GERM
00:00:09.440 – 00:00:11.360
Ciao. My name is Germ.

WORM
00:00:11.600 – 00:00:12.560
I’m Worm.

GERM
00:00:12.720 – 00:00:27.360
Welcome to episode 106 of the Germ and Worm travel health podcast. World Cup Health. Avoid a red card. 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
00:00:27.910 – 00:00:35.510
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
00:00:36.310 – 00:01:59.640
Everyone, welcome to Germ and Worm.

This is the podcast where we answer listeners questions about how to stay healthy during travel and also how to stay healthy when we host people coming in from overseas. Today we’re talking about the World Cup. Yep. All soccer, all the time. And the health concerns that go with that.

Some of the questions we’ll answer today include, if I’m going to the World cup, what diseases might I catch? How can I reduce the risk of catching infections or other illnesses when I go to see soccer attendees at Mexico? Are there any particular concerns?

If you go to Mexico to watch the World cup there and Poutine and Beaver Tails in Canada, is it health food spoiler alert? No, it’s not, but it’s damn good.

A reminder to our listeners, please contact us with your travel health questions, your stories, or your tips for success, or if you want a clarification on something you’ve heard during a previous episode, we’d love to hear from you. Visit our website, germandworm.com or send us an email, germandworm@gmail.com and before we jump in, we always start with 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.

Okay, Chris, we’re talking about the World Cup. We’re talking about soccer. What’s the deal? Why do people care about this? Tell us a little bit.

A lot of folks listening are already into soccer, but some are not. So why is the World cup such a big deal?

WORM
00:02:00.120 – 00:02:55.360
Well, it’s. It is a big deal.

This is a deep, passionate affair in so many countries around the world, and a lot of people are coming to three North American countries to witness these games in the flesh. Actually, more than 5 million people are anticipated to come to Canada, to the United States, and to Mexico.

And there are 16 host cities overall in these three countries. It’s a big deal. I’m delighted that Seattle is one of them, and I have to Tell you, the mood downtown is really good.

There’s Australians and Americans and people from other countries who are just partying and as far as I can tell, getting on really well together. But there are a few health concerns when this many people get together.

Which takes us to our first question, our first topic, which I will address to you. Paul, within the category of things that are spread by breathing by air, what are some concerns for attendees to World cup games?

GERM
00:02:56.160 – 00:05:58.270
Yeah, so could you catch an infection by breathing the air in one of these stadiums, indoor or outdoor? It’s possible. I think you have so many people moving around from so many different parts of the world. This is how the germs travel with us. Right.

We learned that during COVID This is no exception. Let’s focus on this. So, first of all, there are certain viruses that we worry about.

So any of the respiratory viruses that people could spread to others could be acquired in that way. COVID 19 is the one that’s on everybody’s mind. And although we’re sick and tired of COVID it’s still out there.

There are still new variants or strains of COVID that are around that could be a potential risk. So that’s one thing good news is you can still get a shot that can give you partial protection against Covid. That’s nice.

Number two, the influenza virus, the flu. The flu is still something that is a risk. And we don’t think of flu, do we? In the summertime, at least here in Seattle, it’s bright, it’s sunny.

In fact, we’re just about the longest day of the year here. But that’s still a risk, isn’t it, Chris? Because globally, influenza never goes away.

And in fact, our friends in the global south have winter time that when it’s our global North. So when it’s our summer in the global north. And so there’s still risk, risk of people catching the flu even in our sunshiny Seattle situation.

So the good news is that the countermeasure is still there.

And a seasonal flu shot, even in the summertime, you know, if you missed your flu shot in the fall, it’s not too late, is it, Chris, to go out and get your flu shot? Sounds weird. Get your flu shot to go see soccer. It is something that I would recommend people consider. Then there’s measles, right?

The most catchiest of all the viral infections that we know about. And it unfortunately is something that is prevalent in certain countries. The United States is one of those. We have less and less immunity to measles.

As we’ve learned in hard truth here this last year. But that’s still a small fraction of the proportion of people who are at risk of catching and spreading measles coming from other countries.

