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What Is Hand, Foot, And Mouth Disease?
Hand, foot, and mouth disease is a common illness that causes fever, mouth sores, and a rash on the hands and feet. Children under 5 years old are more likely to get hand, foot, and mouth disease (HFMD), especially during the spring, summer, and fall.
A few different viruses cause HFMD, and the illness spreads easily through an infected person's bodily fluids and feces. Most people have mild symptoms that go away after a week, but the illness can be very uncomfortable. In rare cases, usually outside the U.S., people can have neurological complications.
HFMD treatment involves managing and relieving symptoms at home. Typically you have to let the illness run its course, but some over-the-counter medications can help you or your child feel better.
Hand, foot, and mouth disease is named after its two main symptoms: mouth sores and a rash on the hands and feet. Because it's a viral illness, you would likely have flu-like symptoms too.
HFMD symptoms are usually mild and last seven to 10 days, but sometimes adults who get HFMD don't have any symptoms. Depending on how severe your HFMD infection is, you or your child may have the following signs and symptoms.
Flu-like Symptoms and FeverAfter you catch the virus, you can start to develop flu-like symptoms in about three to five days, including:
Mouth sores often appear a day or so after a fever. These look like small, red dots on the tongue, inside the cheeks, or roof of the mouth. These sores can also turn into painful blisters.
Mouth sores and a sore throat can make swallowing, eating, and drinking painful. Some signs your child is experiencing mouth pain from HFMD include:
A rash from HFMD usually appears on the palms of the hands and bottoms of the feet, but you can also get it on your arms, legs, and buttocks. This rash can look like:
Over a dozen enteroviruses, a group of viruses that usually cause mild illness, cause HFMD. In the U.S., coxsackievirus A16 is the most common virus that causes mild HFMD, while coxsackievirus A6 causes more severe illnesses. These viruses spread through infected bodily fluids.
Some ways you or your child may contract HFMD from an infected person include:
People with the virus are typically contagious during the first week of illness. However, sometimes people can still spread HFMD a few days or weeks after they're sick. Researchers have found HFMD viruses can linger in feces six weeks after a person recovers.
Risk FactorsBabies and children under 5 are more at risk of contracting and spreading the virus, especially at daycares and schools. It's rare for adults and older kids to get the illness unless they have a weakened immune system.
The highest risk for HFMD may also be during the summer and fall when the viruses that cause the disease are most active.
A healthcare provider can typically diagnose HFMD with a quick physical examination. They will also consider risk factors like your age and if you are around small children. Given the risk associated with young age, symptoms like a rash on the hands and feet and mouth sores are usually clear signs of HFMD in children.
Sometimes a healthcare provider will swab the throat, mouth sores, or skin sores and complete laboratory testing to detect an HFMD-causing enterovirus. However, laboratory testing for HFMD is rare.
Unfortunately, there's no cure for HFMD. Treatment typically involves relieving uncomfortable symptoms and staying hydrated. Most people recover on their own in seven to 10 days.
Consult a healthcare provider before trying any at-home remedies for symptom relief, especially for young children. Some treatments to manage HFMD symptoms at home may include:
If your child has HFMD, it's especially important to see a healthcare provider if your child:
While rare, HFMD is linked to pregnancy complications. Call your healthcare provider if you're pregnant and think you may have been exposed to HFMD.
Currently, there is no approved vaccine to help prevent HFMD (although there are a few in clinical trials). The best way to avoid HFMD is to help stop the spread of bodily fluids containing the contagious virus.
Here are some ways you can help prevent catching or spreading HFMD:
Dehydration is the biggest concern with HFMD because mouth sores can make drinking painful. However, you can prevent dehydration by drinking enough liquids.
More severe complications from HFMD are rare but can include:
There are a few reports of pregnant people getting HFMD and having complications like stillbirth. However, the connection is unclear. What is known is that HFMD is not usually harmful to a birth parent or baby.
