else can spread it throughout the room.
Michael J. Koren, MD: 2:37
Wow.
Victoria Helow, MD: 2:38
Causing, like you said in the beginning, almost an epidemic. Wow, and although there's only about 2,500 outbreaks per se.
Michael J. Koren, MD: 2:47
Only 2,500?.
Victoria Helow, MD: 2:48
Per Year. Those outbreaks can involve hundreds to 1,000 people.
Michael J. Koren, MD: 2:53
Oh, wow.
Victoria Helow, MD: 2:53
Because of how rapidly this can spread, but, more importantly, how strong of a virus it is
Michael J. Koren, MD: 2:59
Right so I think I'm remembering this correctly from medical school is that norovirus is the most common virus that causes acute gastroenteritis. Is that still
Victoria Helow, MD: 3:08
? Exactly, exactly, 20% of all cases are norovirus. We don't routinely test specifically for this because it's pretty classic, but there have been outbreaks that have been so big that there have been tested. I don't know if you learned about the one in medical school about the person vomited in the restaurant.
Michael J. Koren, MD: 3:28
, yeah, that's a classic.
Victoria Helow, MD: 3:29
Yeah.
Michael J. Koren, MD: 3:30
That's a classic, yeah, so tell everybody about that.
Victoria Helow, MD: 3:33
So a person had vomited in a restaurant where there was 100 guests or so. So a person had vomited in a restaurant where there was 100 guests or so and two-thirds of the people there ended up getting norovirus from that one episode of vomiting Because the person vomited on the floor and it spreads the virus all over the room.
Michael J. Koren, MD: 3:50
I remember the CDC went in there and they found that the people that were closer to the vomiting were more likely to actually get sick. Right, but it's a great point. So that was in a restaurant. So this is not just a cruise ship issue. Usually people hear about this for cruise ships. Any idea what percentage is in cruise ships versus other things?
Victoria Helow, MD: 4:07
I don't know if I know that percentage, but when it is on a cruise ship, pretty much 100% of the people on the cruise ship get it. Because of the fact that, like we said, it doesn't get killed by hand sanitizers, you really need to wash your hands good old-fashioned soap and water for that three minutes. Get that virus off of your system.
Michael J. Koren, MD: 4:25
So explain that. So an alcohol-based hand sanitizer doesn't work, as well as washing the old-school soap and water way.
Victoria Helow, MD: 4:32
And that's because this virus-
Michael J. Koren, MD: 4:35
It doesn't have an envelope.
Victoria Helow, MD: 4:38
The ones that do have an envelope. The alcohol kills that envelope and allows that virus to end up getting destroyed. This one has a coating on it that is not penetrable by that.
Michael J. Koren, MD: 4:49
Right, interesting yeah so some viruses they get to their target because they're protected by an envelope and alcohol will break that down. But for norovirus it's more of a protein shell and you have to break it down by chemical means. I guess really intense scrubbing Abrasion. Yeah, and actually physical means.
Victoria Helow, MD: 5:09
And getting it down the drain.
Michael J. Koren, MD: 5:11
There you go.
Victoria Helow, MD: 5:11
One of the other things I want to point out about taking care of this virus on surfaces is it can live from hours to even days on surfaces, and Lysol wipes, et cetera don't work Just bleach and hydrogen peroxide. So it's important to use the good hand washing, because you don't know what surface you're going to be touching.
Michael J. Koren, MD: 5:31
All right, so interesting. It's interesting how little nuances of viruses actually affect the way we need to strategize against them. So you wouldn't think that hand sanitizers work better for some than others. But in fact, if it has an envelope it'll work better. If it doesn't have an envelope, it won't work as well. And then you need just old-fashioned friction and soap and water. Interesting.
Victoria Helow, MD: 5:53
Even on food. And you know we're not going to wash all our food, we're not going to wash fish, necessarily, before we use it.
Michael J. Koren, MD: 6:01
Yeah, we'll rinse them out, but we're not going to use soap and water on them.
Victoria Helow, MD: 6:04
We're not going to use soap and water on it, and it's been shown to sustain even through ultraviolet radiation and temperatures of 150 degrees Fahrenheit. And so, once it gets spread in a restaurant environment or, worse yet, like I said, on a cruise ship, where there's food all the time everywhere- it's just it's-
Michael J. Koren, MD: 6:26
So one bad sushi chef can do a lot of damage.
Victoria Helow, MD: 6:29
Yes, especially because that's not even cooked. It makes it even worse, right?
Michael J. Koren, MD: 6:33
So how long are you sick for when you have a norovirus infection?
Victoria Helow, MD: 6:36
You know you can get sick, first of all as soon as 12 to 24 hours after exposure. Sickness is usually 24, maybe 72 hours, but unfortunately you continue to shed the virus even beyond that. And that's where we see in the emergency room. It's not uncommon to see two or three members of the family there even at the same time and then learn that somebody else had it a day before. And then sometimes I even hear them say wow, he got over it in like 12 hours and she's had it going on day three. And sometimes that's just volume of like you said with the restaurant amount of exposure to the virus. If you have three people in your house that have it, that's a lot of virus around the house.
Michael J. Koren, MD: 7:22
And for medical school, remember one of the complications is people can get severely dehydrated because they can't keep fluids down. You have to bring them in for IV fluids and certain vulnerable people can get really really sick from dehydration.
Victoria Helow, MD: 7:35
The number one incidence actually in this country, if you don't count cruise ships for sheer numbers, most of norovirus cases are actually in adult living facilities and in the hospital. Because once it gets in the hospital, same thing, exactly yeah.
Michael J. Koren, MD: 7:52
So how do you treat it? Once people get it, is there any treatment for it?
Victoria Helow, MD: 7:55
You just have to treat the symptoms and sometimes that's a little easier said than done because of the vomiting that goes on and the dehydration vomiting and diarrhea. And right now I don't know if you know or not, but our major contributor to IV fluids was in North Carolina and was destroyed by the hurricane. So we are on restricted IV fluid rationing at the hospital right now and if you can orally rehydrate somebody, that's what we're doing. Well, that's not always so easy when it's coming out of both ends.
Michael J. Koren, MD: 8:22
Wow, yeah, I can imagine. That's interesting I didn't realize that it was such a problem in the hospitals right now.
Victoria Helow, MD: 8:27
Yep, we're rationed.
Michael J. Koren, MD: 8:29
So are there any vaccines or anything that we can use to prevent people from getting sick in the first place?
Victoria Helow, MD: 8:34
So people are working on a vaccine and that is going to make a big difference for my job in the ER and just for people in general.
Michael J. Koren, MD: 8:43
Yeah, and I know there's some manufacturers that are working on it as we speak. Yes, so we're excited, we are involved in some of these programs as we speak and one of the things that we're trying to do is just educate the population that this is not just a cruise ship deal, because often people have that association. So you say we're doing some work to prevent norovirus and they say, oh, I'll never go on a cruise ship. Well, as you pointed out, that is not a safety net for everybody. And, Victoria, whether or not a virus is enveloped or non-enveloped, you don't want to get it by special delivery.
Victoria Helow, MD: 9:12
Yes.
Michael J. Koren, MD: 9:14
Thank you for the information and for those of you out there, be careful and wash your hands.
Announcer: 9:20
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