03/18/2010 05:12 am ET | Updated Nov 17, 2011

Swine Flu Smackdown: How to Avoid Infection (and a Fistfight)

The tall woman with dyed reddish blond hair coughed loudly without covering her mouth. The shorter woman with a slicked-back bun wasn't happy about it. They were riding the southbound D train near Rockefeller Center during morning rush hour in New York City this week. A single cough quickly turned into an argument. "You need to cover your mouth," bun-woman reportedly said. "I don't want swine flu."

The war of words flared up quickly, according to a reporter for The Business Insider (who witnessed the altercation). Eventually, coughing-woman spit on bun-woman. Then someone threw a punch. In the end, coughing-woman tried to get off the train at 42nd Street, but bun-woman pulled her down to the ground by the hair.

"I could have decked her too," said a male witness. "That swine flu is treacherous." *****

Treacherous, indeed. In fact, if more people were aware of the contagion of single sneeze (or cough), there would probably be a lot more fistfights around the world.

One single sneeze propels 100,000 droplets into the air at around 90 mph, landing on subway strap handles, door knobs, ATM keypads, elevator buttons, escalator railings, and grocery carts.

In a subway station at rush hour, just one sneeze (i.e. spray + residue) can end up contacting as many as 10 percent of all commuters, according to British researchers. That means as many as 150 commuters can be sickened by one uncovered sternutation.

So what can you do to protect yourself? First and foremost, experts say, get the H1N1 vaccine whenever supplies become available. In the meantime - or in addition - what else can you do?

"No single action will provide complete protection," the CDC notes, but taking a few simple steps can help reduce the likelihood of transmission of swine flu (or many other infections).

1. Sanitize -- i.e. Wash Your Hands Frequently. It may sound obvious, but hand-washing with soap and water for around 20 seconds is the single best thing you can do (if you're going to go out into the world and interact with other human beings). The CDC estimates that 80 percent of all infections are spread by hands. If you can't wash your hands regularly, try hand-sanitizers with 60 percent alcohol content.

2. Avoid -- i.e. Engage in "Social Distancing." That's the fancy term for reducing unnecessary social contact, staying away from crowds, and avoiding people if you're sick or if you're concerned that they may be infected. It may not be especially practical when you have to go to, say, work, but experts believe it's worth repeating: Isolation and avoidance reduce your chances of getting infected or infecting others.

(Researchers in the UK -- mentioned above and sponsored by a cold remedy company -- found that 99 percent of commuters suffer at least one cold per winter. By contrast, 58 percent of people who work from home and 88 percent of those who walk to work caught a cold last winter).

If you need to go someplace crowded, the CDC says, try to spend as little time as possible and try to stay six feet away from potentially infected people.

3. Masks may help, but they aren't foolproof.

When used correctly, face masks may reduce the risk of getting infected or infecting other people, according to the CDC. But "no studies have definitively shown that mask use by either infectious patients or health-care personnel prevents influenza transmission."

When you see a surgeon wearing a mask, the purpose is to keep germs in so you she doesn't infect her patient. So-called N95 respirators are thicker, tighter-fitting, more expensive masks that keep out around 95 percent of all viruses.

However, a recent Canadian study found almost no difference in infection rates between health care workers who wore regular surgical masks vs. N95 respirators. Around 23 percent ended up sick, regardless of the protection.

According to WebMD, "one study shows that when there's a sick family member in the house, other family members could cut their risk of getting sick by 60% to 80% by using face masks consistently and correctly -- in combination with frequent hand washing and avoiding close contact with the sick person."

4. Be Alert -- i.e. Recognize the Symptoms and Get Help.

Swine flu symptoms are similar to regular flu: Fever, body aches, sore throat, cough, runny nose, vomiting, diarrhea, and lethargy. If you don't feel well, seek medical attention immediately.

It may not sound like much, but the best defense against the swine flu (and fist fights in subways) involves some very simple steps: Every sneeze should be covered -- preferably with the crook of an arm -- and every hand should be washed ... and washed again.

**** What happened to the reporter who witnessed the smackdown on the subway? "Well, I seem to have confirmed the central premise of the attack," he writes.

"How?" he asks. "I now have the flu."


For more information about surviving the swine flu, please go to TheSurvivorsClub Website.

Or call the CDC's toll-free hotline: 1-800-CDC-INFO. Or check out the CDC Website.

For more questions and answers about swine flu prevention, visit