A Pandemic Primer for Parents

The Pediatric Insider

© 2009 Roy Benaroch, MD

It’s here.

The “new flu”, officially known as “Novel-H1N1 influenza,” and often referred to as “swine flu,” is now widespread throughout the United States and the rest of the world. We’ve seen dozens of cases in my office, and will probably see hundreds more in the next few months. The World Health Organization has officially declared it an epidemic, and I’m officially declaring it a great big pain in the arse. For parents, kids, and pediatricians, it’s going to be a long, long winter.

The new flu first appeared in Mexico in the spring of 2009, and cases very started appearing in the United States soon after. Although early media reports focused on a very high mortality rate, hundreds of those early cases were later re-classified  by United Nations health officials as unrelated to, or at least not-definitely-caused-by, the new flu strain. Still, media reports have seemed to give the impression ever since then that this new flu was far deadlier than influenza infections we have seen before. While there is some fear that the new flu could become more virulent, right now the strain circulating here is not worse than any other flu. It’s more common, and it’s spreading faster, but in terms of how sick your child is likely to get the new flu is no worse than ordinary winter flu. Which is still pretty bad, don’t get me wrong, but the media is really pushing an unwarranted “killer flu” story that’s causing a lot of unnecessary anxiety.

Let’s set the record straight.

Why is the new flu special? Why are they making such a big deal about it?

This influenza strain, called “Novel H1N1,” truly is a new flu virus. No one has ever been exposed to it before, so almost none of us have any protective antibodies (about a third of elderly people have some antibody protection, presumably from flu strains that circulated long ago, but it’s unclear if that will help prevent them from getting sick.) It has quickly spread throughout the globe, and we’re seeing many cases of flu right now caused by this new strain well before the start of the usual winter flu season.

It is worse than regular flu?

Because no one is immune, the new flu will probably infect far more people this year than typically get the winter flu. Some health authorities estimate that ten percent of the American population will get it. With so many sick people, there could be a major impact on businesses and the economy, and on the ability of hospitals and clinics to help take care of sick people.

But at least so far, individuals who catch this new flu are no sicker than individuals who catch the ordinary winter flu. It makes people sick, sure, but the vast majority of us will recover fully with no medication needed.

Why is it called the swine flu, anyway?

The new H1N1 flu is genetically similar to an influenza virus that occurs in pigs, and may it is probably a mutated version. But you can’t catch swine flu from being around pigs or eating pork.

Good, I like bacon. If I can’t get it from pigs, where can I catch it?

People, especially sick people, and especially sick people who don’t wash their hands.

How can my family avoid it?

There are many strategies that can help. As a community, we need to encourage sick people to stay home from work, and sick children to stay home from school. People with flu need to avoid crowds for about a week, or at least 1 day past the time all symptoms improve. This creates difficulties with people feeling they need to get back to work—but we’re all in this together. Employers need to encourage people to stay home, and schools need to STOP penalizing children for missing days when they’re sick.

One of the most important strategies for avoiding the flu is to keep your hands clean. Flu virus must get into your body through the lining of your nose, or your mouth, or your eyes. It can’t get through your skin. Even if you just shook hands with The Captain of the Influenza Snot team, you won’t catch the flu until you touch your own face. Wash your hands frequently, or use hand sanitizer. Use a tissue if you’ve got an itchy nose rather than your bare hand, and throw that tissue away afterwards. And stop fiddling with your contact lenses, will ya?

Isn’t there a vaccine for the swine flu?

Yes, there is a vaccine in development—but the CDC is now saying they think it will be available in mid-October, and that’s probably optimistic. It’s not clear how it will be distributed, how many doses will be necessary, how many doses will be available, or for whom the vaccine will be recommended. You can follow the latest news about the vaccine and availability at the CDC’s novel H1N1 flu site.

Will the ordinary winter flu vaccine help?

