The Gut Puncher

 

Norovirus, the most common cause of gastroenteritis, also known more inexactly as stomach flu, is making an unwelcome visit to the Winter Olympics in Pyeongchang, South Korea. Considering how norovirus thrives in crowded conditions, its appearance in Pyeongchang before the Games even began is a nightmare for organizers, as well as for the poor unfortunates who come down with the illness. One of the names it has become rather unfairly known by is “cruise ship virus”, as if the illness were more prevalent on cruise ships than anywhere else. Norovirus actually afflicts cruise ship passengers no more or less than people existing in similarly crowded conditions elsewhere, but when it strikes on a cruise ship the outbreak attracts notoriety because of reporting requirements in the industry and because changes in the itinerary of cruise ships to offload sick passengers easily become common knowledge.

Rembrandt Saskia in Bed
A Woman Lying Awake in Bed, circa 1635-1640 drawing by Rembrandt (1606-1669).

As much as the cruise ship industry chafes under its unfairly exaggerated association with norovirus, the citizens of Norwalk, Ohio, might have been perturbed that for the last third of the twentieth century their small city not far from Cleveland lent its name to the virus until the International Committee on Taxonomy of Viruses (ICTV) changed it officially from Norwalk virus to norovirus. An outbreak of the virus at a Norwalk elementary school in 1968 led to the first scientific isolation and identification of it under the microscope, though it had been known to exist from similar outbreaks around the world since at least the 1920s. The history of the virus before then is unknown, which could be due to any number of factors, including the similarity of some of the symptoms to influenza and the low risk of life-threatening complications compared to those brought on by the influenza virus, leading to it not receiving as much notice over the years as influenza, or getting lumped together with it. It is also possible it wasn’t until the mid-twentieth century that the virus mutated to become the causative agent of misery we recognize it for today, drawing our attention, our fear and loathing, and our research efforts toward a vaccine to limit the suffering.
— Vita

 

Can This Be Flu?

 

Since gastroenteritis is commonly known as stomach flu, and since this is influenza season, people can mistake one illness for the other or believe they are different names for the same illness. They are not. Gastroenteritis is technically not influenza, though it is most often caused by a virus and usually presents with some of the same symptoms in the early stages – headache, body aches, chills, and fever. It is in the lack of respiratory distress symptoms that the two illnesses diverge, that and the continued nausea and diarrhea brought on by gastroenteritis. Nausea may subside to a low level, and vomiting may cease after the first bouts simply because of a lack of contents to regurgitate as the sufferer no longer desires solid food. Diarrhea continues, however, since the sufferer’s inflamed intestines do not absorb liquids as they should.

Influenza Pandemic Masked Typist
Typist wearing mask, New York City, October 16, 1918, during the “Spanish flu” influenza pandemic. Wearing a mask would have helped stave off the influenza virus, which is most often inhaled, but done little to protect the wearer from a gastroenteritis virus, which is ingested.

That last part is the most important in understanding how to treat gastroenteritis. Fluid intake becomes even more important than in treating a case of true influenza because while the overall risk of life-threatening complications is less, the risk of life-threatening dehydration is greater. As with any illness affecting them, pregnant women need to carefully monitor their symptoms as well as take special care using medications. In poor areas of the world, where access to clean water may be limited, dehydration is the biggest killer in cases of gastroenteritis. In wealthier areas, even though a sufferer got the infection by ingestion of contaminated food or water, access to cleaner supplies of both after the illness develops makes chances for recovery much greater. The important things to remember in getting well from a bout with this illness which, dreadful as it feels at the time, are that the risks of developing something more serious are lower than with the actual flu virus, and that dehydration needs to be remedied not just by drinking water but by replenishing salts, sugars, and electrolytes in the right combination.
— Ed.