Norovirus can kill

The Norovirus outbreak that sickened 277 on board the Oasis of the Seas of the Royal Caribbean Cruise Lines forced the 7-day Caribbean cruise to return prematurely to Port Canaveral about 3 weeks ago.

This incident puts the spotlight on this most contagious gastrointestinal disease known to man. For the aged and the very young, this virus could be so devastating as to kill some victims.

Annually, about 20 million people in the United States are infected with norovirus, 2 million are so severe as to require hospitalization. New strains are responsible for pandemics every 3 to 4 years. So far, the most virulent strain was seen in the pandemic of 2002-2003 and 2006-2007. Majority (around 80 percent) of norovirus infections are seen annually between November and April.


The symptoms of norovirus could occur suddenly as abdominal cramps and pains, nausea, severe vomiting and diarrhea, 12-24 hours after exposure to the virus. Some norovirus carrier may not have symptoms at all, but could infect other people. The other symptoms include low-grade fever, severe malaise, and muscle aches. The symptoms last between 24 hours and 3 days, depending on the age of the patient and the health of the individual. Most recover without treatment, except infants and those with major illnesses and those immunocompromised. The vomiting and diarrhea lead to severe dehydration and electrolyte imbalance. The infection is common in crowded situations, like cruise ships, nursing homes, schools, etc. About 10 percent of norovirus infection develop sever symptoms.


Noroviruses are found in feces of infected persons and animals. The virus is transmitted through ingestion of contaminated food or drinks, touching the mouth with fingers hat have touched contaminated surfaces or items, and by close contact with an infected person. Noroviruses are resistant to most disinfectants and to hot and cold temperatures. Infected cook could contaminate the food and drinks. The virus particle is about 38 nanometers and 3 particles of the virus could fit across the width of a single hair. Nanovirus travels at lightning speed.


If diarrhea does not stop within 3 days or so, and/or there is blood in the stools, especially when accompanied by vomiting, medical consultation is mandatory. While most will recover spontaneously, untreated dehydration and electrolyte imbalance could be fatal to some. The ones with a higher risk are infants, young children, older persons, those with chronic medical conditions, and those with compromised immune systems. Vomiting and diarrhea could deplete the body of water and vital minerals that allow all organs in the body to function normally. A tilt in the balance due to the loss of these vital element negatively impacts the kidneys, heart, liver, and brain. Normal homeostasis is essential to life.


About 50 percent of norovirus infection is from contaminated food, especially leafy green vegetables, shellfish, and fresh fruits. As with any other infectious diseases, prevention is the key. In case of Norovirus and other contagious illnesses, a person can become infected more than once. Norovirus infected persons must stay home until fully recovered to avoid spreading it to others.

Here are some simply common sense ideas that can help us avoid this and other infections, and prevent their spread to others:

  1. Frequent handwashing after using the toilet, before eating, after any chores (changing diapers or cleaning a bed-ridden persons) that could render the hands dirty. Washing hands with soap and water frequently could go a long way in our quest for health;
  2. Prepare and cook foods with extra consciousness about cleanliness and hygiene around the kitchen, including cook wares and utensils;
  3. Do not eat or drink foods prepared by a sick person;
  4. Chicken, pork, and sea food must be cooked properly;
  5. The plates and utensils must be washed properly, and if in doubt, soaked in boiling water;
  6. Fruits and vegetables must be thoroughly washed, soaked if needed, especially berries.
  7. Stools, vomitus, and contaminated towels or items should be disposed off carefully, quickly, and properly to prevent spreading the disease by air or by contact.
  8. With gloves, clean the contaminated area or surface with liquid disinfectant chlorine bleach. Only very high heat and chlorine-based disinfectants can inactivate norovirus fast.

Proper use of gloves

         To avoid food contamination, some restaurants, fast-food chains, etc., make their food preparers and servers wear gloves. As a surgeon, I am very conscious of the mistakes of food handler using gloves. Almost 100 percent of the time, I see them use the gloves improperly, which could even allow more contamination of the food. The gloves must never touch anything but the food, and the food item only. If the server touches the knife, or the microwave oven door handle, or the surface of the table, or anything else besides the food, he/she is contaminating the food that he touches next. It takes a lot of practice and a good teacher to nuse gloves properly, otherwise it will only give a false sense of security that the food is protected from contamination because gloves are used. That is not true. The situation could lead to more contamination of food, if not properly executed. Cleanliness of the food is assured when touched by gloved hands IF and only IF those hands would NOT touch anything else but the food being prepared. If you notice surgery on television, the operating table and every surface is draped with sterile cover, and the surgeon and assistants touch only the sterile instruments, and the draped areas ONLY.


The management of Norovirus infection among those with significant symptoms includes fluid and electrolyte replacement, monitored by laboratory tests. If the person is able to drink, beverage with electrolytes (Gatorade, etc.) is recommended. If not, and if the vomiting and diarrhea are severe, intravenous fluid drip is initiated in a clinic or hospital ER setting. If there is fever, the patient is hospitalized. In the past, these patients were advised not to eat anything for at least 24 hours, but modern medicine encourage these patients to eat if they tolerate it. This has been shown to shorten the illness and improves the fluid electrolyte and nutrition balance of the patients. If being treated at home, the person should try to avoid contacts with family members and friends, preferably isolating himself, and eating in his room, with separate utensils, plates, glasses, etc.

Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites:,   Email: [email protected]