HFMD usually doesn't cause severe or life-threatening illness in children or adults. Most folks will get better in seven to 10 days, and research has shown even people who take up to 21 days to recover don't have complications.
Still, HFMD is often extremely uncomfortable, and it can be tough to watch young children deal with painful sores and rashes. Under your healthcare provider's guidance, your best bet is to stay on top of drinking fluids and administer pain relievers to stay more comfortable.
The good news is that while there isn't a specific treatment or vaccine for HFMD available in the U.S., there are a few different HFMD vaccines and antiviral medications in the clinical trial phase. So we may see a vaccine or HFMD-specific treatment in the future.
With COVID-19 Coronavirus, Here Are 15 Ways To Avoid Shaking Hands
Alexander Dobrindt (L), leader of the CSU parliamentary group, greets German Chancellor Angela ... [+] Merkel (C) in a Buddhist style to avoid a handshake in times of coronavirus as Ralph Brinkhaus (R), parliamentary group leader of the conservative CDU/CSU parliamentary group looks on prior to the start of a parliamentary group meeting in Berlin on March 3, 2020. (Photo by John MACDOUGALL / AFP) (Photo by JOHN MACDOUGALL/AFP via Getty Images)
AFP via Getty ImagesUh oh. Here it comes. The moment that you've been dreading. That person is about to extend his or her hand to shake yours. But all you can think of is: what is on that hand? Is there the flu virus, the rhinovirus, Salmonella, Campylobacter jejuni, Listeria monocytogenes, or Poopus ohmygoodness? Could there even be the COVID-19 coronavirus? Whatever that person is carrying, he or she is about to hand it to you. And you just want to "shake it off," the handshake that is. What do you do?
Yep, the current COVID-19 coronavirus outbreak is a reminder that the handshake is a great way of transferring different microbes like viruses and bacteria from one person to another. After all, while the eyes may be the windows to the soul, the hands are like the shovels, sponges, and pipe cleaners. They touch, dig, rub, and pick at everything on a person's face and body as well as everything around him or her. They can be, in a word, gross. In two words, they can be really gross. That's why Mark Sklansky, MD, Nikhil Nadkarni, and Lynn Ramirez-Avila, MD, MSC from the David Geffen School of Medicine at UCLA went as far as to recommend in a commentary in a June 25, 2014, issue of JAMA that the handshake be banned from healthcare settings.
So it does make sense to avoid shaking hands during the current SARS-CoV2 outbreak. What then can you do instead? Here are 15 possibilities:
15. The ignore.
This is otherwise known as the "leave them hanging" or the "yeah, that's not going to happen." It's not very creative and brings social and political risk. Avoiding any greetings or farewell is not going to make you too many friends or allies.
14. The explanation
This is like number 15 but potentially better socially and politically. At least, you explain why you don't want to shake hands. Be careful with your explanation, though. The words "filthy", "grubby", "nose-picking", and "poop-laden" should not be part of your explanation. Instead, offer a scientific explanation that essentially says, "it's not you, it's them," with them being microbes like SARS-CoV2. This seems to be the tactic used by the German interior minister, Horst Seehofer, when he declined Chancellor Angela Merkel's attempted handshake as seen in this video from The Guardian:
13. The chest bump.
This has the advantage of not touching hands. However, there are risks. First of all, if you don't position yourself well, it may end up being inadvertently "the kiss," which is not a great way to avoid transmitting microbes if either of you are infected and may not be what one or both of you wanted. Even if you do manage to avoid touching faces, it can bring your faces a little too close. Plus, a chest bump doesn't quite work for everyone. Never chest bump anyone without knowing for sure that he or she is OK with it. All in all, this is not a great replacement for a handshake.
