GERM
00:00:09.440 – 00:00:12.400
Selamat tengah hari! My name is Germ.

WORM
00:00:12.560 – 00:00:13.360
I’m Worm.

GERM
00:00:13.440 – 00:00:28.350
Welcome to episode 90 of the Germ and Worm Travel Health Podcast. Could you be pepper sprayed? What to do? It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of infectious diseases at the University of Washington in Seattle.

WORM
00:00:28.430 – 00:00:36.430
I’m Dr. Chris Sanford, also known as Worm, Associate professor in the departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:36.670 – 00:01:36.680
Chris, we have great questions from our listeners across the country and around the world. Today we’ll answer a few of them, including international airlines. How can you tell if they’re safe? Traveler’s diarrhea. Any new tips for prevention? What’s up with the CDC’s genomic virus airport surveillance program? And what is Dr. Sanford’s patented continuous triple vigilance program?

A reminder to our listeners, please contact us with your travel health questions, your stories, and your tips for success. We’d love to hear from you.

Visit our website, germandworm.com or send us an email germandworm@gmail.com before we jump in today, our medical disclaimer. This podcast is designed to inform, inspire, and entertain, but you should not use this podcast as clinical care before you travel.

Please see a qualified healthcare professional for recommendations specific to you and your itinerary. Now, Chris, speaking of travel, you just got back from a trip to El Salvador. Now, that’s a nation that I have not visited. I’d love to get some quick takes from you about El Salvador that you’d be willing to share with me and all of our listeners.

WORM
00:01:37.000 – 00:02:01.380
Yeah, I had a lovely time. I had never been there either. And it’s gotten more safe recently. And so I thought, hey, good time to go. Looks interesting. And it was wonderful.

I had good food, the people were nice. I saw a couple Maya sites that I thought were fascinating there.

I didn’t make it to the coast, but I spent a few days in the capital, San Salvador, went up into the mountains and so I planned to go back. I thought it was a lovely place.

GERM
00:02:02.020 – 00:02:17.780
And you had no concerns about safety? I was considering a trip to El Salvador 15 plus years ago, and at that time, actually a few friends discouraged me from going. The context, I think, for social unrest at that time was different. Do you agree?

WORM
00:02:18.420 – 00:02:49.200
Yes. There’s been a crackdown and basically the president put a lot of gang members in jail. And that’s a little controversial.

Some people say that he put too many People in, maybe even some people who were not gang members. But from a safety standpoint, and the people I talk to there, who live there say this is true, it’s markedly safer now.

They can do things like pull out a camera or a cell phone in public and not have it stolen. The murder rate is phenomenally reduced. And I think in terms of tourism, it’s totally a option for people now.

GERM
00:02:49.680 – 00:02:58.860
Okay, now here’s something else I want to ask you about. You have your patented CTV Continuous Triple Vigilance. What is Sanford’s ctv?

WORM
00:02:59.020 – 00:05:04.400
Yeah, I made this up. I just got back from this five week trip, really good trip. Went to the Yucatan Peninsula, all three states there.

So Campeche, Yucatan and Quintana Roo. Went to Belize, then went to El Salvador.

And I noticed, and I’ve noticed this in Asia and Africa as well, that when you walk around in a city, I’ve invented this strategy I called ctv, which stands for Continuous Triple Vigilance. And basically, if you’re tall and I’m tall, I’m not real tall, I’m six foot. But it’s taller than a lot of people who live there.

A as you walk, and this is really more in urban areas, you need to look up because awnings are at my forehead level, metal awnings on sidewalks. And if I look down, especially if I’m wearing a hat that partially blocks my vision, I will wang my forehead on a piece of metal.

And I’ve done that in Latin America and elsewhere and it hurts and I feel stupid, so I look up. However, you can’t continuously look up because the sidewalk is not even, so you have to look down.

So as I walk, I kind of look like I’m really agreeable because I’m nodding up, down, up, down. Because there can be a three foot hole in the sidewalk which you can break your ankle in.