So are you at risk of catching measles if you go to one of these games? Yes, you are. You can dramatically, dramatically reduce that risk if you get your measles shot.

And as we’ve talked about on multiple occasions, if you’re not sure whether you’re immune to measles because you can’t remember if you got that shot or if it’s been a very long time.

And for our listeners who are over age 65 in particular, yeah, it’s reasonable to talk to their physician and decide whether they should have a blood test to see if they’re still immune to measles or if there’s any uncertainty. Remember, it’s always safe to get a once in a lifetime booster. Now is the time to do that before you head out to one of these large events.

It’s not that being outside in a soccer stadium is at high risk for all of these infections. It’s just that people are moving around. There’s going to be airports, there’s mass transit. You’re with other people.

It’s not a soccer thing, it’s a people thing. And whether we’re talking about COVID or flu or measles, these are the big three that I think about when it comes to risk of respiratory spread.

Having said so, Chris, there is one more, isn’t there, which is a bacterial infection. That’s meningitis. Would you want to fill us in about meninge and what’s up with that?

WORM
00:05:58.350 – 00:06:49.280
You bet. It’s a nasty bacteria and it causes meningococcal disease, including meningococcal meningitis. The Saudi Arabian government learned this the hard way.

Every year there is a huge religious p pilgrimage in Saudi Arabia, the Hajj. There’s also the umrah.

Millions of Muslims from around the world get together for this pilgrimage and prior to a very good public health rule, which I’ll touch on, there were huge outbreaks of meningococcal meningitis that killed a lot of people. The Saudi Arabian government now has an absolute rule that you may not attend Hajj or Umrah unless you show proof of vaccination.

For meningococcal disease, risk of that is not particularly high, but it has happened before in mass gatherings. And so this might be a vaccine to consider for international travelers and for soccer in particular.

GERM
00:06:49.280 – 00:06:52.920
Let’s Talk about that has, you know, I think the context is a little bit different.

WORM
00:06:52.920 – 00:06:53.200
Right.

GERM
00:06:53.200 – 00:07:28.940
In those contexts, you really have incredible crowding in very hot situations for long periods of time. It’s not totally different from going to see a match at World Cup.

So I, my sense is that the risk of meningococcal infection, that’s bacterial meningitis at World cup events is pro much less than it is in Hodge and umra, but it’s still a thing.

And I think if people haven’t, you know, any question about whether they are at risk of bacterial meningitis or they’re interested in getting immunized for any reason, they should talk with their medical doctor about this. This might be a good catalyst to have those conversations and to consider getting this shot.

WORM
00:07:29.500 – 00:07:57.720
Right. And back to influenza for a minute.

As you mentioned, it’s active during our summer in the southern hemisphere, but near the equator, it’s actually active year round. And there’s no time really, when flu is not a risk, especially when people from all over the world get together in one place.

I’ve read about cruise ship outbreaks of influenza occurring in our summer because there’s either staff or guests from south of the equator or from equatorial areas.

GERM
00:07:58.120 – 00:09:02.880
Yeah, totally, totally agree. And again, we’re talking about vaccines as a countermeasure. I love them because they’re safe, effective and easy, but it does not cover everything.

There’s so many other respiratory infections, especially viral infections, for which we do not have a countermeasure with a vaccine. And that means that, yep, our listeners might in some cases consider wearing a mask.

And I think if you’re going to be totally clear, you’re going to a soccer match, you may not be want to be the guy in a mask. I get that. If you are that guy, by the way, mad respect. And I think that’s, that’s amazing.

And for people with reduced immune systems or who just don’t have time to mess around with these infections. Yeah, you can always mask up. I mean, we learned that in the COVID context for people who are traveling to a match.

You know, honestly, I think the airplane ride, when you’re boarding and getting off the airplane before it’s at cruise, I think that’s probably still the highest risk time for viral infection acquisition.

And so if you’re worried about this and you want to have a great time when you’re going to watch a match, when you’re getting onto the plane, consider masking up.

