What’s up with the Flu this year

H1N1 is a hot topic. It is incorrectly called the Swine Flu, which is a catchier name.

I came to the county hospital at 7 one morning in September, to go over the patients my team of trainee doctors had admitted since I left the midnight before. The internal medicine residents told me about a 25 year old male who had been to the Emergency Department a couple of days before with a cough. He was sent home, appropriately with a cough syrup. He got worse fast and came back very short of breath. His oxygen needs were increasing rapidly. I ordered everyone to put masks on and told him and his younger sister that he may need a machine to breathe for him soon. This was emotionally hard for me to do since I rarely have to say this to such young people. We gave him antibiotics and the flu medicine quickly. He worsened and then eventually died.

I have recently reviewed the public health websites and other information for you and summarize important points below.

297 people have died in California and 5380 have been hospitalized because of H1N1 as of November 12th. Only about 1-3% need to go to the hospital, the rest of them have very minor to moderate symptoms. All who have had this flu are then protected and there is no need to vaccinate them. So he had a 97-99% chance that he wouldn’t worsen. This young man came in quickly as he started to worsen. What could he have done to prevent this terrible end?

This case is an example of this flu hitting young people. This is the first flu to hit less in older and more in younger people. Apart from age, there are other higher risk categories: “asthma, diabetes, suppressed immune systems, heart disease, kidney disease,…” dementia, “…neuromuscular disorders and pregnancy.”

How do you know you have the H1N1 flu? The symptoms can be: “fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.” Many of these can be a sign of other flus or a common cold. It is hard to tell without a test that takes a day or so to come back. There is a quicker test but it can be negative many times when you do have the H1N1.

When can the sick go back into the public and not be a danger? Answer: 5-7 days after the onset of the illness. This can be longer in those with AIDS. It is spread by coughing and sneezing onto people or onto objects (e.g. phone, pen) and then the next person touches the object and then their mouth, nose, or eyes. So cough and sneeze into a tissue and toss it. The next best thing is to cough or sneeze into your sleeve or other handy cloth. Wash or sterilize your hands after this and frequently. A person with a fever should stay home until the fever is gone for 24 hours without the use of pills to lower it. You may be home ill a week.

Other ways to avoid catching it is to avoid touching others, avoid crowds, and washing or sterilizing your hands frequently. Washing your clothes and yourself also kills the germ.

Other factoids: Objects with the virus on it can be infectious for 2-8 hours; there is no evidence that this flu can infect you if your pet has it. You can’t get it from pork.

Some people feel they cannot avoid the H1N1 so they schedule a party with agreeable friends and at least one person who has it, to catch it and get it over with and be protected. This can be dangerous for them and their other contacts since a few of them might have to be hospitalized or die like the young man in our case.

The flu isn’t really what kills you. It infects the lungs in some people so much that it can’t fight off certain bacteria, especially Staph. Staph in this case can be very hard for the doctors to cure. Antibiotics are good, but the body needs to help.

The vaccine has had no problems in 65 million people, so it is safe compared to the H1N1 and you don’t get sick from it. If you are sick with anything after the shot, you were going to be sick without the shot anyway. The vaccine is a good way to prevent this flu.

Vaccines are not 100% effective. Pretend you have a village of people who don’t go outside of the village. For a vaccine that is 80% effective (8 out of 10 are protected) you may be able to vaccinate about 90% of the people so that if a first person with flu entered the village, the chance of transmission to one of the unprotected (those in whom the vaccine didn’t work, and those who didn’t receive the vaccine) is small and for that second person to pass it along to another, the chance is even lower. This stops an epidemic.

There are places in the USA where mainly Anglo, evangelical Christians feel it is unsafe to vaccinate anyone since many diseases are very rare now. These diseases are rare BECAUSE nearly all are vaccinated when they should. With this strategy they are putting in danger those others who did not get vaccinated for good reasons and the few of those who were vaccinated but, unfortunately, are not protected.
Have a healthy and safe holiday season!