And the third part of this is there’s vehicles, there’s motorcycles, there’s cars, there’s other vehicles that even sometimes come onto the sidewalk. So you have to look up, look down, but especially when you step into the street, look right and look left.

What this is not consistent with is any other activities such as pulling out your cell phone and walking and taking a photo.

I recently helped a woman come back from Madagascar, was walking on a sidewalk, she stepped in a hole, she broke her ankle, it was a mess, ruined the trip, had to be medevaced out. And if she just would have stopped walking before she took the photo, that wouldn’t have happened.

And I think that our lives are not so busy that you don’t have time to stop walking before you shoot a photo. So, ctv, continuous triple vigilance. When you’re walking in a city, look up, look down, and if you take a photo, just stop walking, stop.

Maybe get in the shade where it’s comfortable, take a photo, then start walking again.

GERM
00:05:04.940 – 00:05:16.380
And you’re telling me that I should not just follow my phone when I walk around in a foreign country? Folks, this is a service message and request from your friendly doctor Paul Pottinger. Please look up. I don’t care if you’re in Seattle.

WORM
00:05:16.380 – 00:05:16.820
Or where you are.

GERM
00:05:16.820 – 00:05:33.510
I just see so many people following their phones, wandering like zombies. And especially when you’re overseas, I like the CTV approach because you’re going to see more when you look around. And I think that’s.

That’s a fun thing. I was reminded a moment ago what you said about looking left and right.

And I remember, I think it was Winston Churchill, wasn’t it, who was almost killed.

WORM
00:05:33.590 – 00:05:34.310
New York City.

GERM
00:05:34.710 – 00:05:47.430
Yeah. Back in the day, because he looked one direction where he thought the cars would come from. It’s the wrong way.

So I always look both directions in the US as well as elsewhere, but especially when I’m overseas, please look both ways and then look again. It’s a dangerous situation.

WORM
00:05:47.430 – 00:06:04.930
And an allied topic concerns earbuds, which also takes you out of the present tense, sort of cautious mode. I don’t wear earbuds because you don’t hear the bus, you don’t hear somebody calling out. If you do, just wear one.

But I think it’s safer to listen to music when you’re laying on your bed in your hotel room.

GERM
00:06:05.010 – 00:06:37.630
Yeah, I’m different. I always wear my earbuds, including on noise deadening mode, the silence mode, because I hate loud noises. That’s my thing. It’s dangerous.

And the way I accommodate this is I’m hyper vigilant. I didn’t even know I was following the Sanford protocol. Ctv. I’ve been doing that for years. And I really consider.

Think about someone who is challenged with their sense of hearing. What does that person have to do? They have to rely more on sight. And so I try to put myself in the bucket of the shoes of that kind of a person.

It can be done, but it’s a hazard and people should know that.

WORM
00:06:37.790 – 00:06:46.110
Well, I’ll warn you, Paul, if you have your earbuds in and you’re smacked by somebody on a bicycle and you break your ankle, we’re going to talk about you on the podcast.

GERM
00:06:46.670 – 00:06:48.990
I Look forward to never having that conversation.

WORM
00:06:59.550 – 00:07:11.980
Paul, next question. This is for you. What’s up with these desks? Sometimes when I get off a jet at a US Airport, I’ll see a thing that says, cdc, swab your nose desk. What’s going on with that?

GERM
00:07:12.220 – 00:07:20.540
Well, yeah, I’m glad you asked this. In fact, let’s see. You did just come back from overseas. Did you encounter one of these when you immigrated? And if so, what was that like?

WORM
00:07:20.540 – 00:08:23.060
Yeah, you know, I did.

Just when I came back a couple days ago, I had a layover at Dulles, Washington, D.C. turns out that’s one of the eight airports in the US that do screening. And it was super easy. Real nice people optional, it’s anonymous. And they basically say, hey, where you been? How old are you? Are you feeling okay?