WORM
00:09:04.800 – 00:09:10.590
Another measure that’ll give you some benefit for respiratory things. As well as GI Things is frequent hand Washington.

GERM
00:09:11.620 – 00:09:25.700
Yeah, that’s true. And it also leads us into our next category, doesn’t it, which is GI Illness. So, Chris, let’s talk about that.

What are the big diarrheal illnesses, foodborne illnesses that you worry about for someone going to watch a soccer match?

WORM
00:09:25.860 – 00:10:12.390
Well, luckily the risk of foodborne illnesses in the U.S. canada is not particularly high, although it’s certainly not zero. The risk is higher of diarrheal illness in Mexico. Jumping ahead to the recommendation, tap water tends to be safe in Canada and the United States.

I would hold off as a rule on drinking it in Mexico and I would use either bottled water or water which has been treated in some way. Some of the illnesses include norovirus, famous from outbreaks on cruise ships in Mexico.

There’s traveler’s diarrhea, usually caused by E. Coli, usually a strain of it called enterotoxigenic E. Coli. And there’s other things too that are more rare, and this would include salmonella shigella, giardia. Risk is not particularly high.

But things that can happen if you have bad luck with food or water.

GERM
00:10:13.030 – 00:11:01.810
Yeah, I think that’s right. So one of the. So I’m a fan of Purell.

I think if you wanted to take an alcohol based hand rub with you to the soccer stadium, great idea, totally good. And just to use that before you eat, after you’re coming out of the toilet, et cetera.

What you said before about norovirus is always the one that gets our attention. It is relatively resistant to the killing power of alcohol. There’s nothing like soap and water. Soap and water supersedes all else.

Again, I am a fan of those alcohol based hand rubs, but periodically getting to the lab and using soap and water is always a good idea. That’s tip number one.

Tip number two, Chris, what if somebody, they really want those nachos, like they want to have some kind of special food that’s coming out of a cart or something like this. How safe is the food itself that you’re going to consume?

WORM
00:11:02.930 – 00:11:08.690
I can’t give one statement that applies to all food. I would eat it. I mean, if you’re going to the.

GERM
00:11:08.690 – 00:12:34.840
Game, you’re going to get hungry. I’m the same. I think that’s right. The point is, look, you’re going to be at risk of catching foodborne illness when you travel.

And that’s true in the FIFA context. It’s true for any particular context.

My sense is that the vendors and the stadiums, these venues, they’re charging you a lot of money to go to these games. They know that if you get sick, it’s going to be bad for business. They’re motivated to do a good job.

The particular stadium may vary from place to place. I would not be at all surprised if we heard about some norovirus spread or some E tech spread.

Not just in Mexico, that could be in the US Or Canada as well. It’s a risk. I think that risk is relatively low.

So to me, for this particular venue, if you’re thinking about getting that, you know, commemorative soccer ball that’s filled with nachos or something, it’s probably totally okay. And the biggest risk is likely to be getting an upset stomach.

I would say if you’re somebody who’s prone to acid reflux or you’re worried about having something spicy so you’re going to block your acid. That is a risk factor, right? Your stomach acid is actually one of your biggest protections against any of these foodborne illnesses.

If you’re on the fence, look, bring some calcium carbonate with you to chew a tums if you get an upset tum. That’s okay, but I would not preventatively, prophylactically block my stomach acid. Stomach acid’s a good thing.

And if you can keep it bubbling up in your cauldron of your gut, let’s. Let’s make that happen.

WORM
00:12:35.320 – 00:13:29.110
Something to consider taking with you if you’re going to Mexico are a couple of drugs, just in case. One is what we call a gut anti motility agent, and that would be loperamide. Sold in the US under the brand name Imodium.

Another one is an antibiot, and one we often use here is azithromycin. So if I was going to see some games in Mexico, I might take some Imodium and azithro in my travel kit and not take it if I feel good.

Basic algorithm, you feel good, don’t take anything at all. Mild diarrhea, Maybe take Imodium or take nothing. Severe diarrhea so bad it keeps you from your activities. You could do both. Both.

