Soldiers in boot camp are getting something new this year besides rigorous basic training - Army-green bottles of hand sanitizer gel, part of a stepped-up effort by the military to ward off H1N1 and seasonal flu.
Soldiers at the Army's largest training installation and at other boot camps are also getting orders barked by their drill sergeants to use alcohol wipes and cough into their sleeves.
It's all part of an effort that intensified when the new H1N1 flu spread this year to avoid repeating history. The 1918 global flu pandemic hit hard at big training camps like Fort Jackson, where hundreds of soldiers died and thousands became ill.
Army recruits enter basic training from around the nation and the world, so medical officials say they must drill hygiene basics into each and every soldier to keep them healthy amid the stresses and strains of combat training.
"We use this over and over, everyday," said Spec. Arielle Schiltz, 20, of Detroit, Mich., showing how the small vial of hand gel she was issued fits in a shoulder pocket. "You just rub it in. After the latrine, before eating, after eating. It could be 15 to 20 times a day."
Staff Sgt. Anthony Elmore, 37, in charge of Schiltz's unit, said such instruction can't be repeated enough for the estimated 50,000 soldiers who stream annually through Fort Jackson's training units.
"We have to work and talk, work and talk," said Elmore, of Greenwood. "We want to make sure that these soldiers know how to follow proper hygiene, so they won't get sick."
During the 1918 flu pandemic, Camp Jackson, as it was known at the time, had more than 60,000 soldiers in training, according to Dale Smith, the historian for the military's medical school known as the Uniformed Services University of the Health Sciences in Bethesda, Md.
Exact numbers are hard to come by, but estimates are that about 25 percent of those at the installation got the flu, and of the afflicted about 18 to 20 percent died, Smith said.
Many who became ill recovered, "but it still killed a lot of people," Smith said.
Besides rolling up their sleeves to get mandatory vaccinations, the instruction doled out by the military could help anyone keep healthy in a crowded, stressed work place: Keep six feet away from those coughing or sneezing; cough into your sleeve; don't use other people's telephones or computer keyboards, wash your hands often and use hand sanitizer.
Military guidance also includes using larger meeting rooms, using workspace cubicles in offices instead of open places - and even putting bunkmates in head-to-toe configurations when beds are stacked. Stalls with alcohol wipes and gel, masks and instructive posters line the walls of barracks, rest rooms and training areas.
While some anti-flu steps were included in health training in the past, the training and the use of the hand sanitizers were stepped up last spring to battle both the regular flu and the H1N1 virus, said Nichole Riley, public affairs officer for Fort Jackson's Moncrief Army Community Hospital on Fort Jackson. The steps appear to be working, she said.
"We've seen a tremendous decrease in the number of flulike illnesses coming into our urgent care center," Riley said.
In April, the installation logged a high of 187 confirmed cases of the H1N1 flu virus, and now about only 30 cases are being dealt with, she said. Exact numbers are no longer being tallied.
"Using the hand sanitizers, the social distancing, making flu-prevention classes available. It seems to be working," Riley said.
Keeping illnesses at bay among military recruits is particularly challenging.
"Recruits have always been a population we've watched very closely, because historically they've always been at higher risk for respiratory disease," said Lt. Col. Steven Cersovsky, the director of epidemiology and disease surveillance for the Army Public Health Command in Aberdeen, Md.
With the flu season under way, extra attention must be paid to keeping healthy, Cersovsky said.
Soldiers are required to keep their barracks clean, wash or shower daily if training permits, and if water is not available, the small green hand gel containers are issued to each trainee, said Harvey Perritt, spokesman for the U.S. Army Training and Doctrine Command in Fort Monroe., Va.
The command oversees training and schools for 434,400 Army soldiers and 35,000 men and women from other services at 33 schools on 16 Army posts every year, said Perritt. Other basic training sites include Fort Leonard Wood in Missouri; Fort Sill in Oklahoma, Fort Benning, Georgia and Fort Knox in Kentucky.
The Pentagon said there were roughly 2,900 confirmed cases of the H1N1 flu among active duty forces during the outbreak last spring from the end of April until the services stopped counting at the end of July.
No deaths due to the H1N1 virus have been reported in the armed forces, said Department of Defense spokeswoman Air Force Lt. Col. Rene White.
Instructions like those being drilled into soldiers at Fort Jackson have been issued by the medical staffs of all the service branches.
John Conyor, a Department of the Army civilian employee at Fort Jackson in charge of safety programs, says several checkpoints keep those who might be ill from even entering basic training.
Military prospects get medical examinations before entering the military and again upon re-entry to ascertain if they are feverish or ill. If a soldier in training appears to have the flu, they are sent to a sick quarters, and isolated until they recover, Conyor said.
Both Smith and Conyor said great strides in treatment have been made since the 1918 outbreak, such as the use of antibiotics and respirators.
"We didn't have them in 1918. Most people didn't die of the flu but from a secondary attack of pneumonia," Conyor said. "We are on top of what's going on. ... We're ready for whatever happens."