Norovirus in the wilderness? How an outbreak spread on the Pacific Crest Trail

[Eric Kammerer]

From NPR this morning: Norovirus in the wilderness? How an outbreak spread on the Pacific Crest Trail

A very important reminder for backpackers.

[DWR D]

Plus One for the SteriPen… it kills that virus…

But… still can get it from a door handle, etc…

[HkNewman]

This part caught my attention:

 

[Hikers] may not leave visible traces but some may leave germs, like norovirus, that can live on environmental surfaces for a long time ..

While washing after touching doorknobs, handles, etc ..  is common knowledge, think norovirus takes it up a notch as our immune systems probably dealt with past pathogens.

Later on in the article they say norovirus is “extra-sticky”, so wash hands with soap and water as hand sanitizer won’t work.  Probably a good call for everyday life too.

[Jerry Adams]

They recommended to boil water for three minutes to treat it

They obviously didn’t listen to the gear skeptic video that says you only have to bring it briefly to 165 F

Repeating the myth that’s commonly repeated.

[Eric Kammerer]

The CDC is a bit more nuanced:

Bring water to a full rolling boil for 1 minute (at elevations above 6,500 feet, boil for 3 minutes), then allow it to cool before use.

[Jerry Adams]

The CDC hasn’t listened to that gear skeptic video either

He tried to find a source for that boiling for three minutes recommendation but was unable to find anything, but he did find sources that said 165F briefly was sufficient.

That’s kind of a side issue though.  The guy in that story drank untreated water, got norovirus, had to end his PCT thru hike.

[Jerry Adams]

I re-read the story.

The officials could not find any contaminated water.  The fact he drank untreated water probably didn’t matter

They did find a wilderness cabin (south of Snoqualmie in washington) that many PCT thru hikers used.  It had a pit toilet.  Every surface they swabbed in the toilet and cabin had fecal contamination.  So, probably, people used the toilet and then didn’t wash their hands, which caused the Noro virus  outbreak.

[HkNewman]

Every surface they swabbed in the toilet and cabin had fecal contamination.  So, probably, people used the toilet and then didn’t wash their hands, which caused the Noro virus  outbreak

Someone was patient zero.  Apparently it’s highly contagious so one infected hiker could spread it throughout.  I’m guessing that person didn’t wash their hands and/or more people stayed overnight .. becoming spreaders themselves.  The incubation  period is about 24 hrs minimum, so I’m thinking more the former.  My elderly parents caught it on an Iberian cruise right before Covid.  They lost 30 lbs each ..

Some more about the norovirus “what doctors wish patients knew about the norovirus”.

https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-contagious-norovirus

 

Most hikers get a pretty decent restaurant meal at the end of a hike but that may be a problem too as norovirus is also a major foodborne illness mostly via restaurants (maybe where the above patient zero got it?).

From my link ..

 

“Twenty million people a year get norovirus in the food industry—it’s the most common cause of foodborne illness,” Dr. Bisgrove said. And “the biggest reason is that food workers come to work sick or they get sick at work.

“There’s a vomiting episode or a diarrhea episode and it’s very hard to clean up,” she added, noting that “70% of norovirus outbreaks for food is caused by workers”

 

Not sure if a freshly baked pizza at 450 to 500°F (250 to 260°C) would kill it?  I’ll take a Supreme pizza in the name of health..

In my link there’s also info towards the end to treat norovirus symptoms.

 

 

[AK Granola]

I’ve had norovirus, caught from a cheap pizza place in Seattle. It was short lived but extreme. I won’t go further with description. Ugh. My kid got it last year in his college dorm; it swept across the campus. The campus had to set up rehydration tents where students could get IV fluids. He said from his observation, most students do not wash after using the toilet – at all! I have also witnessed this many times in public restrooms. People are on their phones, leave the toilet stall and exit the restroom.

One popular backpacking YouTuber doesn’t use soap and proclaims on his channel that just water is sufficient. I’m sure he influences quite a few people. Many people on BPL have also naysayed soap. One hike with Noro and I’ll bet they’d change their minds.

The soap can go right into the cathole with the poo, far from water sources. A good scrub under the fingernails, all around the fingers and hands. And don’t share the Fritos!

I love staying in hostels, but I sometimes wonder if it’s wise…so far so good.

[David D]

The CDC has a good comparison here between soap and sanitizer.  Soap is more effective against giardia, crypto, noro, chemicals.  I don’t even bother with sanitizer on trail any more (more weight saved!) and just use soap and water.  It’s less convenient but so is getting a bug

[Jerry Adams]

Maybe the take-away is to avoid areas with lots of people using the pit toilet and a cabin?

Can you give norovirus to yourself?  The rare times I hike with other people, we don’t touch shared surfaces.

If I used water to wash my hands, I’d transfer bugs to the outside of the water bottle.  You really need a faucet that comes on automatically, and a soap dispenser that dispenses automatically.

When I use an outhouse I avoid touching any surface.  The outside door handle is unavoidable but that is less likely to have bugs on it.  Lift toilet seat and touch inside door handle with toilet paper…

[Jerry Adams]

The one time I can think of that I got sick was from eating at a restaurant just before

[AK Granola]

Perfect time to tout the bidet solution again. You don’t have to touch that back end at all…I still recommend washing up afterward, but it’s a lot cleaner system overall!

