Ask a Best Doctor: What’s the Worst Thing I Can Catch on the Subway?

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Kenny Tsang wears a protective face mask while riding the subway in New York, USA, 29 April 2009.
Photo: Daniel Barry/Corbis

What’s the worst thing I could catch on the subway?
The good news is that despite the numerous rats, they won't give you the bubonic plague — there hasn't been a case in New York City since approximately 2002, and that was traced back to New Mexico. But there’s always tuberculosis.

Even that isn't very likely, says Dr. Bruce Polsky, an infectious-disease specialist and chairman of the Department of Medicine at St. Luke's-Roosevelt Hospital, since that potentially deadly bacterial lung infection “has been on the decline in the city and overall.” What’s more, you usually have to hang around someone who’s infected for a long time to catch it. The bug you should really worry about right now is the flu.

“Things during the winter months that are of most concern are respiratory infections that are transmitted from person to person through droplets,” says Dr. Polsky. “Every time someone coughs or sneezes, they generate an aerosol droplet of fluid that can contain infectious microorganisms, particularly viruses like influenza. And the Centers for Disease Control is labeling this a potentially bad flu season in terms of the amount of cases we might expect.” The flu hit early this year, and hard — there have been six deaths nationwide from the flu already this year in children (young kids, pregnant women, and seniors are in the most danger from the flu). As of the week ending December 8, New York was one of the eighteen states reporting “widespread” flu activity.

It would help if more straphangers followed what Dr. Polsky calls “respiratory etiquette” — that is, coughing or sneezing into the crook of your elbow to block the dispersal of germ-filled droplets without contaminating your hands, which you will then rub all over shared objects like subway poles, seats, doors, and stair rails. “Although respiratory viruses are most commonly spread through the air, they can also survive for a number of hours on metal poles (and other hard surfaces),” he explains. “So be aware and don’t touch your eyes or put your hands near your mouth or nose before you wash your hands. Cover your own nose and mouth if someone is coughing, and if you’re ultraconcerned, you can always use a mask.” One of the best defenses, of course, is a flu shot, he says: “It’s not too late to get one. We got it right this year, and the strain of flu that is circulating throughout the community now is one of those that is contained within this year’s vaccine.” (Each year, specialists at the CDC try to predict which specific virus strains will be going around, and they include three of them in the vaccine.) Just head to your doctor or local Duane Reade or Walgreens for your jab as soon as possible, since it can take up to two weeks for you to develop immunity. Another train tactic: Get up and move away if some sniffly jerk is coughing or sneezing near you without covering up — having to stand on the train for twenty minutes may be worth it if it means you can escape being knocked down by the flu.