And you swab your own nose and you stick it in a test tube and that’s the end of it. And it’s a really good thing because this is information. They’re doing screening for influenza and Covid and RSV viruses.

And they use this information a to see if something new and bad is coming, but also to help design the flu shot for next year. So I encourage folks to do it. It just takes a few seconds. It’s valuable information.

And reading about this a little bit recently, I that also, the CDC is collecting info from wastewater from jets. So when you do whatever you do in a bathroom, that fluid is scrutinized.

Then they look at the DNA of the viruses or whatever is in your poop or your pee. And that again, helps the CDC know if pathogens are entering the country.

GERM
00:08:23.700 – 00:10:28.090
It’s a brilliant idea. I absolutely love it. And it’s an example of what CDC can do well and do right.

This has been pioneered here, hasn’t it, Chris in Seattle, Washington, by Dr. Helen Chu and her many colleagues. I always. I always refer to this work as the work of Helen Chu because I know her, I helped train her. I’m so proud of her.

She’s an incredible colleague and amazing. But there are many people who’ve been doing this for quite some time. And the concept is, let’s look.

Let’s look and see what viruses are being shed in the nose, for example, of people. And that’s how Seattle became the first place, honestly, to have detected COVID 19 in America because of her work.

And the work of her colleagues who were doing this was originally looked at as something called the Seattle Flu Study, where we would look for. I participated in Seattle flu myself. I had a sense of a cold I got swabbed. Now that information never came back to me. That was de identified.

It was related to doing generalized surveillance. And that’s here again, what’s happening with cdc.

Let’s know what the germs are doing because as we have learned through very hard won experience, let’s honor the sacrifice of those who have served and died before of all these unknown undetected occult infections. Let’s get ahead of them. That’s why I really like this idea.

I think what’s great about it is they’re looking for all kinds of viruses, the ones that we know about in particular, including flu and the coronavirus family. Let’s see what’s happening so that if there is an outbreak, we can actually do something about it. So that’s what I think is great.

What I think is less great about this is the fact that it’s voluntary. I mean, I honestly think we should be doing this for everybody on a much larger scale. That’s not the American way.

People would not want to be swabbed. They’d worry about their DNA getting out of there. Believe me, they’re not looking for human DNA, they’re looking for viruses.

And so I really think this should be expanded. What we can do as responsible citizens who care about our communities and each other, volunteer for this.

If I had come across this, I would have gone through it. In fact, I immigrated back to the US through Seattle. That’s one of the sites where this is. I didn’t come across that desk.

I didn’t have that opportunity. I would have volunteered to do so if I’d had that chance.

WORM
00:10:28.560 – 00:10:31.200
Yeah, it’s a lot of info for a small amount of hassle.

GERM
00:10:31.360 – 00:10:37.960
Correct. And again to emphasize painless, free, harmless, just no risk whatever to the person.

WORM
00:10:37.960 – 00:10:39.600
Anonymous. They didn’t even ask my name.

GERM
00:10:39.600 – 00:11:06.920
It’s anonymous. Exactly right. They’re interested in the virus, not in you. Okay.

Chris, you recently went scuba diving, if I’m not mistaken, on Cay Caulker down in Belize. And I wonder, we’ve talked a number of times about scuba diving and snorkeling and such. Anything you want to share from that experience? Any learned tips for travel, health related to snorkeling or scuba diving?

WORM
00:11:06.920 – 00:12:42.500
Yeah, my wife and I actually was snorkeling and it was off Cay Caulker island off Belize. Lovely trip. Half a day, I think.

There were six or seven of us tourists in the boat and there were these four young women, PA students with us in the boat and just chatting. We had all this downtime and After a while, I said, hey, since you.

Four people have been here for a month doing a rotation, I think their PA School was in New York. What advice. What medical advice would you give to people who were visiting Belize? And they had actually a couple good ideas.

