Thread by @tmprowell

#MedTwitter
There is a widespread outbreak of #norovirus, a GI virus that causes projectile vomiting & profuse diarrhea usually lasting 24-48 hrs. Wastewater levels nationwide are high. It’s miserable & incredibly contagious. So many friends are texting us SOS, so here’s a 🧵. /1

Norovirus spreads when as few as 10 viral particles get in the mouth. This happens via direct contact (eg, kissing), contaminated food/water, or touching contaminated surfaces (countertop, toy, soiled clothes) then mouth (eg, toddler toys in mouth, eating by hand, nailbiting). /2

#MedTwitter
Given how contagious #norovirus is & how it spreads, it is like a brushfire in close quarters and/or where common items are handled by many. Cruise ships are famous for outbreaks, but also daycares/schools, dorms, dining hall/salad bars, nursing homes, jails, etc. /3

Importantly (& a huge inconvenience), #norovirus is NOT DESTROYED BY HAND SANITIZER. YOU MUST WASH YOUR HANDS with soap & water for a min of 20 secs.

It can survive freezing for months as well as heat up to 145F (the max temp of many home dishwashers 😖), so what do you do? /4

First, avoid getting #norovirus on your hands & shared surfaces to begin with if you can. This will simplify everything.

👉Wear gloves if caring for someone or handling their soiled dishes/toys/clothing/bedding
👉Use paper plates, disposable cups/utensils etc for the moment

/5

Second, use bleach-based cleaners if possible. CDC recommends cleaning using diluted bleach. Get a new bottle of bleach (first opened < a month ago for best effect) & add 1/3 - 1 1/2 cups of bleach to a gallon of water. I go at stronger end, but need to ventilate area well. /6

Important: the diluted bleach solution must stay on at least 5 mins!

Don’t have or can’t use bleach? Check if another product works against #norovirus by finding EPA reg # on label & then scrolling to table at bottom of this link to check: . /7 epa.gov/pesticide-regi…

Make sure to note the dwell time for the product, which is how long it needs to be in place to kill destroy #norovirus.
For clothes/linens etc, remove solid matter (I do outdoors into a trash bag) before washing then wash in hot w/ max rinses. Twice if possible. Dry high. /8

It’s incredibly contagious so barring these steps, it’s likely that 80-100% of those exposed will get #norovirus. Fun fact: people with B blood type less often get #norovirus, so if you’ve got one present, put them in charge of care/cleanup (sorry, B bloodtype people, & thx). /8

For those w/ #norovirus, the major risk is dehydration & electrolyte abnormalities from 24-48 hrs of vomiting & diarrhea. Stay hydrated with ice chips & water w/ electrolyte replacement powders. Then move to bland, easily digestible food (toast, broth, applesauce, rice, etc). /9

While most households will recover after a couple incredibly miserable days for each person, people over 65, the immunocompromised, & any at increased risk of dehydration can become severely ill. Know signs of dehydration & seek medical care. /10

If someone in the home has a smart watch or other device that can measure heart rate, blood pressure, & other health parameters, that can be helpful to monitor the person who is sick & communicate w/ their healthcare provider. Just remember to clean it well after use. /11

After many GI infections, including #norovirus, the GI tract makes less lactase, the enzyme responsible for breaking down lactose in dairy products. It’s pretty common to become newly lactose-intolerant for weeks to months w/dairy causing cramps, bloating, gas, or diarrhea. /12

Most doctors recommended starting slowly with dairy after a GI illness & if it causes GI symptoms, then back off & try again in several days. (Yogurt has less lactose than other dairy & may help repopulate your GI tract with healthy microbes after GI illness if tolerated.) /13

In the end, with attention to rehydration, most w/ #norovirus will be fine. Keep a close eye on babies, elders, & anyone who is medically fragile & seek medical care esp if they show signs of dehydration or if symptoms are not improving by 48 hrs. /End

express.co.uk/news/uk/199607…

Please bookmark & share the thread from the top to try to keep #norovirus from spreading in your community. #MedTwitter

If you prefer to read this as one long post, you can tag @threadreaderapp & ask it to unroll it for you

For #MedStudentTwitter & #MedTwitter trainees, there’s some #MedEd that will be useful for your exams in that thread. If you see a pt with #norovirus who recovers then develops intermittent GI symptoms again, the right answer is probably lactose intolerance. Dx/rx in 🧵.