12. The fist bump.
This has the advantage of avoiding the fingers and palms of the other person. People don't tend to pick their noses with their knuckles unless they have gigantic nostrils. They also are less likely to touch things with the back of their hands, unless they tend to use unusual flipper motions. A study published in the American Journal of Infection Control found that the fist bump transferred significantly fewer microbes than hand shakes. However, the back of someone's hands can still come into contact with his or her eyes, nose, mouth, and butt, not necessarily simultaneously. For example, the wipe-off-that-snot move can involve the back of the hand. Moreover, the knuckles and back of the hand are still rather close to the fingers and palms, leaving them vulnerable to spillover. It's like living right next to a bar. So if you do the fist bump, you may want to still wash your hands afterwards. Also, don't do the fist bump too vigorously. Otherwise, it becomes "the punch," which may then become "the get yourself fired."
11. The footshake.
This option has made the rounds on social media as evidenced here:
It's relatively new, so doing it may startle the other person. After all, kicking another person doesn't tend to be a sign of respect. Do this only if the other person has a clear idea of what you are trying to do. Also, make sure that you have your shoes tied on or buckled properly. Having a shoe fly into a person's face completely defeats the purpose of a friendly greeting or farewell. This can be another version of "the get yourself fired."
10. The elbow bump.
Touching your eyes, nose, mouth, or butt with your elbows would require an amazing effort. So your elbows may be distant enough from the microbe-carrying and microbe-vulnerable areas of your body. This American Red Cross Gold Country Region video explains why they've replaced shaking hands with elbow bumps:
One potential complication is that the Centers for Disease Control and Prevention (CDC) recommends coughing or sneezing into one's upper sleeve or inner part elbow. That could leave microbes close to and potentially on the elbow. Moreover, the elbow bump may be tougher to do if you are wearing gigantic shoulder pads or a huge cape.
9. The wave.
This option completely avoids contact, as long as you don't wave too wildly and slap the other person in the face. A slap, by the way, is a terrible greeting. Of course, physical contact can help achieve further rapport, so you do lose that with the wave. But you can potentially compensate by simultaneously revealing an embarrassing detail about yourself, if appropriate. For example, you can wave and say, "Hey, I wore my clothes on backwards yesterday." If you are going to wave, make sure you do it appropriately. An overly enthusiastic wave can make people think you are either a Disney World mascot or someone who doesn't get out of the house much. The accompanying facial expression is important too. Grinning excessively while waving can appear creepy.
9a. Jazz hands.
This isn't different enough from the wave to merit its own number. But it is not exactly the same as a wave. For example, doing jazz hands may be quite different from a simple wave if you are delivering a Presidential address or a sermon.
Jazz hands can be quite different from a standard wave.(Photo: Getty)
Getty8. The one-finger point.
This uses one finger and not multiple fingers. A multi-finger point can look like you are trying to cast a spell on the person or obtain a dog treat. Pointing needs to be done carefully and not too aggressively. An aggressive point may seem like you are trying to draw attention to something like a zit. Your facial expression and posture need to be appropriately synchronized too. Do not have an expression that looks surprised, disgusted, or too intense. Also, do not say, "pull my finger."
7. The wink and gun.
These can be combined or done separately. The gun is not a real gun, which again would defeat the purpose of the greeting, but rather forming the shape of a gun with your fingers. A common tactic is to provide a sound effect or phrase while doing these. It may be making a popping sound with your mouth or saying, "right back at ya." If you are going to do either or both, it's important to do them in a way that's not creepy. Do not say, "I likey what I see," unless you are referring to a piece of cake.
6. The thumbs up.
The Fonz, a character from the 1970's sitcom Happy Days, politicians, and astronauts have routinely used this gesture. Be careful, though. There are some parts of the world where this gesture can be rude. Also, make sure the thumb is facing upwards and not downwards.
5. The 'sup head nod.
This is an up and down movement of your head. You can either utter the word "sup" at the same time or have it be implied. Using this greeting makes it easier to use the word "bruh" during the ensuing conversation.
