Before I discuss the flu, you may notice that I’m changing my column name. Part of it is because many of my friends have given me crap about the name. A lot of it is because I’m on a mission to educate the public about addiction and my previous column name distracts from my mission. Although my column doesn’t represent any entity, I am a full-time physician at Shasta Regional Medical Center, where I’ve worked for 13 years, so I should probably represent the hospital a little more professionally. No, nobody told me to change the name of the column (if they had, I probably would have been stubborn and resisted it). I’d appreciate any suggestions for my column name in the future.
In case you have been living in a bubble and have your news feed turned off, you might want to know that the flu season is in full force. In that case, I’m jealous because I’m tired of being coughed on and I’m tired of the nausea that accompanies reading my news feed every day. Recently the Centers for Disease Control (CDC) declared our influenza season as an epidemic. Usually our influenza season peaks in January or February and this season hit early and hit hard.
First, we need to discuss what influenza actually is. I often hear patients referring to vomiting and diarrhea as “the flu” or the “stomach flu”. Vomiting and diarrhea is often viral gastroenteritis and is caused by viruses completely different from influenza. Influenza rarely causes vomiting and diarrhea in adults. The influenza vaccine and treatment have nothing to do with gastroenteritis (although that was running rampant last month as well). Influenza is usually associated with fever, chills, cough, sore throat, runny or stuffy nose, muscle aches, headaches, and fatigue. Vomiting and diarrhea are more common in children.
Influenza is spread by tiny droplets when people with the flu cough, sneeze, or talk. It can also be transmitted by surfaces that contain these droplets. It is usually contagious from one day before symptoms begin to 5 to 7 days after becoming sick. Most people get sick about 1-4 days after exposure to the virus.
The efficacy of the influenza vaccine varies yearly. This is because those who make the vaccine have to guess what the dominant strains will be prior to the flu hitting the United states. On average the vaccine is over 50% effective but this year was much lower. The fact that influenza tends to hit much harder on years that the vaccine is less effective is testimony to the fact that the vaccine is effective. This year many people have argued that the vaccine was not effective so there is not a reason to get the vaccine. This is just an excuse to argue against the vaccine because we know that the vaccine reduces the burden of disease and saves lives. For those who still think that they can get the flu from the vaccine, it’s not possible. The vaccine is made with antigens or pieces of the virus, it is not actually made from a virus that can cause infection. You get the flu vaccine in the winter when you may happen to get sick from other viruses.
Most people who have influenza can see their local physician or urgent care. Infants, the elderly, and those with significant medical comorbidities may need emergency evaluation and even hospitalization. The treatment for influenza is usually supportive and antibiotics will do nothing for you except give you diarrhea and bacterial resistance unless you have a secondary pneumonia. Unfortunately, many providers still prescribe antibiotics or a “Z-pack” for a viral illness when there is no evidence of a bacterial infection. Antibiotic stewardship is important to prevent resistance so don’t push your medical provider for antibiotics when they aren’t needed. I always appreciate when a patient tells me that they don’t want antibiotics unless they really need them.
Oseltamivir (Tamiflu) is one of the few antiviral medications for influenza. Unfortunately, the effectiveness of this medication is not entirely clear. One of the reasons is that the trials were funded by the manufacturer who then could choose not to publish studies that did not show benefit. The studies that were published showed that the medication decreased the duration of illness by about half a day. A Cochrane review (an independent organization that is generally well respected in the medical community) determined that oseltamivir only provided a slight reduction of symptoms and did not decrease the objective rate of pneumonia nor hospitalization from influenza. The CDC recommends oseltamivir for specific populations – children younger than 2 years, adults 65 or older, people with certain chronic disease, those with immunosuppression, pregnant women or morbidly obese people, and certain other populations. This is based on a theoretical reduction in complications in higher risk populations but this has still not been proven. Antiviral treatment works best when started within 48 hours of symptom onset. Certainly, more severe symptoms should be evaluated by a physician, nurse practitioner, or physician assistant to ensure that you are not having a more serious complication.
It is important not to dismiss the impact of the flu. Although most people who have influenza are just miserable for a week or so, it does kill people. Twenty children in the United States have died from influenza this flu season. The only patient that I had die in the emergency department this month was from complications of influenza. Patients with chronic respiratory diseases or other chronic problems are particularly at risk but we do see otherwise healthy people die from influenza as well.
Treatment of influenza is limited, but prevention is the key. Those who are sick should avoid contact with others when possible and especially avoid those who are at high risk if they get the disease. Good hand washing is very important. Not coughing in the face of your doctor is greatly appreciated. The vaccine is very important for preventing disease as well as preventing the spread. The CDC recommends that all people 6 months of age and older get the flu vaccine, and I agree with that wholeheartedly. You get the vaccine not only to protect yourself, but to protect those around you.
This flu season is far from over. If you are sick with the flu, enjoy a little Netflix, read a good book, but stay out of public if you can. If you are out in public and freely coughing into the air, you may be a sociopath. Or at least inconsiderate. Get the flu shot every year, you may be saving yourself, your family members, or someone around you from dying. Don’t lick random counter tops this flu season because it may have droplets of influenza. While you’re at it, don’t let your infants crawl around on the floor of the emergency department; that grosses me out every time. Don’t ask your doctor for antibiotics unless you really need them because you may not benefit, but you may get some serious diarrhea.
Did I mention not to cough in my face?