QUESTION: I have an appointment with my family doctor coming up soon. I’ve heard it’s a bad flu season and the flu shot isn’t very effective this year. Could I catch the flu in the doctor’s waiting room from one of the patients seeking treatment? Should I postpone my appointment until after the flu season has peaked?
ANSWER: It is, indeed, possible to pick up a bug from one of the other patients.
As you correctly surmise, a lot of people suffering from flu symptoms – or other respiratory illnesses such as the common cold – head to their doctors’ offices in search of relief at this time of year.
“You could ostensibly be sitting right beside somebody who is coughing and sneezing and obviously has an infection of some sort,” says Dr. Mary Vearncombe, who is the Medical Director of Infection Prevention and Control at Sunnybrook Health Sciences Centre.
“Doctors’ waiting rooms are certainly places for circulating infectious agents. But so are subways, grocery stores, movie theatres, and any place where we interact with other people.”
Dr. Vearncombe says physicians are aware of the risks posed by putting infectious people in close quarters with other patients.
Many doctors do take precautions to reduce the chances that germs will spread in their waiting rooms.
Essentially, the staff at these clinics will try to separate potentially infectious patients from others waiting to see the doctor. That segregation process often starts before you arrive.
“When you call to make your appointment, the receptionist will ask why you are coming in, and do you have symptoms that might be infectious – like a fever, a new cough, vomiting or diarrhea,” explains Dr. Vearncombe.
This series of questions helps to identify the patients who might be a risk to others. When infectious patients arrive, they are moved to one of the examination rooms “as soon as possible, rather than letting them sit in the waiting room coughing all over everybody,” she adds.
Some patients may develop symptoms after they’ve booked an appointment for another reason. To cover these cases, many doctors’ offices have signs posted saying that if patients are suffering from a fever, cough, vomiting or diarrhea, they should tell the receptionist immediately upon their arrival. These patients would then be whisked into an examination room.
Of course, there will be times when all the exam rooms are already occupied. So, many medical offices stock facemasks. “At least, if they can’t get immediately into an exam room, they can be wearing a mask,” says Dr. Vearncombe. It’s fairly common to also see tissue boxes and alcoholhand rub dispensers in waiting rooms so patients can contain coughs and sneezes and clean their hands.
What’s more, some doctors’ offices – especially pediatric specialists – have adopted permanent measures to systematically segregate infectious patients from the vulnerable.
At Danforth Pediatrics in Toronto, for instance, new babies (whose immune systems are not yet fully developed) are usually given morning appointments and older kids are booked in the afternoon. “We try to separate them as much as we can,” says Eva Dongas, who is the clinic’s office manager. When children are suspected of having a very infectious illness, “we schedule those patients at the end of day.”
But what do you do if your doctor’s office hasn’t adopted any of these safeguards?
Well, there are things you can do to protect yourself at the doctor’s office – and elsewhere.
First and foremost, get a flu shot, says Dr. Vearncombe. (Ideally, it’s best to get the vaccination in late fall before the start of the flu season.)
It’s true that this year’s vaccine isn’t a perfect match for the dominant flu strain now in circulation. (That flu strain is from a family of influenza A viruses called H3N2.)
The experts picked the strains for the vaccine back in February so that manufacturers could start revving up production for the millions of doses that would be needed for this season.
When the experts have to make these decisions so far in advance, there is always a chance they will select the wrong strains or there will be a significant change (mutation) in the key strains by the time the flu shot is ready for the public. And this year, unfortunately, the experts partly missed the mark.
“It usually provides 60 per cent protection, so it is quite a reduced effectiveness this year,” notes Dr. Vearncombe.
“But 23 per cent isn’t zero. It would be zero without the vaccine,” she says. “Also, the other two influenza strains in the vaccine, the influenza A H1N1 and the influenza B strains are a good match to circulating strains of those types.”
If you drill down further into the numbers, you will find that some people get less protection than others. Older people tend to have less robust immune systems than youth. That means when they get a vaccination they may produce only a feeble defense against the flu.
Still, as Dr. Vearncombe points out, some protection is better than none. It is worthwhile noting that “herd immunity” increases as more people are vaccinated. Simply put, when the vaccine protects one person from getting the flu, that individual can’t pass the flu to others. The flu shot helps to break the chain of influenza transmission in the community.
Aside from the flu shot, you can also protect yourself by frequently washing your hands or using alcohol-based hand rubs. You’re likely to have heard this advice many times before. That’s because it works and it helps guard against other respiratory illnesses – not just the flu.
“Alcohol hand rub is very effective at killing these respiratory viruses. Carry it around with you in your pocket, purse or backpack and use it frequently.”
Dr. Vearncombe suggests that employees who share a workstation with other people should clean the keyboard, desktop and phone with a disinfectant wipe whenever they take over the post.
Respiratory viruses can also be spread through droplets. Stand at least 2 metres away from anyone who is coughing or sneezing. That’s the distance germ-infected droplets can be propelled in a cough or a sneeze.
With that background in mind, let’s now return to your question – should you avoid your doctor’s office in flu season?
“No,” says Dr. Vearncombe. “Unless you are going to live like a hermit, it is hard to avoid exposure to respiratory viruses.” But if you walk into your doctor’s office and see someone with the sniffles, you “may want to sit on the other side of the waiting room.”
Dr. Vearncombe has one last bit of advice: If you do get sick, stay home until you’re better and no longer infectious. So, be nice and keep your germs in ice – that’s ice for isolation.
Note: February 2018: Dr. Jerome Leis is the current Medical Director of Infection Prevention and Control at Sunnybrook.