[David D]

>If I used water to wash my hands, I’d transfer bugs to the outside of the water bottle.

I suds the water bottle at the same time with the soap from my hands. You’d pollute the sanitizer bottle as well and have the same issue there but then are stuck, can’t sanitize the sanitizer bottle without making a mess

Drawback to the bidet is all the extra water used and need to be carried but agree its cleaner!  I have a culoclean but never use mine because of the extra water carry

[MJ H]

If you leave the water bottle in the sun for a bit, will that disinfect it?

[Bruce Tolley]

The references to the thermal heat death of various microorganisms in wilderness waters can be found in the end notes to this summary article: https://academic.oup.com/cid/article/34/3/355/388050

We need to remember that the CDC is making a medical recommendation.  The Wilderness Medical Society summarizes the reasoning for boiling as an end point:

“Although attaining boiling temperature is not necessary to kill microorganisms, boiling is the only easily recognizable endpoint without using a thermometer.” https://wms.org/magazine/magazine/1254/2020water-cpg/default.aspx

I would suggest that the issue here is not pasteurization fact vs boiling myth, but that the CDC and the US Army are making a recommendation to average campers who might be in need of disinfecting contaminated water who are not constrained by availability of fuel.

Like many topics here at BPL, we are exploring advanced techniques for experienced backcountry travellers.  The conventional wisdom still holds. If you bring water to a boil, you kill everything.  But if you have the patience to pasteurize and yoou need to ration fuel, go for it.

[Jerry Adams]

That makes sense.  Easy to recognize when it’s boiling.

Although then saying you have to boil for three minutes is overkill :)

[George W]

Did a winter boating trip to a remote area with 4 friends. On day one the first person got sick from Noro, he got it from his wife the day before. It was like clockwork, 24 hours after exposure the next person would come down with it. Then 24 hours later you would start to feel better. It went through each person, they were miserable. Imagine being out in the middle of nowhere sleeping in a big tent as each person went through it. It was also below freezing the entire trip.
Luckily a couple of people would feel good enough at a time to keep things going in camp. After all, we had to keep fishing.

I didn’t get it during the trip, but I did the day after I got home, mine was very mild compared to the others.

[Terran Terran]

I think a bidet would just spread everything. Most people don’t don’t wash their hands correctly. Simply rubbing your hands together with soap and water isn’t efficient. I started on parts of the CT this year and found it dirty to start. Trampled creeks and stepping around horse manure. I’ll stick to the smaller, less prestigious trails. Very few restaurants and very few motels. I doubt I would have entered that cabin. Play in the dirt, not the filth.

[Jerry Adams]

“I think a bidet would just spread everything. Most people don’t don’t wash their hands correctly. Simply rubbing your hands together with soap and water isn’t efficient.”

Yeah.  You’re supposed to wash for 20 seconds vigorously scrubbing under water.  I don’t see how that advice is useful for backpacking.

Mainly, I make sure not to get any organic matter on my hands, and if so, then wipe it off.  Then, wipe off vigorously on pants.  You can’t remove all the bacteria, but you can remove most of the organic matter that is full of bacteria.

[David D]

That’s really not the correct way to wash hands.  From the CDC web site linked earlier, directly translatable to backpacking:

• Wet your hands with clean running water (warm or cold), turn off the tap, and apply soap.
• Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds.
• Rinse your hands under clean, running water

Sanitizer is just more convenient but with higher risk.

Risk mgt is broken into 2 parts, probability and impact.  To me the higher risk of sanitizer alone (its less effective and not practical to clean the bottle) isn’t worth the possible impact for the modest inconvenience of using soap and water but we all make our personal choices, preferably informed by the facts behind the risks and methods.

[Terran Terran]

I can find 20 seconds in the backcountry. Then again if you’re at a cabin with a pit toilet, are you really in the backcountry?

[Jerry Adams]

good point David, you don’t really need that much water

before, you could get bottle ready with lid off, soap ready.  Do your business using just one hand.  Use the other hand to hold water bottle and get the hand wet (just a bit of water).  Use the other hand to put some soap on the dirty hand.  Rub the two hands together for 20 seconds.  At that point, maybe any bugs have been neutralized so you could then hold the bottle with one hand and rinse off the other hand, then switch hands…

[Bruce Tolley]

There was a game show in the UK I was watching in my hotel two years ago where the contestants were supposed to guess answers to questions to survey questions that had already been asked of national UK audience.

On the question about the washing of hands before leaving a public bathroom, 75% of respondents said they did not wash their hands.  Since that time, like stated above, I have used a piece of paper between my hand and all surfaces when exiting a public bathroom.

Ironically, many public bathrooms have you push the door to open to enter, but pull the door (handle) to open to exit.  Seems like it should be the other way around….

[AK Granola]

And while we wash our hands after using the toilet to keep each other safe (as well as just not being disgusting), washing hands before eating is even more critical, since that’s how Noro gets in. One of the ways anyway, the other is being around people who are being sick. Keep clear! eew. But how many backpackers wash up before a meal or a snack?

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