The Imodium plus the antibiotic, you can check with your doc on the dose on that. Azithromycin.

Final step, though this is rare, but if you’re sicker than usual with blood in your stool or fever, fever or bad abdominal pain, then don’t take the Imodium, don’t take the loperamide and consider seeing a doc. Because it may not just be simple diarrhea. Maybe something else going on.

GERM
00:13:29.270 – 00:13:44.390
Can we. Can we focus in for a second about blood in the stool.

So some of our listeners may have hemorrhoids and they may be folks who have experience with some bright red blood on the toilet paper periodically. I just want to emphasize that’s different from blood that’s in the stool.

WORM
00:13:44.390 – 00:13:44.790
Right.

GERM
00:13:44.870 – 00:14:35.190
So if you have a low volume diarrhea, fever, cramping, belly pain, and you look in the, in the bowl and it looks like the poop itself is bloody, that’s more concerning to us than if you dabbing away with the toilet paper and you see some bright red blood and you know that you’ve had hemorrhoids before. I raise this because I’ve had a number of patients who’ve experienced hemorrhoids. They can get very nervous about this.

Those are two different syndromes. It’s always the right thing to go see a medical doctor. I mean, that’s what we do for a living. It’s fine.

But we want to empower people to say, look, Chris, I think you’re right. If there is that experience with fever in particular, I would not take the Imodium. Fever to me is let it flow. It’s like that song made by Disney.

Let it flow, let it flow, let it flow. And then you want to get in with a medical provider.

And if you cannot, that would be one of those cases, like you said, where you might consider self starting the oral azithromycin.

WORM
00:14:35.510 – 00:15:04.290
Right. In terms of food selection in Canada, in the US I’m an omnivore.

It’s not risk free, but it’s low risk in Mexico, although there’s not a lot of evidence for benefit from following these guidelines. I would do the usual, boil it, peel it, cook it, or forget it. So I would avoid ice, which doesn’t kill most microorganisms.

I would avoid roadside stands. Lettuce and salads are a few things that I would hold off on.

Although I have to admit, as we’ve discussed, some of that street food really tastes good.

GERM
00:15:04.370 – 00:15:05.330
Yes, it does.

WORM
00:15:06.050 – 00:15:08.290
So every. You have to pick your own comfort point.

GERM
00:15:08.610 – 00:15:43.280
I think that sounds smart. Look, here we are, Chris, in, you know, In June of 2026, there is a catastrophe with Ebola virus disease, Bundabugio in particular.

And so people may be wondering, are they at risk of catching Ebola if they go to one of these matches? And if so, should they get a vaccine for that?

Now, we’ve talked about Ebola just recently in a recent episode, and if you’ve not picked that up, please go back and take A listen, but what’s your hot take for this hot problem with hot fever and catastrophe that’s happening currently in Central and East Africa?

WORM
00:15:43.520 – 00:16:12.880
You know, I just don’t see an intersection between Ebola and the World Cup. I think in general, taking a very macro view, going to the World cup is a safe thing to do in these three countries.

If I was going to start listing the top 50 potential health issues, Ebola would not make that cut. So my thought is get your immunizations, wear a seat belt, wear a condom when appropriate. Ebola, that’s, that really is not an issue.

I think I would be very startled if there was any spread of that at these games.

GERM
00:16:13.200 – 00:17:05.310
I am with you. And the reason we share that opinion is for a couple of reasons.

First of all, although it is a catastrophe for the people living in these communities, the numbers are currently as of late June 2026, the numbers remain small. Number two, there are travel restrictions which I happen to be against generally. I think they’re being done in a ham fisted way.

But that does have this spillover potential benefit. Finally, the way it spreads, this is not an airborne spread, right? It’s through direct contact.

Usually somebody is very ill with severe nausea, vomiting, diarrhea. This is not your E tech E Coli experience.

People are very sick and so they tend to seek care and not to just go to a, you know, to spread it around in a pre clinical way in one of these settings. So I’m with you.

