They Call Him Dr. Germ

As UA microbiologist Charles Gerba cheerily explains, billions of nasty microbes await you every day

"Good hygiene has prevented more disease than every vaccine and antibiotic ever invented. But we've forgotten that lesson. We need to reinvent hygiene in the 21st century." -- Charles Gerba
Many of the best stories in Charles Gerba's professional life have to do with the toilet. He rode to semi-fame as a scientist in part because of his study of a phenomenon known as toilet splatter.

It's not as bad as you think. Oh, no. It's much worse.

We'll get to that peculiar horror before long.

At the moment, Gerba is sitting in his windowless office in a windowless UA building, right behind the Sixth Street parking garage. Scientists once worked inside this brick monstrosity to find defenses against biological warfare, and that makes it a perfect setting for Gerba, an environmental microbiologist.

He tests offices, households and public places for germs that can make us sick, or even kill us. Most people, knowing what he knows about the microbes that await us every day, would collapse in a heap, unable to go on. But Gerba draws energy from that knowledge. It gets him up in the morning. It brings him pleasure.

They call him Dr. Germ.

"A few years ago, a fellow threw up while playing craps in a cruise-ship casino," says Gerba, a grin beginning to spread over his features at what's coming. "He projectile-vomited into a spinning roulette wheel, and it splattered everybody. That made my day."

The story ends, as many of Gerba's stories do, with his voice rising toward the punch line. By the time he delivers it, the words have vanished in a high-pitched laugh that concludes with a cartoon squeak, barely audible through the thicket of his beard.

To understand Gerba's work, picture this scene: A fellow is walking along a city sidewalk when someone drops a sofa from atop a tall building. The walker can't see it or hear it, and unless warned, the sofa

will definitely ruin his day. He's us, you and me--about to grab a door handle, make a cell-phone call or eat a salad.

Off to the side stands another fellow, bald, dressed in throw-on-whatever clothes, looking like a shelf stocker at Safeway, glasses clinging to the lower reaches of his aquiline nose, and his hands are cupped to his mouth as he shouts, "Look out below!"

This is Gerba. You don't look at him and think, "Here we have a serious scientist doing important work." But he is. Except that he obscures it--and at the same time makes his message accessible--behind humor and playfulness.

On this beautiful fall day in his office, as students parade past outside, unaware of the fast-descending sofa, I suggest a game. I'll name a place or thing, and Gerba will give a rapid-fire assessment of its--to use the scientific term--germ-osity.

Not only is he willing to play; he practically rubs his hands together in glee.

Office water-cooler handles: "Where does everybody go when they have a cold or diarrhea? The water cooler. Go there for conversation, not to drink."

Office coffee cups: "Sixty percent have fecal bacteria on them, and the higher you go in the management chain, the worse it is."

Airplanes: "Oh, great places. All those people sharing toilets in a short period. By the time the plane lands, a thin layer of E. coli covers those little bathroom sinks."

Cell phones: "Talk about a germ-collection device. The germs on your hand go onto the phone, and a lot of respiratory viruses are put out when you talk, sneeze or cough. People are talking dirty and don't realize it."

Women's purses: "Never touch the bottom of a woman's purse. One-third have coliform bacteria in them."

Grocery carts: "Let's see. Baby's wearing a diaper, and mom puts the baby in the seat facing her, and the next person comes along and puts broccoli there. Fifty percent of grocery carts have fecal bacteria on them."

Kitchen sponges: "Great places for microbes to live: nice and moist, bacteria cafeterias, soaking up food all the time. The bacteria multiply overnight. In the billions."

Kitchen sinks: "If you're cutting carrots, and one falls into the sink, and you use it again, it has more fecal bacteria on it than if it fell into the toilet."

Public swimming pools: "All I can see is butt cracks. Excuse me; I should be more professional--the gluteal fold. I don't go to public pools anymore, especially if there are children in them. They're basically large toilets."

Cracks about butt-cracks aside, the 63-year-old Gerba has a serious message: Microbes matter. And they matter more and more as the world shrinks. We import half of our food now, a lot of which comes from developing countries with Third World sanitation. We import 23 percent of our fresh fruit, 16 percent of vegetables and 40 percent of tomatoes. Fifty percent of food-borne outbreaks since 1974 involved produce.

The explosion in worldwide travel exposes us to organisms we've never seen before. And new diseases keep emerging, such as bird flu, SARS and others that make our aging population more vulnerable.

"A hundred years ago, many of us lived on farms and went to town once a week," Gerba says. "Now we go to malls, health clubs, football games. Our lifestyles have changed so much, we're sharing more germs with more people than ever before."

Think about the news of late. In July, Phoenix closed its public pools after finding cryptosporidium, a water parasite that causes bad diarrhea. This pathogen wreaks havoc on the immuno-compromised. AIDS patients have a 50 percent chance of dying from it.