One, they were all renting an apartment together in Belize City, which is probably the highest crime city in Belize. And one thing they said made them feel safe was they travel in a group. They didn’t go out by themselves, especially at night.

So if they went out grocery shopping, all four of them would go shopping at the same time. They said that made them feel better.

They said they did get some unwanted attention from men, especially if, like, one or two would go out without the group of four.

The second thing they said, and actually this was interesting to me, is most of them had cut their feet at one time or another on something, usually around the beach. So, like, they’d be in the water and step on a rock, or they’d be on the sand and step on a stick.

And so they said, actually, it’s not a real manicured beach there, either in the water or on the sand. And so given that they all had something, some kind of abrasion or minor laceration on their feet, wear rubber soles in the water and on the beach.

Beyond that, they said, nothing bad has happened. No one had even traveler’s diarrhea. And they had a lovely time, and they were really glad they were spending a month in Belize.

GERM
00:12:42.980 – 00:13:30.400
Based on this and your other great rave reviews of Belize, I’m excited to go myself. And if I make it to Cay Caulker, yeah, I’m gonna wear sandals into the water. It may not be the style that people are looking for, but I just.

I don’t have time to nurse a wound on my foot, folks. If you do sustain a laceration, a puncture of some kind on your foot, you have to deal with it. There’s so many microorganisms that live in the sea.

They’re usually quite harmless, but once they get inoculated under the sk can cause an infection, and it needs to be dealt with. So wash it out aggressively with soap and water. We’ve talked about.

If it’s that rare, rare circumstance that you’ve stepped on the spine of an urchin that needs to be dealt with. That spine will often come out on its own, but you just need to let it drain. Hot soaks are good for that. Right, Chris?

Try to let things drain and flow. Thank goodness. It sounds like your friends here may not have stepped on an urchin, they would have told you if they had, Right?

WORM
00:13:30.400 – 00:14:46.020
Another thing they didn’t step on was a stingray. But that’s a thing and it’s not rare.

And so what I recommend folks do in places like even Southern California and certainly the Caribbean, is when you’re walking on the sand, do a thing called the stingray shuffle, which means keep your feet on the sand and walk sideways, kind of gently scraping the sand. Because if you walk normally and step on a stingray, they will sting you. And it hurts like hell. You get swelling and redness and misery.

But if you walk kind of sideways and shuffling and there’s a stingray there which you can’t see, you’ll just kind of hit it from the side and that’ll irk it and it’ll move away, but usually it will not sting you. So again, on sand shuffle, your feet, feet don’t walk normally. If there might be a stingray around, love it.

All right, Paul, I’m sorry I have to bring up this next topic, but let me ask you this.

We recently talked about concerns for international travelers to the U.S. in light of the outrageous and illegal behavior by U.S. border Patrol and ICE. We’re not alone. Shorelyn Travax has recently released an alert on this.

Can you talk about that alert and your thoughts on people coming to the US from overseas?

GERM
00:14:46.420 – 00:19:23.260
Yeah, glad to. You know, it’s unpleasant, but it doesn’t mean it’s not important.

So Shoreland Travax is a travel health service which we find to be very helpful, and some of our listeners who happen to be travel medicine people themselves will be familiar with it. And so, you know, we just received this message from them, which was actually published by Shoreland on the 30th of January, 2026.

And it just emphasized that the security situation in the United States is fluid, that UNWRA is likely, and that there are likely to be protests which may pop up spontaneously in response to the unannounced appearance of these goons who show up and do all kinds of illegal and dangerous activity.

With that in mind, the concept is that travelers, or just good old folks who are walking down their own street can get caught up in a protest situation or a violent situation unexpectedly. This is true for a lot of societies around the world. It always has been.

In the US we’re not accustomed to this, so how can we handle this in a way to try to keep ourselves safe so the assholes who are doing this are likely to see any kind of protest as a threat.