I think if you’re looking for an excuse to skip the World cup, this is not that that I think the ticket expense would be the reason to skip it and not not the concern for Ebola virus disease.

WORM
00:17:11.310 – 00:17:22.990
Right now.

Speaking of other categories of illness, Paul, are people who go to the World cup and engage in World cup behavior at risk for sexually transmitted infections?

GERM
00:17:23.070 – 00:20:37.590
World cup sex at the World Cup? Yeah, no, good question. And yeah, for sure.

I mean this is part of the human experience is that intimate contact between established partners and new partners.

So I’m always interested in helping people reduce their risk of catching a sexually transmitted infection, especially when they’re expanding their sexual network. And we’ve talked about this before. I think World cup is one perfect example of where that opportunity is going to be there.

Make a new partner, have a new romantic relationship, you know, have sex. Including with people who are new to your network. You may not know as much about their status for syphilis, for gonorrhea, for chlamydia, for hiv.

You know, these are new people and you’re having A conversation. I hope you do talk about sexual transmitted infection status with new partners.

But the reality is it can be really difficult to have full confidence in that. So what are the countermeasures you can bring? A moment ago you mentioned condoms.

So condoms can substantially reduce the risk of a whole variety of sexually transmitted infections. Some people choose not to use them and if that’s the case, we can do things that can help to keep those people less at risk as well.

So to reduce your risk of catching HD hiv, for example, there is something called pre exposure prophylaxis that’s called PrEP. PrEP is a technique where we give people an anti HIV medication before they are exposed to HIV during sex, for example.

And if you are curious about HIV prep, now’s a great time to have that conversation with your healthcare provider. Please talk about this. We have options for PREP that include oral medications and also injectable medicines. That’s right.

You get a shot and you’re covered for a period of months to dramatically, dramatically reduce the risk of catching hiv. It’s not in zero, but pretty close to zero. So it’s really exciting times with respect to that technology.

I’m hopeful that everyone will consider talking about pre exposure prophylaxis for HIV. And then what about the other STIs, right. What about gonorrhea, chlamydia, syphilis, the revenge of the sith?

It’s there, it’s around, and these things tend to run in a rough crowd with each other. So we have this nice technology which is number one, condoms, as you said, that can substantially reduce the risk of catching these infectious.

The other is called doxy pep. Doxycycline as post exposure prophylaxis. Put some pep in your step with doxy pep.

So talk to your healthcare provider about whether you might be someone who should have a prescription for doxycycline and that you would take 200 milligrams of doxycycline within. Well, ideally as close to the time as possible after you’re exposed potentially to a new partner.

For people who take 200 milligrams of doxycycline in close sequence after they have sex with a new partner, whether they wear condoms or not. Yes.

This reduces the risk of catching syphilis, chlamydia and gonorrhea, these are bad infections, they’re a hassle and you want to try to reduce that risk as best you can.

Doxycycline as post exposure prophylaxis is not perfect, but it can cut the risk, especially if syphilis and chlamydia can cut that risk by half or more for gonorrhea, it also provides some benefit, although the benefit is a little bit less. Bottom line, please talk with your healthcare provider before you travel about doxy pep and understand that it is not perfect.

And therefore, after you return from a trip, let’s say to World cup, you want to get back with that healthcare provider and consider getting screened for STIs if you’ve had new sex partners.

WORM
00:20:37.990 – 00:20:48.870
And as to the pragmatics of condoms, they are fully legal to take through customs, so you can bring them from home. Also, they’re widely available in all of the cities in which the World cup matches are being held.

GERM
00:20:49.270 – 00:20:56.130
That’s right. And the X ray machine, if you put them through your baggage, the X ray machine won’t punch holes in them.

They’re good to go through the X ray machine and through security.

WORM
00:20:56.290 – 00:20:59.490
And they should be made of latex and.

GERM
00:20:59.650 – 00:21:21.600
Okay, that’s good point. Latex instead of sheepskin. So superior protection for pregnancy, by the way, as well as for STDs.

