Greenie’s Grumbling: The Flu and You

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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?

Greg Greenberg
Greg Greenberg grew up in Santa Monica, California. After undergraduate training at UCLA he attended medical school at Ohio State University and completed a residency in family medicine in Columbus, Ohio. He moved to Redding after residency in 2004 and has served the Redding community as a family physician, hospitalist, emergency physician, and, most recently, in addiction medicine. When he’s not enjoying the calm atmosphere of the emergency department he enjoys the chaos of being a full-time parent as well.
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55 Responses

  1. Avatar Tim says:

    I’m glad to see the flu getting more press for being as deadly as it is. We tend to worry more about preventing rare, sensational deaths than taking simple life-saving precautions.

    Average annual deaths:

    Alcohol: 88,000
    Opiods: 60,000
    Flu: 36,000
    Car accidents: 30,000
    Homicides: 16,000
    DUI: 11,000
    Gun Homicides: 11,000
    HIV: 6,500
    Drowning: 3,500
    Plane crashes: 750
    Falling out of bed: 450
    Rifles (including assault rifles): 350
    Collisions with deer: 200
    Terrorism in the US: 180
    Lightning: 49
    Skiing/snowboarding: 40
    Dogs: 35
    Football: 12
    Vending machines: 10
    Sharks: 1

    63% of auto fatality “victims” were not wearing the seatbelt.
    80% of flu deaths were unvaccinated.

    • Steve Towers Steve Towers says:

      Those are stats for the USA, right?

      Gun homicide rates are interesting. By far, the biggest dent we could put in that figure—short of banning guns outright—would be banning gun ownership by males under 35 years of age. I’m not sure that would make a big dent in Shasta County’s murder rate, though. Our middle-aged men are as murderous as the young guys, it seems.

      • Avatar Tim says:

        Those are stats for the US (many from cdc).

        As for banning guns until a certain age, I’d say that -on paper- a handgun ban until the age of 26 would seem to make sense (you used to have difficulty renting a car until that age – for similar reasons: the impulse-control region of the brain is not fully developed). But we already ban handguns to those under the age of 21 yet handguns still easily find their way into teenage hands…

        • Steve Towers Steve Towers says:

          Tim sez: “But we already ban handguns to those under the age of 21 yet handguns still easily find their way into teenage hands…”

          True, but that has to do with the penalties not being stiff enough. It’s like illegal immigration: Most illegals come here for economic opportunity (witness the mass migration back to Mexico during the last big recession). We’d put a big dent in our illegal immigration problem if we made the fine for hiring an illegal $10,000 and three months in jail for the first offense, stiffer than that for second and third offenses.

          Same for letting your guns get into the hands of minors.

  2. Avatar Beverly Stafford says:

    Today’s column could have been titled Doc G and Germ Warfare with a subtitle of Cover your Cough. Thanks for this timely article.

  3. Steve Towers Steve Towers says:

    “If you are out in public and freely coughing into the air, you may be a sociopath.”

    My first laugh of the young day.

    • Greg Greenberg Greg Greenberg says:

      Tim, I appreciate the stats. The flu kills and I’ve seen many die from it. It’s usually the ill, old, young, or immunocompromised but sometimes not. H1N1 was scary when it first hit the scene because we saw young, healthy people die from it more.

      Beverly, I’m working on the alliteration. Greenies Green Goey Germs Going to the Grave?

      And Steve, I’ve worked the last 5 nights and the Public is determined to test my immune system.

  4. Avatar conservative says:

    Most recent California public health statistics by county.

    Alcohol contributes to cardiovascular disease, the number one cause of death, by causing hypertension and diabetes. Alcoholism contributes to suicide. Stimulant drugs like cocaine and methamphetamine aare powerful causes of premature cardiovascular disease.

    Public health statistics are based on death certificates, which often do not mention the role of drugs in causing the immediate cause of death.

  5. Steve Towers Steve Towers says:

    Interesting perusing the California Department of Public Health’s “County Health Status Profiles 2017” report.