And that means that they may come back with a disproportionate, unnecessary show of force, which includes riot gear, acoustic devices, live ammunition and potentially tear gas. So what should you do if you’re a traveler to our country or just walking down the street as a U.S. citizen?

Maintain your level of awareness, do your continuous triple vigilance of Sanford, always carry a fully charged communication device and just pay attention to what’s going on.

If you get swept up in a demonstration, understand, or if you choose to participate in a demonstration which may also be appropriate, honestly just understand that there’s one special threat which is the threat of pepper spray. And we’ve seen this deployed by these Gestapo on a number of occasions.

Pepper spray is an irritant to the respiratory system and the eyes and there’s a real concern about what do I do if I get this stuff in my eyes. I was so encouraged by a really nice recent post on social media.

I will try to link to that in the show notes by one of our colleagues, Dr. Will Flannery. For those who don’t know Will Flannery by that name, he also goes by the name of Dr. Glockenflecken. And so who is he?

He’s an excellent board certified ophthalmologist living in the Portland, Oregon area. I believe he’s got a wonderful presence on social media. You definitely need to follow him.

Even if you give up your following German Worm, you got to follow him because he’s just please don’t give up following us. But you got to follow because he Glauconflaecken is super, super funny. Very soft spot in his heart for people who do family medicine.

That’s what you do. Chris. I think he also likes us ID doctors because he’s got us in some funny situations. So he brings humor to very serious situations.

But sometimes he’ll also break character and just speak directly to the camera. And he did that recently in a post on this exact topic. What to do if you get pepper spray in your eyes?

First of all, don’t get sprayed and understand that that’s a serious situation.

So try to avoid this either by, by being smart, where you put your body in relationship to the ice agents and or protecting your eyes, especially with goggles. This stuff is under high pressure, it’s very caustic and so it tends to overwhelm eye protection.

Just a pair of sunglasses, that’s not going to do it unfortunately. So what Glockenflecken said was first of all, if you do get sprayed, get Away from the spray so you don’t get sprayed again.

Number two, don’t rub your eyes. It’s the most ir, I’m told, the most irritating, annoying sensation. And you will have a natural drive to try to rub your eyes.

That can be dangerous to the cornea, that the cells that line the surface of the eye. So try not to touch your eyes.

Water as a way to flush is good, but because of the fatty nature of this chemical, actually water alone is often not enough. So he recommended, didn’t he, Chris, a dilute baby shampoo, A mixture of water and baby shampoo that you can pour right into your eye.

Now that sounds weird. When I get in the shower, if I put soap in my eyes, it stings. I don’t like it. This is different.

He’s suggesting baby shampoo in particular that is safe for the especially when it’s diluted in water and to have a lot of that that you can self administer. So you’re going to a protest. Bring a pre made bottle of water with some baby shampoo in it and know how to use it.

And know that when you’re there with your buddies that they know how to administer it to each other. At least a liter of soapy water when you go to a protest.

And don’t wear contact lenses when you go to these protests because the lens that just makes it more complicated, that can get stuck to the surface of the eye, that’s a problem. So again, again, great props to Dr. Glaucomflecken and mad props to all of you if you may be considering going to these protests.

We salute you and we want to make sure that you keep your eyes safe.

WORM
00:19:23.820 – 00:19:46.680
It seems surreal to me that we’re having to talk about this now. But given how many people are protesting and the, shall we say, liberal use of tear gas by the authorities, we thought this was appropriate.

So I actually encourage folks to go to these protests. I think their heart is in the right place.

The next one I go to though, in my back pocket of my jeans, I’m going to have a leader bottle with a little bit of baby shampoo in it.

GERM
00:19:53.160 – 00:20:08.280
Chris, along similar lines, let me ask you about the reverse. We’re talking about the concerns for our friends from overseas coming to the United States. What about the opposite?

What if you’re an American citizen and you’re thinking of doing an overseas trip? Is now a good time to be an American overseas or should we just stay home?

