Cellphones, shared keyboards, maybe even your watch and rings all could help fuel what could be one of the worst flu seasons in recent years, doctors say.
Already in Michigan, more than 300 patients have reported to emergency rooms and doctor's offices with influenza-like illnesses, according to the Michigan Department of Community Health.
The number is most likely much higher because not all hospitals report such cases.
At the same time, doctors are reporting an uptick in cases that patients often mischaracterize as "stomach flu," which really isn't a flu at all, but most likely another virus — easily spread at holiday meal gatherings — that is causing vomiting and diarrhea, said Dr. Matt Davis, Michigan's chief medical executive.
It could be norovirus, the bug that's known for wreaking misery on cruise ships, for example. But because patients aren't always tested at the hospital but instead are treated for symptoms, it's difficult to name the culprit for Michigan's gastrointestinal distress.
Seasonal influenza, which is primarily a respiratory disease, causes a cough, sore throat, and a runny or stuffy nose. It also can trigger diarrhea and vomiting as well as a fever and body aches. In contrast, other viruses, such as norovirus, can cause the same kind of gastrointestinal distress but generally don't cause fever or body aches that seasonal influenza triggers.
"What I emphasize to my patient is this: We can't always tell what kind (of virus) it is, but we can work hard to prevent it from spreading to others," said Davis, who is also a University of Michigan professor of pediatrics and communicable diseases and of internal medicine.
All of this means metro Detroit doctors, already seeing busier-than-usual patient loads, are bracing for more-crowded waiting rooms.
Citing a need to protect its young patients from the spread of flu, Detroit Medical Center's Children's Hospital of Michigan has limited visitors to parents, legal guardians and those over 18 years old.
In the cases of seasonal influenza, many of the Michigan cases are a strain of H3N2 viruses — one that genetically mutated after the development of this year's seasonal flu vaccine, Davis said.
"Every few years, we are outsmarted by the virus," Davis said.
In a briefing several weeks ago, the head of the U.S. Centers for Disease Control and Prevention said about half of the H3N2 cases that labs had analyzed across the country were determined to be the H3N2 virus whose genetics had "drifted" from the one covered by the vaccines, raising concerns about protection against some types of H3N2.
That "drift" wasn't determined to be common until September — too late to change the seasonal vaccine, which takes at least four months to develop, said Tom Frieden, the CDC's director.
Still, the CDC as well as metro Detroit doctors recommend the flu vaccine, noting that it protects against other flu viruses, such as H1N1, which last year sent previously healthy adults to emergency rooms and — for many — onto lifesaving ventilators.
This year's vaccine also protects against other types of H3N2 and may have some protection against what is called the "drifted" strain of H3N2.
If there is good news in either of the causes of misery, it is this: Hand-washing and other commonsense hygiene greatly reduces the odds you'll catch or spread the viruses at fault, Davis said.
That means, for example, coughing and sneezing into elbows and keeping out of the way of those who aren't doing so, said Dr. Marie Lozon, a pediatrician at U-M's C.S. Mott Children's Hospital.
Lozon worries plenty about the spread of germs. So she and colleagues, she said, work on a "clean-in, clean-out" philosophy.
For Lozon, that means wearing gloves and a mask. Her glasses give her extra protection, too, she said. She wipes off her stethoscope between patients. In addition, she doesn't wear a watch at work, worried that the extra crevices could give viruses an additional place to hide when she washes, she said.
Doctors say simple changes can also boost your battle chances against the misery-causing microorganism. They're good practices, even when you don't feel anyone around you is sick. That's because influenza symptoms start one to four days after the virus enters the body. In other words, you can be infected by someone before they feel ill.
•Wipe down phones, keyboards, door handles and other commonly shared surfaces frequently.
•Be conscious of sharing cellphones. Whether it's using them to make a call or flipping through pictures or texts, the surfaces can contain germs.
•Take extra precautions to keep hands away from your face after shaking hands or in other ways physically greeting them.
•When leaving the bathroom, use a paper towel — or your sleeve if a paper towel isn't available — to open doors.
•When hand-washing isn't available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
Robin Erb writes for the Detroit Free Press.