Few people cover coughs and sneezes

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NEW YORK: Lots of people aren't getting the message about covering their coughs and sneezes, at least in New Zealand, according to a study conducted during last year's H1N1 swine flu pandemic.

Public health officials everywhere recommend that people use something -- preferably a tissue or their elbow -- to keep their sneezes and coughs to themselves. To investigate what was actually happening in the real world, Dr. Nick Wilson of Otago University, Wellington, New Zealand and colleagues had 13 medical students watch people at a train station, a hospital, and a shopping mall during August 2009 -- right in the midst of the swine flu pandemic.

Among 384 coughs and sneezes the students observed, fewer than 5 percent were covered up with a tissue, handkerchief, or elbow. More than a quarter weren't covered at all. Nearly two-thirds of the time people coughed and sneezed into their hands, a practice that's now frowned upon because infection may spread via unwashed hands and contaminated surfaces.

But a hand could be better than nothing. "Probably the major transmission is from exposure to uncovered coughing, rather than contaminated surfaces," Wilson noted.

"Obviously uncovered coughing in settings where no one is around is not that risky -- but public health people want the appropriate responses to be automatic" - that is, always cough into a tissue or your elbow, Wilson added.

But as the findings, presented this week in Atlanta at the International Conference on Emerging Infectious Diseases, show, this is not happening yet. Men and women, boys and girls were all equally unlikely to follow these recommendations.

One person accounted for nearly a quarter of all coughs and sneezes that the researchers observed; this suggests that many of these people had a respiratory tract infection and were not following advice to stay at home, the researchers say.

What public health experts call "respiratory hygiene" was worst at the hospital entrance, with no sneezes or coughs being covered at all; it was best at the hospital cafe, where roughly 12 percent of coughs and sneezes were covered with a tissue or handkerchief and 6 percent by an elbow. But overall, only around 1 percent of sneezes or coughs were covered with an elbow, while just 3 percent were captured by a tissue or handkerchief.

Wilson thinks other countries should do similar studies; he suspects "large variations" in respiratory hygiene by country. Indeed, Wilson said when he visited Toronto, Canada in February he noticed much higher use of elbow coughing. "Possibly this reflects stronger promotion of such messages during the SARS (outbreak) and during the 2009 (swine flu) pandemic," he said.

Probably the best way to improve people's respiratory hygiene, Wilson said, would be to teach it in school. "There will be some spin-off benefits for adults learning from children," he added. "But mass media campaigns during epidemics and pandemics are worthwhile so that adults are encouraged to change."