    Shasta County has the 2nd-highest age-adjusted death rate of all counties in the state. (Avis dropped their “When you’re second place, you try harder” campaign years ago, so it’s available.) We have the highest age-adjusted death rate in the state due to all cancers. We come in at 4th highest for age-adjusted Alzheimer’s disease death rate. Third highest for coronary heart disease. Second-highest for chronic lower respiratory disease. Eighth-highest for chronic liver disease and cirrhosis. Tenth-highest for death due to accidental injuries. Tenth-highest for suicide, tenth-highest for murder. (Link below.)

    That’s a lot of hard living in our Shasta County. I’m often reminded of lyrics by the band Cracker about life in inland California. The song is from the perspective of a hard-scrabble conservative working man.

    My people came out of the forests and the mountains
    Into this unpromising land
    Scratched out a living in this desert valley
    Hard living for any man

    It weren’t no Eden, as cold as Sweden
    Like Hades in the summer time
    We built the cities, we dug the ditches
    We picked the fruit from the vine

    We live like serfs in this new feudal land
    We pay the bills and fight the wars
    I ain’t no wobbly, no pinko commie
    Let’s start the end times right now!

    Influenza? At 32nd (of 58 counties) from the top, we’re actually lower than the California average. No worries, doc! (One of the benefits of lower population density, no doubt.)

  6. Avatar Sandy Babcock says:

    Thank you for a very well written article that helps educate the public. I would add is if you are sick and have to be out in public wear a mask. Not 100% perfect but better than nothing.

    • Steve Towers Steve Towers says:

      You see a lot of that in high-density Asia—rarely here. I wonder if it’s partly because Americans think it looks like a sign of weakness?

      • Avatar Beverly Stafford says:

        We took our dog the the vet a few days ago, and one of the assistants wore a mask because she had just come back to work after a bout with the flu. She was no longer contagious, but it was a just-in-case measure. We appreciated it.

      • Avatar K. Beck says:

        Or, maybe, just maybe, it means people here only care about themselves?

        I think it has more to do with my most previous post at 1:04 PM.

    • Avatar K. Beck says:

      Get a mask at one of the medical outlets here, not the ones from Home Depot!

  7. Thank you for your front-line defense of science.

  8. It’s rare for a doctor to publicly point out the sometimes nefarious relationship between pharmaceutical companies and scientific research. To wit:

    “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.”

    Kudos to you. And I think the name change was wise. It’s not your fault someone got to the G-spot first.

  9. Avatar Richard Christoph says:

    Good article, doc, but just one minor quibble. You wrote:

    “For those who still think that they can get the flu with the vaccine, it’s not possible.”

    I believe you meant to state FROM the vaccine rather than WITH, since it is certainly possible to have been vaccinated this year and still get the flu.

    BTW, the Great Influenza Pandemic of 1918-1920 killed between 20-50 million people worldwide—more than WW I.

    • Greg Greenberg Greg Greenberg says:

      You are correct! Proofreading my grammar mistakes is the bane of my existence. That and carbohydrates.

    • Avatar Common Sense says:

      I think what the good Dr meant was….It’s not the “Flu Vaccine” that gives you the Flu! They may be a good idea for those that not overly healthy or are immune compromised…but with the Aluminum and Mercury in those shots….I will pass!

      They GUESS 6 months out what to put into the next years batch……so 50/50 at best!

  10. Avatar K. Beck says:

    First, thanks for changing the name of your column. I just sent Doni an e-m asking what was up with that title. Poor choice, Doc. Sorry, it is just a fact.

    A friend’s husband died from the flu early in the season. I don’t know if he was vaccinated or not. He got sick and 4 days later died. So, there is that.

    Regarding all those sneezing comments. I was in line at the check out counter one time, a few years ago, and for some unknown reason I decided to look behind me. Big mistake. Just as I turned around the person behind me sneezed. Not even one iota of trying to cover their face, or turn away. I got the sneeze, full blast, right in my face! It was all I could do to not punch the person in the face. Seriously. I kept repeating over and over again, “That which doesn’t kill you makes you stronger.” It was all I could think to do to stop myself from ending up in jail.

    I worked in a semiconductor fab for about 30 years. Sneezing and coughing were outlawed in the fab. Bodily fluids on silicon semiconductors are real device killers.

    Allow me to say how to sneeze into your elbow since I see people making the attempt but still throwing germs everywhere. PUT YOUR NOSE, POINTED DOWN, IN THE CROTCH OF YOUR ELBOW. Slightly close your arm so your face is covered by the V of your arm. That way the sneeze mist gets on your sleeve or drops down to the ground.

