Health
Germophobia
It’s viral, destructive and oozing into every crevice of our lives. You may already have been infected.
By Maryn McKenna
From the February 2009 Issue
At least once a day, Lisa Pisano feels the itch.
The 30-year-old fashion publicist goes to the reception desk of her New York City office to accept a delivery of clothing samples from a designer. The courier hands over the garments, swings his messenger bag forward on his hip, fishes inside for a clipboard and hands her a pen. And then she feels it: a tickle at the back of her mind. A little rush of disquiet. Oh, my God, she thinks. Where has that pen been?
She imagines the possibilities: tucked behind the courier’s ear. Clutched by a stranger’s hand, which that day had probably touched a bathroom door or a subway handrail. She thinks about the millions of people in New York, eating, scratching, rubbing their noses, picking up bacteria and then leaving it on that handrail, and then on the person’s hands, and then on the courier’s pen, and then on her hand, her face, her lungs, her…. Ick.
Pisano has always been germ-conscious—she wipes off her purse if it’s been resting on the floor and swabs her keyboard, phone and mouse with disinfecting wipes—but the pen problem pushes her over the edge every time. One day, on the way to work, she spotted her salvation in an office-supply store window: a pen made of antibacterial plastic. She bought a handful and now, whenever the messengers buzz for her, she carries one to the door. Her coworkers tease her. She ignores them. “I’m known in the office for being a little nutty about my pens,” she says, laughing but not apologizing. “If you take my pen, I’m coming after you.”
Admit it: You’ve got something in your own life that makes you go ick. Ask any group of women what they do to protect themselves from germs, and the stories will pour out: We open the bathroom door with elbows, punch the elevator buttons with knuckles, carry wet wipes to disinfect the ATM—and we wonder whether we’re going a little too far. Even the doctors we turn to for reassurance aren’t immune. “I’m extremely aware of the potential for being ‘contaminated,’ in and out of my office,” says Susan Biali, M.D., a 37-year-old physician in Vancouver, British Columbia. “I wouldn’t touch the magazines in the waiting room if you paid me!”
When Self.com polled readers about their germophobia, more than three quarters said they flush public toilets with their foot, and 63 percent avoid handrails on subways, buses and escalators—all unnecessary precautions, experts say. Almost 1 in 10 say they avoid shaking hands, behavior that may flirt with full-fledged obsession, when your efforts to sanitize your life begin to stymie your day-to-day functioning.
Germophobia, of course, is not listed in the Diagnostic and Statistical Manual of Mental Disorders. But mental-health professionals agree that, in vulnerable people, extreme germ awareness can be both a symptom of and a catalyst for a variety of anxiety ailments for which women are already more prone—including obsessive-compulsive disorder, which often features repetitive hand washing and fear of contamination. Ironically, hands that are dry and cracked from overwashing are more likely to pick up an infection through openings in the skin, says Joshua Fox, M.D., a spokesman in New York City for the American Academy of Dermatology.
Even mild germophobia makes you vulnerable to a vast new industry designed to capitalize on your fears and sell you antimicrobial products. But these have proven no better at germ killing than the original products—and may even be bad for your health. “We have now gone so far over the top in our response to germs that it in and of itself has become something of a scandal,” says Harley Rotbart, M.D., professor and vice chairman of pediatrics at the University of Colorado Denver School of Medicine and author of Germ Proof Your Kids (ASM Press). “We can’t live our lives normally if we are consumed by avoiding germs.”
A germier world
The problem is that—in a time when one outbreak of salmonella can sicken 1,400 people without scientists ever finding the source and staph infections kill more people each year than AIDS does—germophobia doesn’t seem so paranoid. On the contrary, it feels like a reasonable reaction to risks we cannot control. Because of population growth, globalization and the movement of most work to the indoors, “we share more space and touch more surfaces that other people have touched than ever before,” says Chuck Gerba, Ph.D., professor of environmental microbiology at the University of Arizona in Tucson, who has spent 35 years tracking germs in public places. More than 300 new infections emerged between 1940 and 2004, according to the journal Nature. Because of record numbers of airplane flights, diseases globe-trot more quickly, and media coverage keeps us more aware of them.
Organisms that can make us sick are everywhere and take every form: They can be bacteria, which are microscopic single-celled organisms such as staph and strep; equally small fungi such as yeast and parasites such as worms; or even smaller viruses such as hepatitis or flu. We pick them up directly from other people in sweat, saliva, semen and other body fluids; in exhaled breath or skin-to-skin contact; or from contaminated surfaces, food or soil. They enter our body through cuts or abrasions or when we breathe them in, swallow them or transfer them to our mucous membranes by touching our eyes, nose or mouth.
Gerba’s annual sampling routinely turns up disease-causing bacteria on computer keyboards, desks, faucets, picnic tables, purses and more. His 2008 study found three and a half times more bacteria on office computer mice compared with 2005. During cold and flu season, one third of office phones housed cold viruses. The skin infection MRSA (short for methicillin-resistant Staphylococcus aureus) has turned up on the seat-back trays we eat off of on airplanes. And when researchers at the University of Colorado at Boulder studied the microorganisms on college students’ palms, they discovered that women’s hands have significantly more types of bacteria than men’s—even though women reported washing their hands more often. The team isn’t sure why, but one theory is that men’s more acidic skin is less amenable to the bugs, says lead researcher Noah Fierer, Ph.D., assistant professor of ecology and evolutionary biology.