WORM
00:20:08.440 – 00:21:26.420
You know, thanks for asking. And, and as I say, I just got back from this long five Week trip, three countries in Latin America, and it was a great time to go abroad.

Nobody gave me any gas, not once, for living in a country with our current politics. Most people avoided it. If I brought it up, often signaling that I was not pro Trump, people would give me sympathy.

They would say, yeah, that must suck. That must be surreal. People kind of didn’t get it. They were puzzled.

And I remember going to this May insight with this nice German man with his family, and after we were chatting a bit, a little more, frankly, he said, well, why do people believe him? Trump so obviously all day says things that aren’t true. Like he says he’ll end a war in one day, and then he doesn’t end the war.

But then people believe him the next time he says something outrageous. And I had no answer for that. I don’t know why that is, but he wasn’t blaming me for it. You know, I was seeming like a reasonable person.

And I think, if anything, it was good to go abroad to make people realize that not everybody is a supporter of our current administration. So I think it’s a great time. People don’t tend to blame you.

Just like when I go to a country with a totalitarian government, I talk to the people, I’m friendly with the people. I don’t blame them. They’re not the government. So I think it’s a great time to go abroad. So that’s my take. Paul, you just got back from a trip.

What’s your two cents?

GERM
00:21:26.420 – 00:22:42.240
I was in Mexico and France recently, and it was a similar experience at both places. I think old friends and new friends, people I was just meeting, they just can’t quite believe it’s happening.

I mean, I think people just can’t, like, what are you people doing? And it’s a great opportunity to remind them, number one, that he was barely elected. Number two, that his approval rates are really low.

Number three, that we’re divided in a way that we haven’t been for more than 100 years. And I think that does bring sympathy in many parts of the world.

I think folks have been living under similar kinds of demagogic fascism for a long time. And so there’s this sense, like, welcome to the club. I just think the whole world is sad about this.

The United States was supposed to be the place where that wasn’t going to happen because it’s a democracy, because we have that gift and the power to make a change. And that’s all true. It’s 100% true. And I just have to remind people that it’s an ugly, messy process. The pendulum has swung way too far one way.

It’ll come back. We’re going to get our society back. I think people get that. But I must say, I’m the same as you.

I always lead with that, making sure people know right out of the gate. I don’t even know what their politics are. I’ll just tell them I hate Donald Trump. I hate these people.

And that helps to open up doors and I think creates a common bond with at least the people I’ve been lucky to meet over overseas.

WORM
00:22:43.600 – 00:22:52.640
Paul, there was a recent New York Times article on traveler’s diarrhea and how to bring the risk down. And I know you’ve read that article. What’d you think of it?

GERM
00:22:52.880 – 00:25:11.410
Yeah, thanks. So what do I think of it? I think there’s some good stuff in there. I think there’s some mistakes in.

There are things that I might have said a little differently. I’m not clear that they talked to an infectious disease doctor. They interviewed some people who are, I think, probably expert in their field.

When the whole story comes together, the perspective and any individual who’s interviewed may be misconstrued or, you know, they may have something that’s correct sentence by sentence, but the overall message may be lost. Look, I’m not telling you not to read this article. If you do, please go ahead. There’s some good stuff in there. It’s common sense. It’s common wisdom.

And I think most of it’s probably incorrect. So the idea here was be careful what you eat, and that if you eat something that’s risky, you could get diarrhea.

And that we should, as we’ve heard before from Centers for Disease Control, either boil it, peel it, cook it, or forget it. And, you know, that’s a nice idea. It makes sense. It just may not be true. Is that not right? Correct, Chris.

I mean, we have people who are very, very choosy, cautious, thoughtful eaters. We have other people who just are adventuresome and they’ll eat whatever they damn well please.

The risk of traveler’s diarrhea is the same in both of those groups. We cannot identify that someone’s ethos or behavior with eating when overseas is related to their risk of catching diarrhea. Shit happens.