    I get my flu vaccination at Shasta Co. Health, usually in October. The nurse there told me the vaccine is made up well before the flu gets to the States, basically based on what germs were flying around the year before. He told me that this would be a bad season. I asked how he predicted that. He said the flu starts in Australia and New Zealand. That gives the medical profession in the States a heads up as to what to expect. That is why the mix is behind the real current virus. They can’t wait until there is a break out to mix the vaccine because it would be really too late in the season.

    WASH YOUR HANDS WITH SOAP AND WATER. Those antibacterial hand sanitizers end up killing the weak germs and letting the strong germs live and multiply so the germs only get stronger.

    One burning question: Why is it the CDC does NOT include people who are 65 & older in the flu death statistics? Are they glad to get rid of us? Hoping the flu will knock a bunch of us out in an attempt to keep SS solvent? What?

    • K. Beck, the column title was my brainchild.

      • Avatar K. Beck says:

        I never sent my question, I found it in a draft. Here is what I planned to send: “…been meaning to ask: What is with the TITLE of this column? I thought maybe “G Spot” had morphed into some other meaning, but doing an online search did not turn up a new definition”

        I missed the connection to his last name.

        Thanks for fessing up!

        The heading really does need to be changed…perhaps Dr. Nancy Sutton Pierce would like to use it, I know she already has a title for her column, but Dr. Greenberg’s former title might work, too. : )

  11. Avatar Tim says:

    Why can’t they have multiple flu shots to cover a wider range of strains? Even if you can’t get them all in one dose, why do you not have like 3 shots spread over 3 months?

    • Greg Greenberg Greg Greenberg says:

      Even if they spread them over months, the manufacturing process takes too long, they can only decide the strains long before the flu actually hits us. I would assume the number of strains affects the cost and manufacturing process. After H1N1 hit, they created a specific vaccine for that because of the pandemic flu. The next year went from tetravalent (three strains) to quadravalent (four) to add H1N1. So there much be some flexibility in the number and process but not much.

  12. Smithsonian Magazine carried a very valuable article last month concerning the 1918 influenza pandemic which killed between 50 and 100 million people world wide, largest disease death in world history. Basically, the killer started just like this number, rather serious the first time and a true monster when it mutated and returned in September before WWI ended. Recent mapping has western Kansas as the likely origin even though many people refer to the inferno as Spanish Flu. It was our troops which spread this number everywhere. Most importantly, young people were the most affected. Lungs turned to the density of liver in twenty four hours. There was and is nothing to be done for a similar situation today despite our advanced medical technology. Get vaccinated, stay home if sick, hope history does not repeat itself or even give a hint at a vague copy.

    • Avatar Richard Christoph says:

      “….many people refer to the inferno as Spanish Flu.”

      The probable reason for the name:

      “….initially gaining its nickname from wartime censorship rules that allowed for reporting on the disease’s ravages in neutral Spain.”

  13. Avatar Common Sense says:

    The Flu Vaccine….a Multi Billion dollar cash cow for the RX companies.

    • Avatar cheyenne says:

      I get my flu shots every year and I don’t get the flu despite living in a severe winter area. I don’t care who gets a cash cow from the vaccine.

      • Avatar Common Sense says:

        At your age….I would probably get one also. For most normal healthy adults…the risk of problems later in life is not worth the Aluminum and Mercury in the Flu Shots. Every notice the amount of people with Alz/Dementia?

        • Avatar cheyenne says:

          CS, I have not noticed people getting Alz/Dementia from flu shots. This is the same radical objection to vaccinating children because they will become Altruistic. With that kind of thinking we would still have Smallpox running rampant. Perhaps Dr. Greenberg could do a future column on the vaccination conspiracies.

        • Steve Towers Steve Towers says:

          People who don’t get vaccinated (or refuse to get their kids vaccinated) are taking advantage of everyone who does. That’s especially true if you live in an urban or suburban area, where you’re certainly going to be exposed to various diseases unless nearly all of the “herd” is immune, thanks to vaccines. You’re riding the coattails of those who are intellectually capable of considering the benefits and risks, and understand that the benefits outweigh the risks by orders of magnitude.

