Flu? What Me Worry?

by Dr. Ann L. Engelland

(October 26, 2004) As always, a New Yorker cartoon in my mail today captures it best. Roz Chast’s drawing shows three middle-aged folks standing under the caption: “Survivors of Near-Flu Experiences.” The surprised woman says: “I thought I was getting a chill, but, as it turns out, I was just cold!”

When our babysitter went home sick today, wondering if she had the flu, one of my middle-schoolers wondered aloud: ”Why is everyone so worried about the flu?” I would grant that the children of pediatricians are rather smug about mundane illnesses, but it struck me that she had indeed been influenced by the hype surrounding us.

So what is the deal? Do we need to panic that we can’t all get vaccinated, even those of us who fall into high-risk categories?

Some questions and answers:

Is the flu supposed to be worse this year than in years past?

There is no evidence at all to support that. The virus itself is no more potent, dangerous or lethal, and there is no reason to believe so far that there will be more cases than in the recent past. In fact last year’s “flu season” was relatively early and mild. Generally, the flu peaks in January although sporadic (and well publicized) cases are reported to have begun appearing already.

Why were so many people led to believe they should get vaccinated this year when they never got it before?

It’s an ironic and unfortunate coincidence that this year the government, Centers for Disease Control, and the American Academy of Pediatrics all urged clinicians to vaccinate nearly everyone. The thinking was that we had a safe, at least partially effective, and relatively inexpensive vaccine that if given in huge numbers to most of the population would help prevent a widespread epidemic of the flu. That was fine until the supply diminished.

Why do some people feel they must get the shot?

The vaccine is now (and hopefully temporarily) a scarce commodity. It has a new value that few thought of before. For some it seems to be a badge of “depends whom you know” kind of thing. I would say anyone flaunting the “ability” to obtain or luck into procuring a vaccine should keep his or her mouth shut. There will be millions of folks who should have the shot who won’t.

But they say there really is enough vaccine for those who need it.

Experts say that the absolute numbers show enough vaccine in circulation for all at highest risk and those who until recently would have been the only ones for whom it was recommended.

But, hold on. It’s not that simple. Much of the supply has already been delivered. The distribution to those most in need depends at this point on the good will of those providers who have it and their willingness to pass it on. It also depends on the privileged few with resources or connections to forego vaccination so, it is hoped, their doses can be recycled into the distribution stream. This is not difficult to do. When I found myself with fifty extra vaccines, one quick phone call to a busy internist was all it took to rid myself of this moral hot potato.

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 something has to be rationed. We are not used to any sort of altruistic sacrifice. Those who are eligible for the vaccine in this time of scarcity could truly die of the flu. 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.

Is there anything we can do to prevent the flu?

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. Simple.

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. 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.

Although it is possible to make a definitive diagnosis, it does not serve any useful purpose in most patients, other than for epidemiological tracking.

What remedies are recommended?

Unless you are a person who is 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. When it still feels unbearable, most doctors recommend Jewish Penicillin—chicken soup.

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 698-5544.

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