It happens to the best of us. It happens in spite of the best of intentions. I’m not telling you to just give up and eat anything that looks nasty on the street.

You need to use your common sense sense. But if there’s something that you want to eat and you’re thinking, God, I didn’t boil it, peel it, or cook it myself.

You could probably still eat that. You’re overseas, you’re trying new cuisine. You got to eat. You got to just be sensible about things.

So, you know, some foods are obviously risky and those can be avoided, but for the majority of cuisine that you go after, I think it’s really hard to tell. I did a culinary tour when I was in Mexico City with a guide whose business is taking people on culinary tours. Oh, my God, it was so.

What a great city, first of all. Second of all, great food. And she took us to holes in the wall that I would have never even known was there.

And if I had been walking, I would have crossed the street to avoid. But the kitchens were meticulous, the food was spectacular, and I would have missed that opportunity.

So that’s one way to thread the needle, which I don’t think I saw in this article. I’m sorry if I missed it. Have a guide who knows the culinary scene, who can get you to places that are reputable and also delicious.

WORM
00:25:11.970 – 00:26:03.570
Yeah. There’s this frustrating paradox within travel medicine, which is that we think we know how travelers diarrhea is transmitted.

And in theory, following the safe food guidelines should bring your risk down. Boiling kills everything.

So if you are safe by the guidelines and avoid lettuce and salads and, you know, only have things that are cooked or packages, your risk should come down.

However, study after study shows the same thing, just as Paul said, which is that cavalier eaters who eat everything have identical rates of traveler’s diarrhea as cautious eaters who have follow all the rules. So, yeah, boiling is good, but no one has shown that actually brings your risk down of diarrhea.

So I think that article, which was published back on January 12, should have admitted that.

Yeah, here’s all the advice, but don’t get too meticulous about it, because the evidence showed, as far as we can tell, there’s no benefit in following it.

GERM
00:26:03.730 – 00:26:23.710
Look, if you travel overseas and you bring a suitcase full of instant ramen and you boil it up and you eat nothing but that, you won’t get diarrhea, and what a terrible idea that would be.

I actually have friends who have done that because they have underlying immunodeficiencies and GI can be done, but that’s probably not why most people would choose to travel internationally. Food is part of the reason to go, and that should be enjoyed.

WORM
00:26:23.710 – 00:26:56.500
You know, I’m going to push back a little on that. I think even if you went with ramen, which I’m not pushing back, that you shouldn’t do it. No, you should not do that.

But I think you could get diarrhea even if you did the ramen thing, because maybe you would touch something, you would take your shoe off, there was poop on your shoe. You touch your mouth as an example. I used to be on a US Federal disaster response team.

We went to Port au Prince Haiti right after the earthquake in 2010 and all we ate was MREs, same as the military. And all we drank was bottled water, zero local food. And in two weeks, 1/3 of us got diarrhea.

GERM
00:26:56.500 – 00:26:57.900
Wow, that’s amazing.

WORM
00:26:58.220 – 00:27:07.340
So it’s not entirely foodborne? I don’t think so. Basically, you might as well eat some good food while you’re there because you’re at risk if you’re gonna leave.

GERM
00:27:07.420 – 00:27:37.180
I think in the context of a natural disaster response, all bets are off. And Chris, I’m going to take the initiative. I’m going to interview you on that topic of the work you’ve done with IMSURT on that concept.

So stay tuned folks, if you want to hear about Dr. Sanford’s good work in difficult situations, we’ll bring that to an upcoming episode. Chris, here’s a question. How can you tell if an airline that you’re booked to fly on is safe?

WORM
00:27:38.620 – 00:29:31.380
Luckily, there’s a lot of stuff online. So first, internationally, almost all of the big airlines are really safe. Tremendously safe, ludicrously safe.

So if you compare traveling by big passenger jet, big commercial, regularly scheduled jet, to any other mode of transport such as car or motorcycle or walking or bicycling or pogo sticking, it’s many orders of magnitude more safe. So big air crashes in big jets are super rare.

