What we can all learn from Hillary Clinton’s coughing spell? Cough hygiene

For most illnesses, staying about a meter away from someone sick will keep you in the safe zone.

Hillary Clinton in New York City, September 11, 2016 (photo credit: REUTERS)
Hillary Clinton in New York City, September 11, 2016
(photo credit: REUTERS)
Whether or not people believe that Hillary Clinton has neurological problems, tics, lung cancer or seizures, many of us saw her coughing spell at a rally in Ohio weeks ago. As a health care provider, I was concerned about her moist cough and hoarse voice, which has since been diagnosed as pneumonia, but I cringed when I saw her poor cough hygiene.
Where were all of the news health reporters? Too busy deciding if she has Bubonic plague, perhaps? With flu season on our doorstep, now is the best time to learn about disease prevention, and there’s no better place to start than cough hygiene.
What is cough hygiene? Keeping your cough (and the millions of microscopic and not-so-microscopic particles full of bacteria and viruses) to yourself.
Clinton may not be able to keep a secret, and may inadvertently (we hope) have spread sensitive, classified information to enemies of the US – but did she have to get up on national TV and show millions of people how to spread the plague? How can the American voter not cringe when sputum is flying into the microphone, into the air, into her hand which will shake a few hundred people’s hands only moments later?
Even the bottle of water that she will hand to her unwitting aide – who will then open a door, use a pen, a cell phone (but hopefully not a cursed BlackBerry) and then drive home to her family? Whatever Clinton has, now lots of other people have it too. Maybe they won’t get symptoms right away.
Maybe their immune system is stronger than hers. And maybe some people will get very sick. If we hear about a flu or pneumonia outbreak in Ohio, epidemiologists should investigate whether Democrats are getting sick more than Republicans. People who attend her rallies and line up to shake her incubator hand may be the first to get sick.
I remember meeting vice president Walter Mondale (realizing that I just blew my age cover) as a child. He shook my hand, and my father joked that I should never wash my hand again.
He was kidding, but as a kid, I really tried not to wash my hand. Until my mother made me wash my hands before dinner. Thank goodness! Perhaps a few hard-core Democrats, unwilling to catch the next epidemic even from a celebrity like Clinton, are smart enough to carry alcohol sanitizing gel? Not many, though, because it is not a freebie sponsored by the Obama administration.
Perhaps the better question is – where was Clinton’s hand sanitizer? She must be smart, after all she went to Yale Law School. Even her critics must agree that she is well educated. But even some well-educated people have no common sense.
Like when you leave your non-secure Blackberry in your hotel room, full of state secrets. Or when you think hammering a BlackBerry means that its data is “erased” magically. Or when you link a “C” on a highly sensitive documents about drones and undercover agents to mean a delicious pastry.
What is good cough hygiene? First you need to understand that many diseases are spread through droplets expelled from our mouths and noses when we cough, sneeze, vomit, speak, sing and even breathe. Many germs can live in the air on microscopic droplets for many hours... waiting for someone to breathe them in.
For most illnesses, staying about a meter away from someone sick will keep you in the safe zone. So Clinton coughing into the air was disgusting, but not dangerous from an epidemiological point of view.
But so-called “polite” people, who perhaps do not want the world to see the bits of phlegm streaming out of their mouths, cough into their hands. Like Clinton did when she wasn’t coughing in the air. Hands are a bad place for these germs.
Think about all of the places you touch with your hands every day.
You forgot about door handles, car doors, steering wheels, supermarket carts, remote controls, cell phones, pens at the cash register, food items, credit cards, and don’t forget shaking hands with colleagues. Now imagine these places teeming with the germs you “politely” expelled into your hands. Pretty gross. Germs can live on hands for 24 hours.
Another “polite option” is coughing or sneezing into tissues. Yes, tissues catch most of the droplets (at least the non-microscopic ones), but the non-waterproof tissue is being held – by your hand. The germs in tissues will die pretty quickly, but the leftover “moisture” on your hands? Read the last paragraph.
So what is there to do? The answer is cough hygiene. Bacteria and viruses can live for a long time outside of someone’s body. That is how these germs find new hosts and make babies (read: make you sick, too).
Most common bacteria and viruses (even some uncommon ones like HIV) die quickly when they are on soft surfaces like material. On hard surfaces, like door knobs, kitchen counters and faucets, germs can live for many hours. These surfaces and items then become sources for disease to spread.
When people cough and sneeze, the best option is to aim their cough into their shoulder or sleeve.
The mouth/nose area should be completely covered by the material of your shirt/jacket. People are unlikely to touch your sleeves (except Clinton’s Secret Service people keeping her on her feet), unlike your hands. Also, people don’t use their shirtsleeves to open doors, use elevator buttons, or key their iPhones... so it is unlikely that the “contaminated” corner of your shirt will spread germs.
Teach it to your kids! I taught cough hygiene to my children when they were two years old. They were experts at cough/sneeze hygiene while still in diapers. Most adults do not know about this hygiene issue, but slowly the word is spreading.
If you are wearing a sleeveless shirt, use a tissue and carry hand sanitizer. Let me rephrase that: use the tissue, dispose of the tissue, use your hand sanitizer (or wash your hands with soap and water) and then wipe down the bottle of hand sanitizer. And close the sink faucet with a paper towel. It’s an old nurses’ trick.
As for hand sanitizer, it should be used on visually clean hands, or not on hands that are dirty to the eye. The US Center for Disease Control and Prevention (CDC) recommends using hand sanitizers that contain at least 60 percent alcohol.
Remember that the bottle of hand sanitizer is being used with unsanitary hands and so should be wiped down or cleaned periodically. The best option is still good old-fashioned soap and water.
The US Federal Drug Administration (FDA) just shut down the commercial anti-bacterial soap business because plain old regular soap is just as effective (and does not contribute to anti-biotic resistance).
Twelve years ago, while working at the US Consulate, I was able to lower local employee sick days in a specific, overcrowded department by some 80% by providing this training and a heck of a lot of hand sanitizer. It really does work.
TIP – when in public facilities, do not use multi-use cloth towels. Use paper towels to dry off, as electric dryers have also been shown to be unsanitary.
After drying your hands, open the bathroom door while holding the used paper towel.
Then toss the paper towel in the garbage on your way out (I hold the door with my foot).
As for Clinton, no matter what side of the aisle you are on, she is recognized as a role model for women everywhere. I don’t wish for anyone to be sick, and I do not want to theorize about potential health issues. But as a role model, she and other public figures should be role models for good health habits, which can help people stop the spread of illnesses and keep people safe on both sides of the aisle.
The author is a nurse, nurse practitioner and professional health advocate. She has a doctorate from Yale University, is the director of EMA Care medical concierge and case management company, and worked for Hillary Clinton’s State Department as the director of the health unit in the US Consulate General in Jerusalem for eight years. This article was not intended to advance any political point of view.