In 2005 in Flagstaff, a norovirus outbreak made hundreds sick at Northern Arizona University. A wrestler threw up in a bucket, after which teammates went to a common area to eat, and the spread was on. The virus found its way onto doorknobs, toilet handles, surfaces--everywhere.

Called the curse of the cruise ships, norovirus is highly contagious and causes projectile vomiting in 70 percent of those infected. But what makes it insidious, says Marlene Gaither, environmental health manager for the Coconino County Health Department, is that 30 percent of those infected show no symptoms, yet can still spread the virus. Even after you've been sick, you can shed the virus through feces for up to seven to 10 days.

"We actually had a second mini-outbreak in 2005 because of that," says Gaither, an investigator in the Flagstaff episode. "Someone had recovered, started prepping food, and they were still shedding the virus, and it got onto their hands and spread from there."

In May of this year, a potentially deadly salmonella outbreak, first thought to be caused by tomatoes, began by sickening a few people in New Mexico. By the end of the summer, almost 1,500 people in 43 states were infected, most with diarrhea, fever and abdominal cramps, according to the Centers for Disease Control and Prevention. The culprit turned out to be Mexican peppers, but it took weeks of work by investigative teams to figure that out.

Sometimes Gerba is one of those investigators. In the summer of 2006, he hustled off to California to find the source of an E. coli outbreak in spinach fields around Fresno. It killed three people and sickened 200. Gerba decided wild pigs were to blame: At night, after spinach farmers water their crops, the pigs come along to wallow in the mud; they defecate, and it spreads E. coli on the spinach. But the United States Department of Agriculture concluded the bacteria came from the water sprayed on the crops. No firm conclusion was reached.

Gerba enjoyed his trip anyway. He spent his time with a professional pig hunter. This fellow's job is to kill wild pigs in California state parks around San Francisco. He knocks off 2,000 a year, working stealthily to avoid the wrath of animal-rights activists.

To Gerba, always curious and a man of wide interests, hanging out with the pig assassin was like being in a swine-adventure movie. "He reminded me of an Indiana Jones character," says Gerba. "I was impressed with this guy. He could track a pig a mile away.

"He smelled like a pig, too."

The answer to our new microbe vulnerability, says Gerba, is going back to the future.

Fast history lesson: Up until the late 1800s, few realized that germs caused diseases. Tuberculosis is a good example. It was a killing machine responsible for, as author Nancy Tomes writes in her 1998 book, The Gospel of Germs, as many as 25 percent of all deaths in the first two-thirds of the 19th century.

Most of the medical community then thought tuberculosis was caused by a weakness of the lungs at birth. The real cause is an airborne bacteria expelled when people cough or spit.

Beginning in the 1870s, scientists were able to prove that a number of devastating illnesses--tuberculosis, cholera, diarrhea, typhoid, scarlet fever--were, in fact, caused by microbes. We also began to understand the necessity of keeping sewage away from water supplies, and how to prepare and keep food.

With city populations swelling in the early 20th century, the death rate from communicable diseases peaked. This sparked public-education efforts to let Americans in on what scientists had learned. Groups like the National Tuberculosis Association launched campaigns using moving pictures, health exhibits and even hygiene parades to convey its message. Parade organizers would march elephants down city streets with signs across their backs sloganeering about prevention.

It worked. But the anti-germ crusade lost steam after World War I, and Tomes says it really slowed with the widespread use of antibiotics following World War II. By 1980, infectious diseases had fallen to fifth on the cause-of-death list.

Today, they're back up to third, and Gerba expects they'll top the list again this century as microbes keep evolving, and as treatments for heart disease and cancer, the current top two, keep getting better.

"Good hygiene has prevented more disease than every vaccine and antibiotic ever invented," says Gerba. "But we've forgotten that lesson. We need to reinvent hygiene in the 21st century."

Bring back hygiene parades? Gerba is all for it, and he'd even be willing to lead them. "I'd probably dress as E. coli," he says.

No joke. When it came to choosing a middle name for his first son, Gerba's wife, Peggy, left the task to him. He settled on Escherichia, one of the most common intestinal bacteria. It's the E in E. coli.

The boy became Peter Escherichia Gerba. Today, he teaches English at Tucson's Mountain View High School, and he loves the name. "I won every bet I made in school that my middle name is worse than yours," jokes Peter Gerba. "I'm still undefeated on that one."

Charles Gerba's march into the world of microbes began as a kid in Scottsdale. At 10, he asked his mother for a chemistry set. She messed up and bought him a microscope instead. Not wanting to disappoint her, he started looking at microbes.

But the bigger career spark came as a high school senior, when he read Microbe Hunters, by Paul De Kruif. The 1926 best-seller profiled a number of scientific heroes in the early struggle against infectious diseases. Gerba was thrilled by its tales of men solving microbial outbreaks.