4. The bow.
Japan has clearly been on to something. They've been using bowing as a greeting or a farewell for years now. Before you bow too low, remove any excessive bling from around your neck or pocket change from your shirt pocket that may then drop on to the ground. There are many variations of the bow, including partial bows like the "namaste," which is a slight bow while your hands are pressed together and the "Corona Curtsy," introduced recently by artist and actress Annika Connor. The "Corona Curtsy" has nothing to do with the beer, but instead is a bend of the knees which may be accompanied by a slight bow and one foot stepping backwards.
3. The tip of the hat.
You may think that this requires wearing a hat. But you can pretend that you are wearing a hat and then do a virtual tip. Do not take this make-believe out too far, though. If you continue to pretend that you have an imaginary hat, the other person may start to wonder about you. Also, try not to make the hat too enormous, whether real or imaginary.
2. The shimmy.
This is a dance move in which you hold your body still except for your shoulders, which you alternate back and forth quickly so that you look like a giant sprinkler or something trying to get out of a cocoon. This CBC video shows how to do it:
1. Any other dance move.
The Charleston, the Robot, the Dougie, the Floss, the Carlton, the River Dance, or the dance that John Travolta and Uma Thurman did in the movie Pulp Fiction. All of these could be viable greetings and farewells. Hey, you can even get creative with it and make up a dance. At least, you will be remembered.
Kissing and touching cheeks could also transmit respiratory viruses. (Photo: Getty)
GettyWhat about kissing and touching cheeks as a way of greeting and bidding farewell then? Certainly, touching your faces can be an even more direct way of transmitting respiratory viruses. You may not be able to effectively smear hand sanitizer all over your face or stick your face under a public bathroom faucet after such a greeting has occurred. Even if you could, it may not effectively prevent the virus from getting into your eyes, nose, and mouth. Therefore, consider replacing kissing with the aforementioned handshake alternatives as well.
The SARS-CoV2 undoubtedly will have a number of lasting effects. One of them may be to change the way that people greet and bid farewell to each other. Shaking hands may seem convenient and a good way to establish rapport. But is it really necessary? Wouldn't you rather see people do the Robot to each other?
Nicholas Humphrey's Beautiful Theory Of Mind
One night in 1966, a twenty-three-year-old graduate student named Nicholas Humphrey was working in a darkened psychology lab at the University of Cambridge. An anesthetized monkey sat before him; glowing targets moved across a screen in front of the animal, and Humphrey, using an electrode, recorded the activity of nerve cells in its superior colliculus, an ancient brain area involved in visual processing. The superior colliculus predates the more advanced visual cortex, which enables conscious sight in mammals. Although the monkey was not awake, the cells in its superior colliculus were firing anyway, their activation registering as a series of crackles issuing from a loudspeaker. Humphrey seemed to be listening to the brain cells "seeing." This suggested a startling possibility: some type of vision might be possible without any conscious sensation.
A few months later, Humphrey approached the cage of a monkey named Helen. Her visual cortex had been removed by his supervisor, but her superior colliculus was still intact. He sat beside her, waving and trying to interest her. Within a few hours, she began grasping chunks of apple from his hand. Over the following years, Humphrey worked intensely with Helen. On the advice of a primatologist, he took her for walks on a leash in the village of Madingley, near Cambridge. At first, she collided with objects, and with Humphrey; several times, she fell into a pond. But soon she learned to navigate her surroundings. On walks, Helen would move directly across a field to climb a favorite tree. She would reach for fruit and nuts Humphrey offered her—but only if they were within arm's length, which suggested that she had depth perception. In the lab, she could find peanuts and currants scattered across a floor strewn with obstacles; once, she collected twenty-five currants from an area of fifty square feet in less than a minute. This was not the behavior of an animal without sight.
