View source for Illness on the Water

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Illness on the river occurs. It can be a simple as a common cold, or a more nasty and highly contagious disease such as Norwalk Virus. Norwalk is a bad one. This highly contagious intestinal virus can easily spread though your trip, and from river trip to river trip. There are two things to keep in mind here:

How to stabilize sick trip participants, and How to keep Norwalk like virus from spreading on your trip.

'''1) How to stabilize sick trip participants:'''

The goal of treatment is to prevent dehydration by making sure the body has enough water and fluids. Fluids and electrolytes (salt and minerals) that are lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

Older children and adults can drink sports beverages such as Gatorade, but these should not be used for younger children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.

Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don't replace lost minerals.

Drink small amounts of fluid (2-4 oz.) every 30-60 minutes. Do not try to force large amounts of fluid at one time, which can cause vomiting. Use a teaspoon for small child.

Food may be offered often in small amounts. Suggested foods include:

Cereals, bread, potatoes, lean meats

Plain yogurt, bananas, fresh apples

Vegetables

People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children. This will require a medical evacuation. 

Antibiotics do not work for viruses.

Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your health care provider. DO NOT give these anti-diarrheal medications to children unless directed to do so by a health care provider.

People taking water pills (diuretics) who develop diarrhea may be told by their health care provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your health care provider.

The risk of dehydration is greatest in infants and young children. 

Source: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001298/ National Institute of Health]


'''2) How to keep Norwalk like virus from spreading on your trip.'''


In 2012, Grand Canyon National Park provided this information on how to keep Norwalk like virus from spreading on your trip:

'''BACKGROUND:'''  Norovirus is a very contagious virus that infects over 20 million people in the US every year. You can get norovirus from an infected person, contaminated food and water, or by touching contaminated surfaces.  Norovirus causes sudden-onset vomiting and diarrhea that lasts about 24-48 hours. On rafts and in camps, norovirus can spread quickly. The best way to prevent norovirus is to practice proper hand washing and general cleanliness.
Each season, there are multiple river trips that are affected by norovirus.  So far in 2012, the number of infected trips is about average.  Large outbreaks of norovirus can be prevented if you do the following:

'''BEFORE AN OUTBREAK:''' Trip participants may bring norovirus from home or from their travels. Many people who carry norovirus do not have symptoms. You may not be able to prevent the first case of norovirus on your trip, but you can prevent its spread by practicing good health habits from day one.    
Handwashing: Explain and enforce good handwashing habits in your group.  Use hand sanitizer post-wash.

'''Food Handling:''' Use hand sanitizer on the boat before sharing snacks. If you are sharing something from a common bag or box (e.g. trail mix), have everyone pour the contents into their hands, rather than reaching into the bag/box.  At meals, encourage everyone to wash their hands before eating.

'''Drinking water:''' Make sure no one touches the nozzle of water dispensers. Wipe the nozzle with bleach solution twice a day. If you are filtering water from the river, remember that norovirus is tiny and can pass through filters. Treat drinking water (2-5 drops of bleach per gallon of water) and set aside for at least 30 minutes before using.

'''Setting up camp:''' When you enter a camp, observe whether it appears to have been occupied by ill people recently. Cat-holes, vomit, etc., may indicate a sick trip before you. Be careful about where you set up your tents, toilets, chairs, and kitchen. Avoid setting up sleeping camps in questionable areas. Assume that norovirus contamination may be present at all beaches and take appropriate precautions.

'''Toilets:''' When setting up at taking down the trip Groover, keep these simple precautions in mind:
  
1) Wear eye protection (e.g. sunglasses) and two pairs of disposable gloves. Before putting on gloves squirt a small dollop of hand soap on the back of one of your hands for hand washing afterwards

2) Don’t use toilet brushes. They carry contamination. Use disposable paper towels (see below).

