February 09, 2018

“Cruise ship illness”, “winter vomiting bug”, “food poisoning”, “stomach flu”, and many other names for norovirus appear in headlines globally each year. This winter, this highly contagious virus is making headlines for an outbreak in South Korea, and it will most likely get worse before it gets better. Transmission of the virus is extremely efficient; it only takes a small amount and short exposure time before it can be effectively passed to another victim, it can withstand temperature fluctuations, and people can pass the virus to another before and after they become symptomatic.

Symptoms of norovirus are simple; profuse vomiting and diarrhea, possible low-grade fever, and fatigue. From time of exposure to symptom development is typically only a matter of hours. Complications may include dehydration – the most severe threat from the virus. There is no cure or vaccine. Treatment includes fluid replacement and time. Medication for symptoms can be given in severe cases, but generally, rest and oral rehydration are the recommendations. Because it is a virus, antibiotics will not help. Is there good news? Yes! The virus typically only lasts one or two days, a miserable but short duration of illness.

Annually, norovirus is responsible for more than 685 million cases of acute gastroenteritis (stomach bug) globally. Estimated direct and indirect costs to patients and organizations top USD60 billion per year, largely for healthcare expenses and lost productivity. The virus is responsible for special protocols aboard cruise ships, hospital ward closures, school absences, and this year, concern over the impact to the Winter Olympic Games.

Why might it impact the Olympic Games if it is so common? Mass gatherings are a perfect forum for viral circulation and outbreaks. People congregating close together cannot practice the social distancing recommended during periods of disease outbreaks. Additionally, opportunities for thorough handwashing may be limited and alcohol based hand sanitizers have limited efficacy against this virus. Because norovirus can withstand cold temperatures, environmental exposure may not be effective and sunlight (UV light is a great viricidal) may be scarce due to cloudy weather and reduced daylight hours. Because of cold temperatures, people congregate indoors (hence “winter vomiting bug” nickname). The virus can live on fomites (inanimate objects) for hours, and people tend to touch things frequently, possibly spreading germs on handrails, elevator buttons, pens or pencils, keyboards and touchscreens, phones, and many other common objects. Bleach solution has proven to be effective in killing norovirus, but you can imagine the difficulty in continuously wiping down so many surfaces during the Games. Because an ill person can still pass the virus on for up to two weeks after recovering, it is likely that as soon as someone feels better, they will be out and about, inadvertently spreading norovirus for the remainder of their visit.

How much this outbreak – currently at 128 reported cases in South Korea, as of Feb. 7 - impacts the games is a matter of timing. Athletes who are exposed and develop illness may not be able to participate in their events or perform sub-par if they are infected near performance time. Reportedly, 1,200 security personnel are being quarantined, fortunately, because the duration of illness is so short, those impacted should be able to return to duty quickly. In the meantime, military personnel are filling in for security staff. The International Olympic Committee and health authorities are distributing information pamphlets about the virus and ways to prevent becoming ill. Food and beverage vendors are aware and all measures possible are being taken to prevent that avenue of spread.

What can attendees at Pyeongyang do to stay healthy? Wash hands thoroughly with soap and water. Reduce touching surfaces with bare hands whenever possible (pull your sleeve over your hand to press buttons or hold handrails), eat foods served hot, and drink only sealed cans and bottles. If you do fall ill, drink lots of water and clear fluids; rehydration drinks, sodas without caffeine, and broths will help prevent dehydration. Seek medical care for dizziness or altered mental status and if urination becomes infrequent. These are some signs of dehydration that may require intravenous (IV) fluids. Get plenty of rest and try not to pass it along! Aid stations will be operational throughout the Games and in most venues for assistance as needed. Hopefully, this outbreak will be short lived and not steal the show.