Britons 'kissed through swine flu'

Man sneezing The survey compared behaviour during the pandemic in Britain, Argentina, Japan, Mexico and the US

Do you remember the "sneezing man in a lift" public health advert? Released during the swine flu pandemic it was aimed at promoting the "Catch it, Bin it, Kill it" message.

But a survey published in the Lancet Infectious Diseases medical journal suggests that people in Britain were far less likely to adopt simple protective measures during the H1N1 pandemic in 2009 than those in Argentina, Japan, Mexico and the US.


Researchers at Harvard School of Public Health in Boston questioned nearly 5,000 people. Just 25% of British people surveyed said they more frequently coughed or sneezed into their elbow or shoulder during the pandemic compared with 82% in Mexico and 84% in Argentina. Some 53% of Britons said they washed their hands or used hand sanitizer more frequently, compared with 89% in Argentina, and 72% in Japan and the US.

Just 2% of Britons said they avoided hugging or kissing family or friends compared with 46% of those questioned in Mexico and 21% in the US.

One of the study's authors, Dr Gillian SteelFisher said: "The wide variations between countries in our study shows that in the event of another serious outbreak of infectious disease, public perceptions have to be taken into account to best tailor and communicate policy approaches that need public support in each country."

The study did not set out to find out which of the nations was the most hygienic but rather to see whether increased handwashing and social distancing reduced H1N1 vaccination uptake. It did not, although overall vaccine rates were low in all the countries.

Studies like this clearly have limitations. These were telephone interviews with the respondents self-reporting their behaviour. Furthermore, the questions were posed several months after the end of the pandemic so recall may have been shaky.

But if the results are accurate the obvious next question is why Britons were less likely to adopt protective behaviour than other countries? There the survey doesn't help.

Mexico was hit first by swine flu and there was a great deal of initial fear and uncertainty about potential danger from the virus. So it understandable that people there took social distancing measures and personal protective behaviour more seriously than in Britain.

The supposed differences in behaviour between the US and UK are less easy to explain. It would have been helpful to have another European country to compare with the UK.

Alison Holmes, Prof of Infectious Diseases, Imperial College London told me: "This research is a good starting point but it begs the question, what next? It is vital that we reflect on how best to communicate public health messages. We need to be more scientific and understand how people make sense of recommendations."

That applies to the media as much as to the government and medical profession. I did many reports stressing the importance of basic hand hygiene - perhaps journalists need to re-think the way they present such information.

You may be asking why all this matters at all, given that the vast majority who got swine flu experienced a mild illness? It matters because there are plenty of other bugs out there that will happily hitch a ride on our skin and up our nostrils.

World record attempt

Despite all the limitations of the survey it does seem to suggest that not enough of us take hand hygiene and the health of the wider community seriously. There was a huge response to a blog I did last year about research at the London School of Hygiene and Tropical Medicine. It suggested that one in six mobile phones is contaminated with faecal matter.

Handwashing is not a very exciting or hi-tech public health measure. It does not grab the headlines like a new wonder drug. Nonetheless it is one of the most effective means of reducing the spread of viral infections like influenza, rotavirus and norovirus, and bacterial infections that cause diarrhoeal disease. In the developing world more children die from diarrhoeal disease than HIV/Aids, malaria and measles combined.

Good and bad hygiene habits start young. That's why Global Handwashing Day on October 15th will see schools across the UK attempting the break the world record for the largest simultaneous hand hygiene lesson.

Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this

    Comment number 53.

    50.YUG - ".....Antibac sprays are completely unnecessary for a normal home."

    That much is true - there's a good reason why surgeons still scrub up the old fashioned way with hot, running, water & ordinary soap.

    But Swine Flu was one tiny mutation away from being utterly deadly - we survived mass deaths by a stroke a luck......

  • rate this

    Comment number 52.

    49.Squiz of Islington - "......As for the Japanese they are paranoid and wear masks even in London - despite their country being contaminated with radiation. Apparently."

    That'll be one area of the country, not all of it - the reason why there were no deaths at Fukishima & 1,000s at Chernobyl, is that the Govt stopped people eating the food/drinking the water from the contaminated areas.....

  • rate this

    Comment number 51.

    Yeah right - swine flu. That's why I haven't kissed long-time.

  • rate this

    Comment number 50.

    I was born in 1970. We didn't have antibacterial spray, we didn't disinfect every surface every 5 minutes. We played out in the dirt. NONE OF US DIED. We didn't get sick that often. And I still don't get sick that often because I went outside, got exposed and developed a strong immune system. Antibac sprays are completely unnecessary for a normal home.