"I love the challenge of tracking something, finding out where it came from," he says. "Every organism is another adventure."

The book inspired him to major in microbiology at Arizona State University. He got his Ph.D. at the University of Miami, and his career accomplishments include writing or co-writing more than 500 journal articles. But one in particular launched him. It was published in 1975 under the title "Microbiological Hazards of Household Toilets."

The idea originated in 1973 when Gerba was a 26-year-old post-doc at Baylor. One of his professors, polio-vaccine pioneer Joe Melnick, burst into Gerba's office one day and pulled him down the hall to the men's room.

He pushed Gerba into a stall and said, "Your future is there, Gerba! In the toilet! Now drop your drawers, and sit down!" When he sat, Melnick flushed the toilet and said, "Do you feel all those droplets on your fanny? That might be a source of microbe transmission. You should study it."

Gerba spent two years seeding toilets with E. coli, stretching gauze over the toilet, flushing and squeezing the gauze to remove the organisms. He measured how much E. coli shot out and how far it went. It turns out flushing launches the bacteria into the air; then it arcs and missiles to earth--and not just back into the toilet. It goes all over, landing on surfaces as far as 3 feet away and onto everything on those surfaces, including hairbrushes and toothbrushes.

The finding proved too gross to ignore. Gerba began taking calls from health officials around the country asking him to give speeches on toilet splatter.

Isn't that always the way? The sexy stuff gets the attention.

In fact, Gerba says, office phones and desks have 400 times more germs than toilets; toilets are frequently cleaned, after all. Also worse than toilets: restroom faucets, kitchen sinks, sponges and dishcloths.

His knowledge of microbe pits has made Gerba a rock star among germophobes. He has been on all of the big network shows--48 Hours, Dateline, Today--and has been featured several times in the National Enquirer, once opposite a story headlined "Alien Graves Found on Moon."

The exposure also has transformed him into a media pro who averages two to four press calls a week, during which he spews out quotes like ... well, you know.

"Somebody once said the whole Earth is covered with poop, and it's just a matter of the thickness," says Gerba. "I'm beginning to believe that."

He has found that 93 percent of shoes worn for at least 90 days have E. coli on them. Ten percent of households' sponges have salmonella. Gerba and his team made that discovery walking door to door and asking people to hand over their sponges. Women usually cooperate.

"But if the guy answers," says Gerba, "he'll go, 'What're you, some kind of pervert?' I say, 'No, I'm a scientist.'"

If Paramount's prop department set out to create a mad scientist's lab, the nondescript room on the fourth floor of the UA's Veterinary Sciences and Microbiology Building would do the trick. It's down a badly lit, grimy hallway. Unidentifiable smells hang in the air. In a different place, you'd ask what those smells are. Here, you hold your breath, grab the door handle next to the biohazard sign and hope your affairs are in order.

Inside, the light is scorching and florescent, the room small and cramped. A countertop holds test tubes and vials of innocuous-looking liquids tended by grad students in white coats.

Sheri Maxwell, Gerba's assistant of 14 years, opens the refrigerator door and grabs a petri dish, one of many on its shelves. She raises it to the light. "These are fecal coliforms from a home carpet," says Maxwell. "Home carpets haven't been tested much, and we're trying to find out what's in them."

This unremarkable lab is on the frontier of efforts at germ prevention. The ideas tested here, and the behavior changes they bring about, might one day achieve wide currency in American life. So, too, may the products tested here.

Right now, Gerba's lab is looking into a vacuum cleaner with an ultraviolet light that its maker claims kills germs as you vacuum. Tests are also underway on something called the Germy Wormy. A woman invented it to reduce the likelihood her daughter would get sick at day care.

In researching how viruses are transmitted, the woman learned it's healthier to sneeze into your elbow than your hand. The Germy Wormy looks like a sock with the end cut off. When a child feels sick, she pulls the Germy Wormy up her arm and sneezes into her covered elbow instead of her bare hand. Gerba's workers are going into day-care centers to sample kids, before and after the Germy Wormy, to learn if it reduces the spread of germs.

For each of these lab workers, constant exposure to microbes has changed how they live. They've replaced germy kitchen sponges with paper towels. They're obsessively careful about what they touch when preparing chicken and ground beef at home. Grad student Jonathan Sexton says, "I've become a poster boy for Clorox disinfectant spray. I use it everywhere at home." Sheri Maxwell even sprays Clorox on her couch and her mattress when washing the bed sheets.

But there's something else going on, a phenomenon akin to the Stockholm syndrome, where hostages begin to identify with their captors. Call this the microbe syndrome. In addition to viewing certain microbes as beasts to be avoided, they become objects of admiration, even beauty. Maxwell's screensaver shows pictures of mold, and as she leans over her monitor, she says, "Aren't these beautiful!? Dr. Gerba thinks I should make T-shirts of them."