          Anti-vaccers who publicly advocate against vaccines apparently are so incapable of understanding cost/benefit ratios, they undermine their own herd-immunity benefit. The more people you talk out of getting vaccines, the more you expose you and kids to horrible and potentially fatal diseases.

          If it was just you and your spawn you were putting at risk, I’d say fine……knock yourselves out. The gene pool could use a little chlorine. But you’re also substantially increasing the risk for people who can’t get vaccinated for actual medical reasons (e.g., kids with compromised immune systems). That makes you both ignorant AND profoundly selfish.

          • Avatar K. Beck says:

            Steve, thanks for this. I might have used a bit of different language, but I totally agree with you. I am old enough to remember polio.

            NO ONE knows what causes Autism. The link to dementia from Al, is always preceded with “High Levels.” Life is a crap shoot, at best. So many really horrible diseases have been made mute due to vaccines. Steve’s last paragraph says it all.

            We Are All In This Together.

  14. Avatar Virginia says:

    Thank you for not bring in political rhetoric into your column. I enjoy it for what you are writing about on health.

    • Greg Greenberg Greg Greenberg says:

      Virginia, I will try to keep politics out of the medical topics. I may throw politics in with addiction medicine because the issues are often intertwined.

  15. Avatar George Parker says:

    Okay…whenever somebody brings up the ‘hazard’ of mercury in vaccines, you are demonstrating ignorance of really basic science.

    “Mercury is a naturally occurring element found in the earth’s crust, air, soil, and water. Two types of mercury to which people may be exposed — methylmercury and ethylmercury — are very different.

    Methylmercury is the type of mercury found in certain kinds of fish. At high exposure levels methylmercury can be toxic to people. In the United States, federal guidelines keep as much methylmercury as possible out of the environment and food, but over a lifetime, everyone is exposed to some methylmercury.

    Thimerosal contains ethylmercury, which is cleared from the human body more quickly than methylmercury, and is therefore less likely to cause any harm.”

    • Avatar Common Sense says:

      Thank you for the clarification….it appears that Aluminum is more of a concern then! With a 12 year average effectiveness of 40.85%….I will take my chances regarding no flu shot for myself.

      It’s even less for those that take Statins!

      • Avatar K. Beck says:

        This Flu Season Is the Worst in Nearly a Decade
        By DONALD G. McNEIL Jr.JAN. 26, 2018

        “…and still getting worse”

        “Despite the late date, the agency still recommends that Americans get flu shots. Because some doctors and pharmacies have none left, Dr. Jernigan suggested checking to find providers with stocks.”

      • Avatar cheyenne says:

        CS, the doctor expert you linked to about the dangers of aluminum also published in the Journal of Science about the .04% of aluminum in marijuana. Did you miss posting that on purpose? In fact I could not find one piece where he said flu shots contained aluminum. Just another vaccine conspiracy I hope Dr. Greenberg will explore in a future column.

        • Avatar Common Sense says:

          Haha….yep….I am guessing he tested it all personally? You need to read the Insert that comes with the Vaccine….you know….next time you line up to get your flu shot!….if you love them…have at it…..I will pass. Doctors get a bonus from Blue Sheild/Blue Cross when they get 63% of all their patients to have all the Vaccines…. $400.00 per patient….but then you know that right?….since we read the same publications/news? Mind explaining that one to the crowd?

  16. Avatar AJ says:

    Oh, Dr. Greg, I’m right there with you in wishing people had a little more sensitivity about how they shared their sough/sneezing. School teachers are second in line behind ER workers in being exposed to all types of suspect bacteriological life. One little darling sitting next to me at the piano (he was having a lesson) politely turned to me and sneezed into his elbo . . . . The problem being that his elbo was up around his eyes and the spray got me full face. We’ll see what happens in the next few days. LOL!! And BTW, I loved the former name of your column. Nothing like a good ol’ double entendres to entertain an entertainer.

  17. Avatar dawnie says:

    “I Opened the Window and Influenza” – My dad used to say that every year since he died last year I guess I

    have to say it for him…………………….

  18. Avatar Jorgi B says:

    There are a few of us who are unable to take the flu vaccine. I’m severely allergic to it, and although the formula may have changed since the time I reacted so badly, no one will administer it to me. I just try to be as healthy as possible, and, yes, I wash my hands a lot!