As Humphrey tried to understand Helen's condition, he recalled an influential distinction, made by the eighteenth-century Scottish philosopher Thomas Reid, between perception and sensation. Perception, Reid wrote, registers information about objects in the external world; sensation is the subjective feeling that accompanies perceptions. Because we encounter sensations and perceptions simultaneously, we conflate them. But there's a difference between perceiving the shape and position of a rose or an ice cube and experiencing redness or coldness. Humphrey suspected that Helen was making use of visual perceptions without having any conscious visual sensations—using her eyes to gather facts about the world without having the experience of seeing. His doctoral supervisor, Larry Weiskrantz, soon made a complementary discovery: he observed a human patient, a partially blind man who was missing half his visual cortex, making consistently accurate guesses about the shape, position, and color of objects in the blind region of his visual field. Weiskrantz named this ability "blindsight."
Blindsight suggested a lot about the workings of the brain. But it also posed fundamental questions about the nature of consciousness. If it's possible to navigate the world using only nonconscious perceptions, then why did humans—and, possibly, other species—evolve to feel such rich and varied sensations? In the nineteenth century, the biologist Thomas Henry Huxley had compared consciousness to the whistle of a train or the chiming of a clock. According to this view, known as epiphenomenalism, consciousness is just a side effect of a system that works without it—it accompanies, but doesn't affect, the flow of neural events. At first glance, blindsight seemed to support this view. As Humphrey asks in a new book, "Sentience: The Invention of Consciousness," "What would be wrong—or insufficient for survival—with deaf hearing, scentless smell, feelingless touch or even painless pain?"
In more than half a dozen books over the past four decades, Humphrey has argued that consciousness isn't just the whistle on the train but part of its engine. In his view, our ability to have conscious experiences shapes our motives and psychology in ways that are evolutionarily advantageous. Sensations motivate us in an obvious way: wounds feel bad, orgasms feel good. But they also make possible a set of sensation-seeking activities—play, exploration, imagination—that have helped us to learn more about ourselves and to thrive. And they make us better social psychologists, because they allow us to grasp the feelings and motives of other people by consulting our own. "The more mysterious and unworldly the qualities of phenomenal consciousness"—the felt sensations of properties such as color, smell, and sound—"the more significant the self," he writes. "And the more significant the self, the greater the value that people will have placed on their own—and others'—lives."
Humphrey quotes the poet Byron, who wrote that "the great object of life is Sensation—to feel that we exist—even though in pain," and he often advances views with an aesthetic quality that reflects his own wide-ranging life. He left Cambridge at the age of thirty-nine to write books, host television shows, travel, and read as widely as possible; he has studied gorillas with the primatologist Dian Fossey and edited the literary journal Granta. Although he later returned to Cambridge and held other prestigious academic positions, his work doesn't fit neatly within a single academic discipline. Humphrey holds a doctorate in psychology, but he is more engaged in philosophical arguments than a traditional psychologist would be; the philosopher Daniel Dennett, who is one of his longtime friends and intellectual sparring partners, told me that some philosophers view Humphrey as an interloper trespassing on their terrain.
More broadly, Humphrey's views on consciousness subtly challenge many current ideas. The startling performance of software programs like ChatGPT has convinced some observers that machine consciousness is imminent; recently, a law in the U.K. Recognized many animals, including crabs and lobsters, as sentient. From Humphrey's point of view, these attitudes are misguided. Artificially intelligent machines are all perception, no sensation; they'll never be sentient so long as they only process information. And animals such as reptiles and insects, which face little evolutionary pressure to develop a grasp of other minds, are also very unlikely to be sentient. If we don't understand what sentience is for, we're likely to see it everywhere. Conversely, once we perceive its practical value, we'll acknowledge its rarity.
After reading "Sentience," I contacted Humphrey. He told me that, after a vacation in the Peloponnese, in Greece, he and his wife, Ayla, a clinical psychologist, would have a free day in Athens, where I live. I suggested that we visit the foothills of Mt. Hymettus, where we could see a cave in which the god Pan and the nymphs were worshipped in antiquity. Some early archeologists have suggested, speculatively, that the cave is the basis for the one that Plato describes in his famous allegory, in which prisoners confuse the flickering, fire-cast shadows on a cavern's walls with reality. (Humphrey has likened consciousness to "a Platonic shadow play performed in an internal theater, to impress the soul.")