Actually, Maxwell wants to start a publishing company to produce coffee-table books. She'll go into your home, swab your hand and mouth, take more swabs in the kitchen and bathroom and elsewhere, then shoot full-color photos of the germs she finds for compilation into a book.

"It'd be like your own personal germ profile," she says. Is the market among, er, microbe lovers big enough?

"Why not?" says Maxwell. "A lot of people already have everything. Remember on Seinfeld when Kramer published a coffee-table book about coffee tables? I think this could work."

But much of our talk on this day revolves around the lab's work on MSRA--methicillin-resistant staphylococcus aureus--an antibiotic-resistant staph infection. It has received a lot of publicity of late, much of it stemming from an article in the Journal of the American Medical Association in October 2007.

The article concluded that the invasive variety of MRSA, which can get into the bloodstream, has become a major public health problem responsible for 18,650 deaths in 2005. If those numbers are correct--and the CDC uses the same figures--MRSA killed more people that year than AIDS and constitutes a greater public-health threat than previously thought.

The JAMA authors stated that 85 percent of all invasive MRSA infections occur in people who have been in hospitals or health-care facilities, and 15 percent were community-associated.

Gerba says hospital hygiene has diminished so much in recent years that hospital-caused infections are now the 10th-leading cause of death in the United States. But CA-MRSA, a separate strain that has moved out of hospitals into the community, is also spreading, mostly by getting on the hands through contact with infected skin, or by touching areas of the body where the bacteria lives, such as the nose. Then the infected person touches a surface and leaves the bacteria there, or it moves from the hands onto a personal item such as a towel, which is then shared.

Gerba says CA-MRSA is reaching near-epidemic proportions in some settings such as prisons and firehouses. In his tests at five Tucson Fire Department firehouses, MRSA was commonplace--on keyboards, pens, couches, remote controls, kitchen counters, classrooms and tools. They also found it on 47 percent of the household hairbrushes and 20 percent of home desks.

While acknowledging that more research needs to be done, Gerba believes the public needs to pay attention to CA-MRSA. He's especially concerned about the elderly and kids active in contact sports who spend a lot of time in locker rooms, where both skin-to-skin contact and the sharing of personal items is more common.

"I've been an expert witness in three likely CA-MRSA cases, and in one of them, the person died," says Gerba. "I know I sure watch for MRSA a lot more. It looks like an insect bite, then you scratch, and it becomes red and can go deep into the tissue. Whole families can get it."

But Dr. Rebecca Sunenshine, a deputy state epidemiologist for the Arizona Department of Health Services, cautions that while CA-MRSA might be common in the environment, that doesn't mean it causes disease, the important link to public health.

"The vast majority of the skin infections won't become serious, and by that, I mean invasive," she says. "They don't get into the blood. Nobody really knows how many people with CA-MRSA get the invasive kind, but one estimate is .3 percent."

She calls MRSA an "important infection" the public needs to be aware of. Infected people shouldn't share soap, towels or razors, and should wash clothes after using them once. If the infection involves pus, see a doctor.

But Sunenshine says the JAMA article sent people with swollen pimples or boils running to doctors, thinking they might die. She emphasizes that the majority of MRSA deaths are health-care related, and most are among elderly patients with contributing medical conditions. "The risk of dying from influenza is much higher than the risk of dying from CA-MRSA," Sunenshine says.

Our game of germ roulette is over. The effort leaves Gerba with an expression of exhilaration.

He loves this stuff.

"Got anymore?" he asks. Actually, yes: With cold and flu season here, what's the best way to stay healthy? Answer: Tame the germ monsters otherwise known as your kids.

"They're the best friends germs ever had," says Gerba. "Kids under 2 touch their hands to their faces 30 to 40 times per hour, and college students 18 times per hour."

The influenza and flu viruses are opportunistic. They land on surfaces, then get onto hands, then into your eyes or nose. The solution is frequent hand-washing, and to make sure kids do the same after school. It can reduce by 30 percent your chance of getting sick.

But Gerba's ultimate dream is a future in which we get the upper hand over microbes. One intriguing idea is to make more products out of silver and copper, which are anti-microbial metals.

"All life is negatively charged," says Gerba. "My dream is to make surfaces positively charged so that when microbes land there, they die and can't come off and spread. There are companies working on products like that, and we're studying them."

Pause. Drum riff. Squeak, squeak. "It's a fantasy I have while sitting on the toilet," he says.

Back to the commode again. Gerba spins in his chair and brings up on his computer a time-lapse photo that beautifully captures the phenomenon of toilet splatter. It shows dozens of droplets exploding from a bowl, then arching like fireworks on descent.

Gerba stares admiringly. "It looks like the Fourth of July," he says.

Or a hundred falling sofas.