Diane Bates, owner of a marketing and public relations agency in New York City, is more aware of this germ explosion than she ever wished to be. When her twin daughters were 2 years old, they contracted rotavirus, an intestinal infection she believes they caught from an acquaintance whose child had it. Hospitalized for five days, the girls were so sick that Bates couldn’t enter their hospital room without a mask, gown and gloves. “It was very traumatic, and it got me thinking about germs and I started to modify my behavior,” says Bates, 41. Four years later, avoiding germs is almost her household religion: She constantly surfs CDC.gov to check for infectious disease alerts, buys every new air purifier and uses antimicrobial tissues. She doesn’t allow her kids to touch salt shakers in restaurants, skips family gatherings if another child has a cold and scolds her husband when he lets the girls play on jungle gyms. “My friends and family roll their eyes. But I’ll take whatever sarcasm I have to in order to keep my family healthy,” Bates says. “At some point, I know it is more phobic than productive, but I feel if I do every single thing I could possibly do, it might make a difference.”
When bugs aren’t bad
It is hard not to feel under siege, but the reality is that all of this germ exposure is unavoidable—and most of it is harmless. In fact, bad organisms are far outweighed, in the environment and on our own body, by good ones. Our body is covered in bacteria—billions on our skin, trillions in our intestines—that live in friendly symbiosis with us, helping us digest food and absorb vitamins and protecting us from other bacteria that make us sick. “Some bacteria produce vitamin K, which prevents bleeding, and others turn fiber into a compound that helps protect against cancer,” notes Vincent R. Young, M.D., assistant professor of internal medicine in the division of infectious diseases at the University of Michigan at Ann Arbor.
Even when organisms are disease-causing, being exposed to them won’t necessarily lead to an infection. First, organisms have to reach the tissues where they are most likely to reproduce: The bacterium Helicobacter pylori causes ulcers only in the stomach, whereas flu viruses attach to the lining of the lungs. Our body puts plenty of hurdles in a germ’s path. Robert Tauxe, M.D., deputy director of the foodborne, bacterial and mycotic diseases division at the Centers for Disease Control and Prevention in Atlanta, points out that a foodborne germ, for instance, has to live through cooking, survive the antibodies in our saliva and the acid in our stomach, and then escape any protections in our immune system before it can potentially make us sick.
Whether a germ succeeds depends on a long list of additional factors, including how old you are, how strong your immune system is and how many individual germs—called the infective dose—it takes to cause disease. The dose varies with the germ: If only one hepatitis A virus gets past your defenses, it can make you sick (the upside: Most people develop immunity after one exposure). It would take as few as 20 cells of salmonella, many hundreds of cells of campylobacter and E. coli, and perhaps hundreds of thousands of the bacteria that cause typhoid and cholera.
Granted, some bacteria have worked out ways around our multiple lines of defense; because they reproduce every 20 minutes, they have had millions of generations to figure out strategies. The foodborne illness listeria, for instance, has adapted to technology: Although most bacteria prefer warm places, it can also grow in food that is refrigerated. But even in this case, Dr. Tauxe notes, unless you are pregnant or otherwise immune-compromised, “you could probably swallow a large number of listeria organisms of the most virulent kind and not become ill until you got up to around 1 billion or more cells—and then it would give you only fever or diarrhea.”
A research concept called the hygiene hypothesis even holds that allergies, along with eczema and autoimmune disorders such as Crohn’s disease, occur when we are deprived of enough contact with common bacteria, because that exposure teaches our immune system how to distinguish and react appropriately to threats. Research has found that children tend to develop more allergies if they took antibiotics early in life or if their parents made them wash their hands frequently and bathe more than once a day. A 2008 study in the Journal of Infectious Diseases also links lower rates of asthma to infection with intestinal worms and the bacteria that causes stomach ulcers. And what’s true for children is even more so for adults. In 2002, a massive survey published in the Journal of Clinical Immunology showed that hay fever, allergies and asthma are less common in people who have been exposed to hepatitis A, herpes virus 1 (the one to blame for cold sores) and toxoplasma, a parasite found in cat poop.
The idea is that our immune system reacts very sensitively to invaders such as disease organisms and parasites, says Graham Rook, Ph.D., professor of medical microbiology at University College London. What keeps them from overreacting is an internal regulatory system that we developed over thousands of generations, thanks to the interactions between our immune systems and nonthreatening bacteria that were always around us in mud, soil and untreated water. Take those organisms away by making life much cleaner and the internal controls go haywire. The immune system revs out of control, and the result is asthma, allergies and inflammatory bowel disease—and possibly even type 1 diabetes and multiple sclerosis, Rook’s research suggests. “People have to distinguish between the bugs that are dangerous and the bugs that are helpful,” he says. “It makes sense for a woman in her kitchen to make sure she has cooked chicken well. But if a child comes in with a muddy hand from the garden and grabs a sandwich, there is no need to scream and shout and insist he wash his hands.”
