What do we know? What don’t we know yet?
Even for those of us on the front lines (as a private practioner and as the physician for the Mamaroneck schools), this flu is confusing and potentially worrisome. I say “potentially” because we don’t know enough yet about this particular virus.
Influenza virus is notoriously wily, able to mutate faster than we can produce an annual vaccine and clever enough to pass from species to species (in this case, swine to humans). And with international travel and porous borders we do not know where it will appear next. We do know that it will continue to spread. This is why it is being called a “pandemic” – it will likely show up all over the globe. But just how serious (or virulent) is this flu?
We know that this virus appears to have been more serious in Mexico where it seems to have originated, but as of the time of this writing, only one death has been reported in the United States due to swine flu. It is not clear why the death toll in Mexico is higher so far. A reminder: there have always been deaths from even run of the mill or seasonal, flu. That’s why a vaccine was developed and we have encouraged especially at-risk people to get it.
And consider this: malaria, HIV, and diarrhea kill more people every minute than are likely to die in this epidemic. According to the World Health Organiation, developing countries will bear the brunt of the mortality and suffering from this swine flu.
But knowing all this doesn’t stop people from worrying, so what should doctors and patients do?
Tamiflu Is not for everyone.
That doesn’t stop people in Larchmont and Mamaroneck from worrying. Yesterday a patient with three grown children called to ask about my “policies” on the swine flu. She had learned from her pharmacist that he had no more Tamiflu (the recommended medication for this strain of flu). She rightly assumed that doctors must be prescribing it and did not want her family to be left out.
Soon after, I heard of a parent whose young children were prescribed Tamiflu because they had been in the same room with someone just back from Mexico who was running a fever and was later treated by a physician for the flu. There was not evidence yet that the traveler actually had swine flu.
Let us be clear: There is no current recommendation to treat anyone preventatively ( say following exposure to someone with a fever) for the flu. In fact, dispensing treatment unnecessarily would be medically irresponsible and probably unethical.
How so? We have learned over the past 50 years that injudicious use of antibiotics will invariably cause microbes to develop resistance. In order to prevent complications in vulnerable individuals and to help slow down the spread of the virus, some physicians may elect to treat the disease with anti-viral medications, but they should not use the medication before any symptoms arise or tests have been examined.
At this point, public health experts are encouraging judicious use of the medications. Remember, this is a wily critter and will quickly develop resistance to any drugs we put into its environment (i.e., ourselves!). When micro-organisms mutate and develop resistance, we have problems like MRSA to contend with.
What about those who rationalize that the flu would wipe them out for ten days and they have important jobs to do?
This is a rare time in our lives when a scarcity – of Tamiflu, in this case – may require rationing. We are not used to any sort of altruistic sacrifice. While evidence suggests this flu may be no worse than your typical yearly flu, the truly vulnerable are at risk of death. It is much more than an inconvenience for them.
Picture the child with severe asthma or cystic fibrosis. Picture the elderly man on an oxygen tank with emphysema. Picture the woman whose immune system is suppressed and is recovering from breast cancer. They could require hospitalization or artificial ventilation just to survive the flu, even with drugs.
Is there a vaccine for the swine flu?
There is no evidence that the 2009-10 flu vaccine is effective against swine flu. And there is not likely to be a new swine flu vaccine for many months at a minimum. The World Health Organization is encouraging accelerated development of the vaccine.
What is the best way to prevent flu and stay healthy?
First of all, we all need to practice good nutrition, exercise and hygiene habits in order to minimize our exposure to virus and maximize our immune response. Good hand washing before eating is a simple and effective way to prevent all viruses transmitted in the same manner as the flu, including the common cold. It sounds basic, but we often neglect this important habit and need to remind our kids to wash when they come home, before eating and after using the bathroom.
Re-learn how to sneeze! A proper sneeze lands on your bent elbow. Not only does it prevent you from spreading the germs with your hands or tissues, but it prevents the “aerosolization” of the virus into the air. You’ve seen the backlit sneeze on television ads! Don’t do that!
What are the symptoms of the flu? How do I know if I really have it?
The flu typically begins with fever, upper respiratory symptoms, runny nose, cough, aches all over, and general malaise. Some may have vomiting and diarrhea (not to be confused with Montezuma’s Revenge, a frequent memento of a trip to Mexico). People generally want to go to bed, be pampered, and rest. Most often the symptoms worsen over 2 to 3 days then begin to abate. If the symptoms worsen after 4 to 5 days, a secondary infection like pneumonia or sinusitis may have set in and may require an antibiotic.
If your symptoms are classic and you have been exposed to a known case of the swine flu or have returned from a place with a known outbreak, a test can be done in a lab for swine flu.
What remedies are recommended?
Unless you are at risk of severe lung disease, wheezing, or pneumonia from the flu, chances are that time-tested remedies like rest, fluids, painkillers and Ibuprofen (Advil family) or Acetaminophen (Tylenol family) will help most. Unless symptoms are severe or there are underlying health problems, it is best to stay home. Most doctors still recommend Jewish penicillin – chicken soup.