The Bugs Among Us

Are you a bit slack about washing your hands? You won't be after reading this book on the life and times of the most successful - and deadly - life form on the planet: the lowly germ.

Consider the germs that author and microbiologist Philip Tierno Jr. spots on a sweep of New York City's more elite locales: the bar at a posh Manhattan hotel teems with Strep D, a bacterium found in feces; the shower at a high-priced gym sports germs that cause pneumonia; and flesh-eating bacteria are just waiting to say hello on the handset of a Madison Avenue pay phone.

Fortunately, most people's immune systems are strong enough to fight off these microscopic monsters. But not when it comes to killers like the Ebola virus. Tierno sketches a frightening hypothetical scenario in which a United Nations official returns to New York from Africa unknowingly infected with Ebola. When he collapses in a public restroom, he passes on the deadly virus to two strangers who help him to his feet. One man exits the restroom without washing his hands and soon becomes infected. The other fastidiously cleans his hands and thus washes the virus down the drain.

"What makes this important is the fact that eighty percent of all infectious illnesses, from the common cold to flesh-eating bacteria and lethal viruses like Ebola, are transmitted by touch," writes Tierno, who serves as the director of clinical microbiology and diagnostic immunology at New York University Medical Center and Mt. Sinai Medical Center. "In this light, hand washing emerges as a public-health issue that is every bit as serious as smoking, if not more serious."

He's not exaggerating. Reaching out and touching someone can kill. For instance, as many as 100,000 people a year in the United States die from infections they contract in hospitals. How does this happen? Often it's simply because doctors and nurses fail to properly wash their hands and thus pass on germs from patient to patient, according to Tierno. The annual cost of treating these infections: $4.5 billion. And bugs that may give a resident of Europe a bout of diarrhea can be deadly in developing countries where residents lack access to clean water and are constantly exposed to high concentrations of dangerous microorganisms from inadequate sewage systems. Millions of Third World children still die every year from diarrhea-related illnesses.

You might recognize Tierno's name from his appearances on Oprah and his investigative work for 20/20 and other television programs. A sort of Carl Sagan of inner space, Tierno has a light touch and has written an accessible scientific book that doesn't overwhelm readers with jargon. Instead, he mixes history, science, and anecdotes from everyday life to tell you everything you ever wanted to know about germs but were afraid to ask. It can make for fascinating reading, and Tierno includes practical advice on protecting yourself and your family from germs and the diseases they cause.

The Secret Life of Germs is timely on two fronts: Globalization means that once unknown and geographically remote diseases like Ebola fever are a mere plane ride away from millions of people. Second, the post-September 11 anthrax attacks have brought biological terrorism as close as your mailbox.

But it would be a mistake to think that all germs are the enemy, stresses Tierno, who helped solve the mystery of toxic shock syndrome in the 1980s. In fact, our lives are utterly dependent on germs. Friendly bacteria help digest our food, and others neutralize dangerous germs. Without bacteria to decompose organic matter, every square inch of the Earth would soon be piled sky-high with dead animals and plants, writes Tierno. And though we try mightily to minimize our contact with germs, there's simply no escaping them. Your intestine alone, for example, contains billions and billions of germs. The same is true for your skin, nose, and teeth.

That said, Tierno's tour of a typical germ-infested home is sure to make your skin crawl. Roll out of bed in the morning and your feet hit a carpet chock full of sloughed-off skin cells, fungi, and mites. That's nothing compared to what awaits you in the bathroom. If you flush the toilet without closing the lid, aerosolized fecal matter can fly as far as 20 feet, landing on combs, towels and toothbrushes. The bathroom is a virtual germ hothouse, with bacteria growing on wet bars of soap and sponges. Down in the laundry room, germs can take a ride in the dryer and in all but the hottest washing machine water and emerge none the worse for wear. You can guess what goes on in the kitchen, with all that inviting food offering an endless bacterial smorgasbord.

At home, at least, germs stay more or less all in the family. At the office, however, you're sharing the germs your colleagues leave on phones, computer keyboards, and copy machines. And any parent knows what germ-factories schools can be.

You can't escape germs, but you can minimize the risk of them making you and your family sick. To that end, Tierno offers what he calls a Protective Response Strategy, written in bullet form at the end of relevant chapters. It's commonsense advice -- wash your hands, cover your mouth when you sneeze, and so on -- sometimes taken to an extreme. Following Tierno's strategy no doubt will limit exposure to nasty bugs. But your friends and coworkers might think you've turning into a latter-day Howard Hughes if you adhere to Tierno's public-restroom protocol and use paper towels to turn off the water tap and grip the doorknob when you exit. His detailed instructions for cleaning your anus after a bowel movement are unlikely to be adopted by the masses. Still, with surveys showing that most of don't even bother to wash our hands after using the toilet, or are content to dribble some water on our fingertips, Tierno's message needs to be heard.

Unfortunately, there's not much individuals can do to protect themselves against germs manipulated by humans for evil ends. In an eerie foreshadowing of the bioterrorism incidents that followed September 11 attacks, Tierno imagines a disgruntled government laboratory technician flying a crop-dusting plane toward New York City and releasing a payload of anthrax. (The Secret Life of Germs was published two months after September 11, and although there's a brief mention of the terrorist strikes, the chapter on bioterrorism appears to have been written prior to the anthrax attacks.) Tierno recommends that the public be inoculated against diseases like anthrax and that doctors and other health workers be educated to diagnose and treat diseases likely to be related to a bioterrorism attack.

The chances of dying from bioterrorism, however, are minuscule compared to the risk of contracting a life-threatening infection in, say, your local hospital. The best way to protect yourself is also the simplest. "The bottom line is that clean hands can be the most powerful weapons for health on Earth," Tierno insists.

So now that you are done reading this review and have picked up god knows how many germs from your computer keyboard, go wash your hands!

A Review by Todd Woody
The Secret Life of Germs: Observations and Lessons From a Microbe Hunter
By Philip M. Tierno Jr., PhD

Todd Woody is a former senior editor at The Industry Standard, where he also covered the Internet health care business. His work has appeared in The New York Times, the San Francisco Chronicle, Columbia Journalism Review, and other publications.