Calming germ jitters
Despite all the evidence that bacteria are not always bad for us, the insatiable germ-fighting industry is desperate to strip us of as many bugs as possible. If you weren’t phobic before, contemplating the products could make you that way. You can buy bug-bashing sprays, window cleaners and air purifiers. There is a bracelet that dispenses disinfectant and a key chain unfolds a claw for opening doors and operating ATMs. Enterprising manufacturers have infused washing machines and vacuums, sheets and towels, mattresses, chopsticks, high chairs and toys—more than 700 products, all told—with antimicrobial chemicals.
Yet doctors say the only products you need to fight germs effectively are the old-fashioned ones: soap, the alcohol in hand sanitizer and, for cleaning surfaces, very low concentrations of bleach like those on disinfecting wipes. “It really doesn’t pay to use an antibacterial soap over plain soap,” says Allison Aiello, Ph.D., professor of epidemiology at the University of Michigan School of Public Health in Ann Arbor. Her review of published research, featured in the American Journal of Public Health, shows that people who use antimicrobial soaps have the same amount of bacteria on their hands after washing with them and suffer the same number of colds, fever and diarrhea as people who use regular soaps.
Meanwhile, triclosan—a chemical used in hundreds of “germ-fighting” household products—has been linked in animal studies to liver disease and disruption of thyroid hormones. The Environmental Protection Agency currently regards the chemical as safe, but a new review of its status is due later this year. The Environmental Working Group in New York City has urged the EPA to ban triclosan and consumers to avoid it.
Perhaps most alarming, some scientists also link antimicrobial products to the rise of so-called superbugs such as MRSA and antibiotic-resistant E. coli. Because drugs often have similar chemical structures, bacteria that evolve a genetic dodge around an antimicrobial product can simultaneously acquire what is called cross-resistance to antibiotics, too, Aiello explains. (She does note that so far the mechanism has been demonstrated only in lab studies, not among people using antimicrobial soap.) “And what are we doing in terms of tipping the balance among different types of bacteria living on the skin? We don’t know yet, but we ought to be thinking about it,” she adds.
Instead of investing in unproven antimicrobial products, learning some simple rules of thumb can help you understand what’s paranoid and what’s prudent. Next time you’re seized with germ panic, take a deep breath and remember that.
There are simple ways to avoid most infections. The only place you really need to avoid contamination is on your hands, which transmit infections—especially cold and flu—more effectively than any other part of your body. “Wash hands every time you enter your home, and after any event that involves a lot of hand-to-hand contact, such as a big business meeting, a receiving line or high fives after a softball game,” Dr. Rotbart says. Don’t touch your face before you’ve had a chance to wash your hands, and always keep hands out of your mouth, eyes and—heaven forbid—your nose.
Viruses don’t live very long on dry surfaces. Most colds, flu and common infections are caused not by bacteria but by viruses. And although viruses can travel up to 3 feet when a person coughs or sneezes, they live for only a few minutes to at most two hours if the landing place is dry, Dr. Rotbart says. Exercise more caution around wet surfaces, which provide a friendlier home for viruses, and always dry your hands after washing up.
You can never infect yourself. Your toothbrush is full of germs, but they are yours; replacing it frequently won’t help you avoid illness. It’s sharing of toothbrushes—and towels, shoes, food, kisses—that can get you into trouble. Still, life without kisses and splitting dessert is a sad prospect. Likewise, if you catch a cold this winter, you can’t get sick again from the same germs. “But disinfecting is important to protect others,” Dr. Rotbart says. “Your bedroom, bathroom and kitchen should be washed after an illness using bleach-containing disinfectant, which kills both viruses and bacteria.”
If you’re going to extremes, there’s a problem. People who feel the urge to wash their hands over and over should try setting limits—programming a timer for how long they can wash, for instance—and seek help if they begin slipping into a repetitive pattern, says Pamela Garcy, Ph.D., a clinical psychologist in Dallas. “Don’t allow yourself to go beyond the limit,” she says. “Someone might say, ‘I’ll wash up twice to be extra sure.’ Once you start to feed into irrational ideas, you can develop a habit, and it gets harder to break. If it becomes OCD, it will get worse, not better.”
Germophobic behavior dies hard, as Missy Cohen-Fyffe, a 47-year-old in Pelham, New Hampshire, can attest. She was so repulsed by the idea of a baby teething on the handle of a supermarket shopping cart that she invented a portable cart cover, the Clean Shopper. She knew she had a twitch of obsessiveness; as she puts it, “I come from a long line of germ freaks.” But after 10 years of talking to germ-aware customers, she realizes how mild her obsessions are. “A lot of our people do take things to the nth degree: We had one woman tell us she doesn’t allow her family to enter a hotel room until she has washed it down,” Cohen-Fyffe says. “I have two sons. I have a dog. I have to live in the real world. I can’t be the germ freak I want to be in my heart.”