  • rate this

    Comment number 49.

    This research only asked if you were more likely to adopt precautions, not whether you already did, so it's pointless. Indigenous Britons formally had very good hygiene standards - it isn't the locals that spit on the pavement.As for the Japanese they are paranoid and wear masks even in London - despite their country being contaminated with radiation. Apparently.

  • rate this

    Comment number 48.

    I think many people struggle when it comes to evaluating risk. If I go for a drive and don't crash, that doesn't mean putting my seat belt on was a waste of time. Similarly, if a flu pandemic turns out to be less deadly than it might have been, that doesn't mean precautionary immunisation was a waste of time. It's too late to put your seatbelt on after the impact.

  • rate this

    Comment number 47.

    Am I the only one who noticed that the hysteria whipped up around the flu outbreak was at the same time as the international agency that monitors disease epidemics was campaigning for a renewal of funding?

    I am sorry that I cannot remember the exact name of the agency.

    Being a carer with a 'high risk' wife I was probably the only idiot who wore a mask and fell for the emergency - other than HMG

  • rate this

    Comment number 46.

    NO it is NOT better to 'over stress'. Remember the story of the 'chicken little', or the 'boy who cried wolf'. If you keep banning this and that because someone might if they were really really stupid stub a big toe nail, or saying you should wash hands/ shouldn't eat that.... over every possible stupid minuscule risk no one takes you seriously.

  • rate this

    Comment number 45.

    In the UK we are far less likely to kiss family and friends compared to the Latin American countries and the lift ad was memorable but sadly did not inform us about the number one risk! Touching contaminated surfaces and then touching the nose especially. Look around and you will see people (children in particular but adults surprisingly often too) rubbing their noses without thinking!

  • rate this

    Comment number 44.

    #30 Stats are indeed 'flexible'. As you say in your post #35 if someone has terminal cancer and a few months to live then gets flu & dies what killed them? The Flu that finished them off or the cancer that weakened them so much that they were vulnerable to the flu?

    However if you have terminal cancer & I shoot you I'm definitely a murderer. By that logic cancer patient dies of flu = flu death

  • rate this

    Comment number 43.

    Perhaps it is time that we, as a society, debate & decide whether we'd rather only be warned about definate scares & therefore accept preventable casualties when the worst does happen - or whether we'd rather be warned when the risk is high but not definate & accept a few flase alrams...???

  • rate this

    Comment number 42.


    We are far too sanitised

    I'm not! :)

  • rate this

    Comment number 41.

    The whole swine flu thing was out of all proportion - the media were desperate for a story to take our minds of other problems, politicians were happy to have their failings hidden.
    While the 'epidemic' was small then there was no real danger for most people.
    The difference between a kiss and being in a room with some snot nose sneezing everywhere is small.

  • rate this

    Comment number 40.

    'Just 2% of Britons said they avoided hugging or kissing family or friends compared with 46% of those questioned in Mexico and 21% in the US.'

    Does that mean all 2% of Britons who habitually hug/kiss people who aren't their partners stopped doing so for fear of flu? Or that less than half of the (maybe) 50% of US who are profligate hug-kissers stopped?

    How do you interpret change without totals?

  • rate this

    Comment number 39.

    If the other comments here are representative, it appears to be a lack of trust in media and politicians coupled with common misunderstanding of basic statistics and probability.

  • rate this

    Comment number 38.

    The importance to us of physical contact more than outweighs the risk of contagion - I do prefer a good hug however to this modern concept of kissing acquaintances on the lips.

  • rate this

    Comment number 37.

    The problem is that there are so many health warnings, which are taken up by the media and blown out of all proportion that when, or if, something really serious comes along people just don't believe them. Same applies to "severe weather warnings"

    Sadly H1N1 was, in my opinion, another overblown scare.

  • rate this

    Comment number 36.

    We are far too sanitised, getting used to bugs and viruses is part of the defence system of the body. If you are not "battle hardened" then you will succumb too easily to flu.

  • rate this

    Comment number 35.

    Then there's the scaremongering issues

    "Flu kills 20 million people a year !"


    (19.95 million of whom were already physically weak and were going to pop their paws as soon as anything challenging their old knackered body came along)

    Disingenuous government propaganda has replaced genuine public health information

    (Keeps someone in a job... but it's useless for credibility purposes)

  • rate this

    Comment number 34.

    Our blasé attitude wouldn't have anything to do with panic-mongering by the media, now, would it?


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