3) Keep bleach solution in the toilet kit to disinfect the toilet seat, toilet box, and handles. Don’t use the same bottle for your dish-wash/potable water – have a separate bleach bottle for toilets.  

4) After you properly store the toilet seat in a separate plastic bag in the toilet kit and place the toilet lid back on the toilet, remove and discard the outer pair of disposable gloves. 

5) Wipe down the hand soap, toilet “key”, toilet paper container, etc. with the bleach solution, using a disposable paper towel. 

6) Lastly, take off your gloves, and use the dollop of soap on the back of your hand to wash hands thoroughly at the hand wash station followed by a hand sanitizer.   

For additional information on Norovirus, see this [https://rrfw.org/RGCwiki/images/5/58/Avoiding_Norovirus_on_a_Grand_Canyon_River_Trip_2nd_Edition_5.2022sm.pdf handout] by river runner Marc Hunt.


'''IN THE EVENT OF ILLNESS'''

'''Supplies:'''  If someone is sick, make a bleach solution (5-25 tablespoons per gallon of water) each day. Do not use this for food surfaces or hand-washing. It is for cleaning contaminated non-food surfaces only. 
 
'''“Spill” clean-up:''' Try to avoid putting vomit or feces in the river. Don’t leave vomit or feces on a beach, and don’t bury it.  Put it in a toilet or trash container. If you use a trash container, use extra trash bags to close and seal the vomit away. If you use a toilet, reserve that toilet for sick people only.  
If you don’t have room to carry all the vomit or feces with you on the rest of the trip, scoop it into a five-gallon bucket, and saturate it with the bleach solution as specified above. After 15-20 minutes, throw it into the main current of the river and rinse the bucket with the bleach solution.    (Try to limit any damage to resources during clean-up, especially if you’re near an archeological site.)

'''Isolate ill individuals and gear:'''   Have ill people sit on the same boat. Wash the boat and other potentially contaminated equipment frequently with the bleach solution. If clothing is soiled with vomit or feces, store it in a dry, labeled bag. Paco pads, tents, etc. must stay with the people who were sick for the rest of the trip. Have sick people stay in the same area of camp, if possible.  

'''Toilets:''' Consider taking extra disposable toilet bags (“wag bags”) to provide for participants to use in camp or in case of sudden emergency. If you have day-tripper ammo cans, consider creating an additional one (or two) for sick participants. Also:

1) Set up a “sick” toilet and hand-washing area for those who are ill or recovering 

2) If feces or vomit are on the toilet seat or on the outside of the toilet box, clean with a bleach wipe, discard it in the toilet, and then rinse the surface with the bleach solution. Wipe with a disposable paper towel and dispose in toilet.

3) Never wash off fecal material in the river or side tributaries. Get it into a toilet.  

'''Food preparation:''' If you have an ill participant, enhance food prep safety.  Make every effort to have only people who have not been sick in the previous two weeks prepare food.  Wash your hands more frequently followed by a hand sanitizer. Wear non-latex disposable gloves.  Have someone who does not have symptoms serve all food so only one person touches serving utensils. Serve sick people separately.   Do not save unused food. Wipe down the outsides of condiment containers with a weak bleach solution (1-2 teaspoons of bleach per gallon of water).   

'''Reporting:'''  Please report any trip with gastrointestinal illness to the National Park Service after the trip, using the form in your private trip regulations, http://www.nps.gov/grca/planyourvisit/overview-lees-ferry-diamond-ck.htm.  Reporting will help the National Park Service learn more about norovirus and how to prevent it for future river runners.  If you rented gear from a private trip outfitter, tell them that you had illness on the trip so they can take extra care in cleaning your returned gear. 
 
After the trip: The National Park Service may ask you to hold your toilets for testing at the end of the trip. Sanitize all equipment using the bleach solution or hot water > 140 degrees.  Launder sleeping bags and other soft goods in hot water and hot dry. Don’t forget to clean all items that have hard surfaces, such as the ammo can that holds your library.


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