Chris, what about the idea that someone could go to a soccer match and catch a vector borne infection? Is that a risk? And what do we mean by vector borne infection anyway?

WORM
00:21:21.600 – 00:21:59.610
You bet. Vector born means something like a mosquito or another insect spreads it.

And not so much in Canada in the U.S. but yeah, in Mexico in two of the three cities that the World cup games will be in. There’s some risk of that. So in Mexico, the World cup games are in Mexico City, Guadalajara, Monterey. In Mexico City it’s a pretty high altitude.

There’s not a lot of vector spread diseases there. But at the lower altitudes there’s some dengue fever and some other insect spread things. So using bug repellent would be a really good idea.

Paul, you can talk a little bit about appropriate bug repellent measures.

GERM
00:21:59.690 – 00:23:31.080
I mean the, the bug avoidance measures that we’ve talked about in general for travel. Yes, it still applies here, doesn’t it?

So I think if you’re going to be out and about in one of these hotter, humid, lower altitude settings, especially in Mexico, please consider protecting yourself. So that’s either DEET or Picaridin to your, your exposed skin and and then you could even pre treat your clothes.

You got your favorite jersey, you know, you’re gonna wear some clothing to the game. Spray it, please, with permethrin spray. Permethrin will not harm the colors. I’ve never seen fabric actually damaged by this stuff.

Most of my Outdoor clothing is covered with it, even for here in Seattle. You spray it on, let it dry and then you’re good to go. Even for a number of wash cycles.

It can substantially reduce your chance of getting bitten by a vector. Specifically, the mosquito is what we’re talking about. So that’s an additional thing to do.

If you’re wearing a hat, and I know you will, so you don’t get sunburned, spray the hat too. It’s the exterior surface of your body that you can spray. Any textile or clothing that way too. As for the other question, should it be DEET?

Should it be Picaridin? You can choose either DEET. Up to 55.0percent is the most that I would recommend using.

Beyond that, I’m not sure that it makes a difference and it’s just less pleasant. I personally use picaridin at 20% on my exposed skin because I like the smell, feels better and I think it works quite well.

It’s not as good against tick borne illnesses, but if you’re in a stadium, you’re very unlikely to get bitten by a tick. That’s not a factor. We’re talking about flying bugs, not creepy crawly bugs.

WORM
00:23:35.240 – 00:23:55.100
Paul A lot of people, when they think of the United States, think that we all drive pickup trucks. We all have a big.45 pistol on our hip and people are worried about gun violence.

And indeed our level of gun violence here is higher than a lot of other countries around the world should be. People be concerned about guns and street violence if they’re coming to the United States?

GERM
00:23:55.660 – 00:25:10.240
Well, not if they hang with me because of my big truck and my gun. No, just, just totally kidding there. It is a concern. It’s a concern for those of us who live here and it’s a concern for people who want to travel.

The absolute risk of getting killed or injured by a gun in the United States is very low. It’s unacceptably high. In my opinion, it should be close to zero, if not zero. It’s not. And that’s a whole cultural failure in our country.

But the truth is, if you’re coming to our country to watch soccer, you are almost certainly going to be okay so long as you behave the way you would in any other international context. So we have a perception problem and we have a very real problem. Those two are not, not different from each other.

But the reality is, as we’ve talked about here many times, if you’re sensible and you’re following the usual flow of human interactions with each other, your chance of being Robbed or injured is extremely small. I’m thinking about in particular our city of Seattle, where we’re happy to host, I think, three different games here in Seattle.

I would encourage folks to consider doing that. To me, that risk is small. All but the same countermeasures you would take to keep yourself and your family safe.

That’s as true in the United States as it would be in other countries, including Mexico.

WORM
00:25:10.720 – 00:25:33.770
Yeah, I think that. Personally, I wish that we would imitate with our gun laws some countries that do better, such as Canada or Japan.

But even with our laws which do, as Paul alludes to, allow an unacceptably high rate of gun deaths, the risk to a visitor is minuscule. And I, I wouldn’t avoid the games because of fear of violence. I think the actual risk, as you say, to a particular person is extremely low.