Humphrey is a young seventy-nine; when the three of us met, on a warm fall afternoon, he wore khaki pants and a green polo, looking less pink than most British vacationers in Greece. He led me to his and Ayla's rental car, speaking in precise, onrushing sentences about the archeology that he and Ayla had seen in the Peloponnese and the architecture of the buildings around us. His philosopher friends, he told me, were jealous that he would be seeing the cave that might have inspired Plato.
He broke into a broad smile as we reached the car. "I'm quite looking forward to this," he said. Philosophical spelunking would be a new sensation.
Humphrey was born in 1943, in London, into an illustrious family of intellectuals. His father was an immunologist, and his mother a psychoanalyst who worked with Anna Freud; his maternal grandfather, A. V. Hill, had won a Nobel Prize for work on the physiology of muscle contraction, and the economist John Maynard Keynes was a great-uncle. Home was a Scottish baronial mansion with more than two dozen rooms. Humphrey, his four siblings, and their fifteen cousins roamed the neighborhood and played hide-and-seek and other games. In the basement, rooms were cluttered with lathes, microscopes, pumps, engine prototypes, and other scientific equipment with which the children were free to tinker. When a fox was run over by a car outside the house, they took it inside and dissected it. Humphrey remembers with special vividness a day when his physiologist grandfather acquired a sheep's head from a local butcher and taught an anatomy lesson at the kitchen table. The children took turns peering through the eye's lens; Humphrey held it up to see the garden and trees outside inverted.
When Humphrey was eight, he left for boarding school, where the highlight of each year was a dramatic production. He starred in "Richard II" and "Romeo and Juliet" before he was in his teens. He read voraciously and transcribed his favorite passages into a commonplace book, a version of which he still maintains today; he fell in love with the character Natasha, from "War and Peace," inscribing her name in Cyrillic on his pillowcase. Physiology continued to fascinate him. In 1961, when he arrived as an undergraduate at Cambridge, he found his physiology tutor, Giles Brindley, standing shirtless in a salt bath, wearing a helmet from which a metal rod projected against his right eye. Inspired by an experiment that Isaac Newton had conducted on himself in the sixteen-sixties, Brindley was running an electric current through the rod to his retina in order to study phosphenes—the visual sensations produced by pressure on the eyes. Humphrey tried the setup for himself, seeing the phosphenes when the current stimulated his retina. Later, he'd realize that they embodied Reid's distinction between perception and sensation: they were visual sensations that didn't correspond to perceptions about the world.
How do our brains, which are made of the same stuff as everything else, create sensations? No other objects (tables, engines, laptops) have interiority, and, when we look at neurons, nothing that we can observe suggests how they generate it. Some philosophers find consciousness, with its qualitative sensations—the scratchiness of sandpaper, the saltiness of anchovies, the blueness of the sky—hard to reconcile with a standard view of matter. "The existence of consciousness seems to imply that the physical description of the universe, in spite of its richness and explanatory power, is only part of the truth," the philosopher Thomas Nagel has written. Some thinkers have suggested that understanding consciousness may be too difficult for human brains; others have proposed that all matter is conscious to some degree—a position called panpsychism.
Humphrey sees consciousness as wondrous but not intractably mysterious. He has his own theory about how it's generated by the brain, involving feedback loops between its motor and sensory regions—but, however it works, he argues, it must have evolved through natural selection, and this, in turn, means that conscious sensations must be valuable in their own right. In "Sentience," he asks readers to imagine the mind as a library. The texts of the books that it contains are our perceptions, providing relevant information about the world. At some point in evolutionary history, a subclass of books developed illustrations; these helped us to value, experience, and understand the texts in new ways. Sensations vividly represent what our perceptions mean to us. If perceptions make life possible, sensations make it worth living. They have also allowed our species to enter a new landscape of possibility—what Humphrey calls "the soul niche." In this evolutionary niche, we use our sensations to better enjoy and understand ourselves, one another, and the world.
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