Measles? That is so 1890s

“The right to swing my fist ends where the other man’s nose begins.” – Oliver Wendell Holmes, Jr.

It was recently announced that a child with an active case of measles flew from Amsterdam to Portland, exposing an unknown number of people to the disease.  Measles, a highly contagious disease causing a high fever, cough, runny nose, and rash covering the entire body, isn’t something we hear about frequently. (Though it is known for killing many a traveler in the computer game “Oregon Trail,” proving that the dream of the 1890’s, where people needlessly die from entirely preventable diseases, is alive in Portland.)  And for good reason. There are less than 1000 cases per year in the United States, making it by any measure a rare disease.  In recent years, however, the number of cases has been rising.

What is causing the resurgence of this disease?  Put simply, rejection of the last few hundred years of scientific progress (i.e. forgoing vaccines).  The arguments against vaccines are largely misguided and fueled by suspicions of a profit-driven healthcare system and conflicts of interest rather than grounded in science (i.e. (usually) reality).  Like most all debates in the United States, the rhetoric of the anti-vaccination crowd is largely individualist and ignores negative externalities of the decision to refrain from using vaccines.  “I choose what goes into my child’s body.”  Implicit in this statement is, “I have the right to put my child’s classmates, friends, and neighbors at higher risk for being exposed to communicable diseases.  Ron Paul 2012.”

Whether we like it or not, we are interdependent and our decisions have impacts on those around us.  For the most part, public health policy recognizes this, with public schools (kind of) requiring children to be immunized.  Vaccine “mandates” like this are only being strengthened, where recently in Washington state legislation was passed making it more difficult to opt out of immunizations.  Perhaps in addition to schools, it is time we require people show their immunization record to the TSA before boarding a flight?  I certainly don’t want to be exposed to measles or whooping cough when I travel.  I imagine parents who have immunocompromised children or children who have allergies that require they go unvaccinated feel the same way.  Given that the TSA requires one show their ID, naked body, shoes, belt, liquids, metal objects, etc, all while subjecting yourself to unnecessary radiation, handing over your immunization record doesn’t seem that extreme.  If one is really opposed, there are always covered wagons.

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By any means necessary…

“Wash me thoroughly from my iniquity, and cleanse me from my sin.”  – Psalm 51:2 

I was at Whole Foods (I know I know…) the other day using the restroom.  Someone in the stall next to me was clearly having a bowel movement.  No big deal, right?  People do these things.  Predictably, the toilet flushed and the stall door opened.  But then, the bathroom door opened.  The silence of the sink faucet was deafening.  I tried to rationalize.  “Someone else must have come into the restroom.  Who would leave without washing their hands?”  I turned to find the restroom frighteningly empty.  My mind started to race.  “Oh my God!  Have they done all their shopping?  Shit, I need kale.  What if they touch the kale? What if I check out using the same check out stand they did?”  Needless to say, I left the store carrying prepackaged kale and a bottle of (organic French lavender) hand sanitizer.

This, unfortunately, is not a rare occurrence.  Studies have shown that rates of hand washing are alarmingly low, 77% in men and 93% in women.  Given that so many diseases are spread through the fecal-oral route, this is something to think critically about how to improve.

As previously mentioned, the bathroom was completely empty (aside from me in a stall) when this person left.  They didn’t have to look at anyone, or really be accountable in any way to the fact that they walked into a store full of things people put in their mouths with E. coli (AKA poop) covered hands.  What if they had?  What if I had been washing my hands when they left the bathroom stall?  Research suggests that this may have changed the outcome.  While I don’t like to admit it, people are sheep.  We like to conform to what is expected of us.  This is true when it comes to hand washing as well.  When people are observed, they are more likely to wash their hands than if they are alone.  That being said, we don’t spend the majority of our days in the bathroom.  Public restrooms generally aren’t as crowded as the areas they service (thank God).  So we either need to find ways to get more people in bathrooms to increase peer pressure, or get people to wash their hands in public.  Given that many feel more comfortable in single occupancy restrooms, or unisex restrooms, getting more people into bathrooms isn’t a solution.

One beautifully simple way to do this is to remove sinks from bathrooms entirely and put them outside.  One grocery store has done just that (whether it was intentional or not I don’t know).  Like many grocery stores, this store has a seating area where people can sit to drink coffee, or eat lunch.  Right next to this area, and within full view of the large seating area, are the restrooms.  There is nothing special about them.  What is interesting is that the sink is outside the restroom, in full view of everyone in the store.  In order to leave the restroom without washing your hands, you have to walk by dozens of judging eyes.  While I would like to think people would wash their hands because it is the right thing to do, clearly they don’t.  If the only way we can increase hand washing rates is through guilt and shame, so be it.  Clean hands by any means necessary.  Good work unnamed grocery store.  I would eat your produce any day.