GERM
00:25:33.930 – 00:27:35.190
And to put a finer point on it, you and I recently came out with our own personal recommendation, speaking on behalf of German Worm, that people not visit our country because of government sanctioned violence. We have this thing called Customs and Border Patrol, Immigration and Customs Enforcement, or ice.

These are jack boots, people who in some cases are doing a great job.

But in other cases, there have been very high profile failures, failures of leadership, failures of common sense, human decency, and shootings sanctioned by the government of. The government of innocent civilians. So it’s unacceptable. And for that reason, we had recommended people not come to our country.

Now here we are with the World cup and people are coming in. So how do we handle this? The reality is that, thank goodness, the situation with ICE in our country has reduced in terms of the risk of violence.

There’s a new leader. There’s been some of kind, kind of cultural shift, or at least public policy shift, where they’re killing fewer Americans right now.

Are they still going to hunt you down? If you’re an international visitor, it’s possible.

I think the context of coming in for World cup is just very different from people who are living here in our country, running our economy, taking care of business, raising their families. These are the people who live here who are being run out of the country. It’s outrageous.

For visitors, that chance, I think, is much less now you may get stopped at the border if you don’t have the right documentation. Make sure that your paperwork is what it should be to come to our amazing, and I promise you sincerely, beautiful, warm country.

Once you get past the border guards, you’re probably gonna have a great experience and will not be hassled by international Customs Enforcement concerns. Having said so, please Bring your documents with you all the time.

I want you to have your passport with you so that if you are hassled by somebody, you can say, here’s who I am. I’m here legally. Now leave me the hell alone and let me go drink my slushie in the stands. So I think that’s important to do.

And I just want to acknowledge that, that we are still way behind the curve where we should be as a society for visitors to our country. You are probably currently, in this context, going to be okay. Yee haw.

WORM
00:27:36.150 – 00:27:44.280
Now, Paul, some of the places where the games are being held are potentially going to be hot and humid and sunny. What should people do to deal with those factors?

GERM
00:27:44.360 – 00:29:42.170
These are factors. And I really worry about folks being out in the sun, having a great time, then coming home looking like a Red Lobster.

If they are Caucasian like I am, risk of sunburn. So these are the obvious things that we want you to think about in you mentioned a moment ago Mexico City.

This is higher elevation, one of my favorite cities. It’s such a cool city. I was just there. It’s incredible place. You’re high and so not high on drugs like you’re high in elevation.

And so your risk of getting sunburned at certain elevations is greater than what you may be accustomed to. Maybe you’re somebody from Florida who thinks they know the sun. When you go to higher elevations, you can still burn. So take care of your skin.

That’s about shade, that’s about sunblock as well. What kind of sunblock is best? It’s whatever you’re going to wear. I mean, remember the number that is on that upf, the UV protection factor.

That tells you how quickly you need to reduce reapply. Right, Chris? So the greater the number, theoretically, the longer you can wait. My rule of thumb is that every hour you should reapply.

I mean, if you were reapplying, whatever the number is, if you’re reapplying every hour, you are less likely to get burned. Having said so, if you’re not in the shade with a hat and a long sleeve shirt, that risk is there as well. For altitude.

Can you get sick with altitude illness going to Mexico City? It’s possible, right?

People who fly to Denver, USA or also at risk of this, if you know that you have chronic lung disease or you’ve had trouble with altitude illness before, remember Mexico City is a risk. Come to beautiful Seattle.

Most of these places in Canada as well, where the elevation is less and you’ll be less likely to get into trouble with that.

I do not recommend that people take Diamox when they go into Mexico City in general, although for some small proportion of people it may make may make a difference.

Honestly, to me, the biggest factor for people being comfortable and healthy healthy is that if they know they have sleep apnea, obstructive sleep apnea, bring your CPAP machine with you because if you don’t sleep well when you travel, you’re not gonna have a good time. And that’s especially true at these higher elevations. Anything else you’d say about this? How do people beat the heat and the humidity?