There is a data site which is really nice, it’s called International Air Transport association and they have statistics on every airlines in the world.

Naturally, I looked at this recently because in addition to, I think Alaska, which I flew out of Seattle on, I went on some smaller airlines, smaller planes, prop planes in Belize, Tropic Air, and then a bigger one called COPA out of El Salvador. And basically they were all safe.

Couple general rules, the big regularly scheduled ones, you know, if you’re on a 737, it’s probably going to be really safe. The smaller planes may be piloted by a private pilot. Those are less safe, especially in places like Africa. Those have a worse safety record.

But if you want to find out specific info, International Air Transport association me, I don’t worry much about jets. I take security from statistics.

And so even though it seems like you’re up there on a chunk of metal and the thing could plummet, I just know that the big jets don’t crash very often. Now, this was pointed out in a good movie called Rain man, where the character played by Dustin Hoffman noted that Qantas has never had a crash.

And whereas some other airlines, including one that I go on all the time, Alaska, has had a small number of crashes. However, I don’t think you should only go to Australia and fly Qantas. I don’t think the difference is big enough to direct your itinerary.

GERM
00:29:32.570 – 00:30:05.790
I have said it before and I’ll say it again. When it comes to air safety, by far, far the greatest risk to your health is the drive to the airport.

Chris, you know, as we wrap up this episode, I just wanted to reflect for a moment on the death of Dr. Bill Foege. William Foege died in January 2026 at age 89. Interestingly, we both had the opportunity to meet him, even though just briefly.

He’s a hero to both of us. And let me pass it off off to you to have you share any thoughts or admiration you might have for Bill Foege.

WORM
00:30:05.790 – 00:31:15.900
Yeah, he’s one of the most important public health figures of the last hundred years. His real claim to fame is he spearheaded the global eradication of smallpox. This was a disease that’s been around for thousands of years.

It killed tens, if not hundreds of millions of people.

And he wasn’t the only person, but he was one of the main people who basically helped eradicate this thing worldwide, working in Africa and elsewhere. He went on to be head of the CDC. He in the late 70s and early 80s. So he was involved in the early HIV response. Did a lot of good work.

I saw this quotation by him recently in one of the obituaries that I liked.

He was commenting on, shall we say, his disagreement with the current Secretary of Health and Human Services, RFK Jr. And this shows that Bill Foege had his mental smarts about him until the very end. He said that he wished that RFK Jr had gone into cardiac surgery.

Surgery and not become head of CDC, because if he had gone into cardiac surgery, he would only kill people one at a time.

And this is opposed to him being head of CDC, where he is putting out policies that are going to kill thousands or tens of thousands or even more people.

GERM
00:31:16.860 – 00:31:51.340
You know, it’s a great quote. Holy smokes. Brilliant, brilliant guy. Very inspiring and a hero to all of us. If you want to learn more about him, you can look online.

He’s also written a book about his experience, the fight to eradicate smallpox. It’s called House on Fire and it’s excellent and I recommend it to all of you.

Thanks to everyone who helps support Dr. Fahey and anyone who was touched by his amazing work. If you have recollections of him or the smallpox quest in general, hey send us an email germanwormmail.com we would love to hear about that.

WORM
00:31:51.420 – 00:31:53.340
Yeah, I read that book too. It’s really good.

GERM
00:32:08.550 – 00:32:29.920
Everyone, thank you so much for joining us here on episode 90 of Germ and Worm. As always, we welcome your questions on travel health.

Just send us an email germandworm@gmail.com or find us online germanworm.com if you’ve enjoyed episode 90 or any of our other episodes, please subscribe, rate us favorably and spread the word with friends, family and on the socials. I’m Germ.

WORM
00:32:29.920 – 00:32:32.680
I’m Worm. It’s a big planet. See it in good health and we’ll.

GERM
00:32:32.680 – 00:32:52.200
See you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.