WORM
00:29:42.170 – 00:30:28.450
Chris well, as you say, sunblock is great stuff, but most studies show that people don’t put on enough and they don’t reapply it often enough. Water is a beautiful thing and beer, although though it’s often a traditional World cup drink, is dehydrating, as are all alcoholic beverages.

If you want to feel really good during the game, I would treat your attendance as if you were an athlete, by which I mean wear comfortable clothes, hydrate. A good way to feel fairly crappy during a game is to get bombed the night before and then maybe have a drink or two for breakfast.

And this may put you in a festive mood, but at some point you’re going to get a headache and just feel like hell versus if you get regular sleep and drink water and use sunblock, you’re going to feel more perky for the entire duration of the games.

GERM
00:30:29.170 – 00:30:44.790
It’s very true. Let’s see how many of the listeners out there in German Worm Nation are going to take our advice on alcohol consumption.

Let us know if you think we’re giving you the right advice. Drop us an email. Or if you can’t remember what we’ve said because you’re so blotted out on beer, we’d also love to hear from you.

German wormmailmail.com.

WORM
00:30:52.300 – 00:31:13.030
Now Paul, let’s talk a little bit about an important World cup subtopic, which is junk food. Now, often when I go to a sporting event, I like to eat crappy food and we do pretty well with junk food in the United States.

There’s a lot of dishes that I love and could mention. However, I think Canada in a couple of ways takes it to a whole a whole new level. Could you touch on that?

GERM
00:31:13.030 – 00:31:33.070
Paul I cannot, but I’m going to pitch it back to you. So you had mentioned earlier in the episode that you’re curious about poutine and beaver tails.

Now, to me it sounds like something you would get at A brothel. And then beavers, I thought was a protected species. What the hell are you talking about? And fill us in, please.

WORM
00:31:33.230 – 00:32:26.510
Well, Putin, I love poutine. We don’t have it. For some reason.

It never took off in the United States, but every time I cross over the border and we’re pretty close to Canada here in Seattle, I always get poutine. And I don’t know where it came from. Maybe it’s French, but it is this lovely concoction of French fries, gravy, and cheese curds.

It’s really fatty and junky and salty and satisfying. And if you eat too much, it does not rest lightly on your stomach. You kind of feel this sphere of congealed cholesterol there for some time.

So you wouldn’t want to do it the in every day. But as a treat, I think it’s great stuff. I wish it would take off here. The second thing is beavertail, which is this fried dough, large thing.

Again, it’s the inverse of health food and you shouldn’t eat it every day, but I think it’s just delicious. So if I was going to a World cup game in Canada, I would have at least half a dozen meals of poutine and beavertail.

GERM
00:32:26.670 – 00:32:36.370
And just to emphasize in this context, beavertail is not a beaver tail. We’re not talking about beavers that had their tails chopped off in deep frost. This is made of dough or something like that.

WORM
00:32:36.370 – 00:32:38.290
Right? Right. It’s dough. It’s deep fried dough.

GERM
00:32:38.290 – 00:32:38.970
Okay. Okay.

WORM
00:32:38.970 – 00:32:40.050
Yeah, no meat involved.

GERM
00:32:41.170 – 00:33:21.180
It’s got to be healthy. We’re going vegan, Everyone. That’s a wrap for episode 106 of Germ and Worm for our listeners. We always love to hear from you.

Send us your questions on travel, health, your tips for success, or suggested corrections.

You can get us by email germandwormmail.com or just visit our website, germandworm.com if you’ve enjoyed this episode, please follow us on the socials, give us a good rating and spread the word with friends, family. Those are totally free ways to support this podcast. We hope you join us next week for episode 107, Travel Without Limits During Menopause: A conversation with Dr. Karen Tang. Till next time. I’m Jerm.

WORM
00:33:21.260 – 00:33:23.820
I’m Worm. It’s a big planet. See it in good health.

GERM
00:33:23.820 – 00:33:44.390
We look forward to seeing 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.

Our opinions belong to Dr. Sanford and Dr. Pottinger alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.