You should definitely get the ordinary winter flu vaccine, which is available now. While it won’t specifically protect you against the new flu, soon the regular winter flu will also be circulating, and getting them both will be a miserable double-whammy. If fewer people catch the ordinary winter flu, may help prevent the new flu from becoming more virulent.

What are the symptoms of the flu?

Fever, body aches, headaches, runny or congested nose, and cough are the most frequent symptoms. Some people also have nausea, vomiting, or diarrhea. The symptoms last about five days. While some people use the word flu to describe any sort of bad cold, the symptoms really are quite different from and more severe than an ordinary upper respiratory infection.

If I think I have the flu, or my child has the flu, should I go to the doctor?

People are having severe symptoms should certainly see their doctor. This includes difficulty breathing or pain that isn’t relieved by over-the-counter medicine. People whose illness lasts longer than five days without improvement, or people who are at high risk for complications of the flu (babies, elderly people, or those with chronic health problems) should also strongly consider a doctor visit.

On the other hand, most people with influenza have relatively mild symptoms that are at least temporarily relieved by rest and over-the-counter medicine. These people really ought to stay home so they don’t unnecessarily expose more people to illness, and so they don’t overwhelm clinics and emergency rooms that will be needed for sicker patients.

What are the warning signs of severe flu—the signs that we need to see the doctor right away, or go to the emergency room?

  • Fast breathing or trouble breathing
  • Bluish or gray skin color
  • Not drinking enough fluids
  • Severe or persistent vomiting
  • Not waking up or not interacting
  • Being so irritable that a child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough

(from http://www.cdc.gov/h1n1flu/qa.htm)

What can relieve symptoms of the flu?

Rest and fluids are very important. Over the counter medicines like ibuprofen (Motrin or Advil) and acetaminophen (Tylenol) will help relieve the aches and fevers. Honey helps cough, nasal saline spray helps congestion, and a nice pot of chicken soup helps everything. I like ice cream and popsicles, too (I am a pediatrician, after all.) There are shelves full of “cold and flu” medications available at the local CV-Rite-greens, but by and large they don’t actually work.

There are a few medications that can be prescribed to fight the flu virus, but they’re not especially effective and shouldn’t commonly be used. The one that’s most widely known is Tamiflu. Ordinary winter flu has already become nearly 100% resistant to this drug, and the new flu is quickly becoming more resistant as well. To work, Tamiflu and other flu medications need to be started as soon as possible after infections; even then, they don’t confer a tremendous benefit. Currently, anti-flu medicines are recommended only for cases of severe flu and for people at high risk for complications from flu.

What’s the incubation period for flu? How long is a patient contagious?

The incubation period for ordinary flu is 1-4 days, usually 2. A person becomes contagious 1 day prior to the fever, and can continue to spread the virus at least until the fever is gone (5 more days), and probably for one further day. Although these characteristics aren’t as well studied for the new flu virus, they’re probably about the same.

What’s with the masks, anyway?

Media reports on the new flu from Mexico, and the Bird Flu of East Asia, invariably showed people wearing masks. Though flu virus can spread in coughs and sneezes, the main way that masks probably help is by preventing healthy people from reaching up to scratch their noses, or reaching into their own mouths. Likewise, eye protection will not only keep sneezed flu-laden mucus from reaching you, it’ll also keep your hands away from your own eyes. That’s a very good habit for this winter.

Wow, thanks unpaid physician author, I’ll sleep much better tonight! But what if I have more questions?

Stay away from the “It bleeds, it leads” local news, and instead check out these reliable resources:

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11 Comments on “A Pandemic Primer for Parents”

  1. Kelly Says:

    Thanks for this timely topic with excellent real-world information and links to help us separate fact from the considerable hype(and you make it fun to read, to boot). Thanks for writing about this.


  2. Deborah Says:

    Thank you for your research, frankness, and wit. Somehow the email from your practice that drew on this post omitted all apostrophes. I just thought you might want to know that your writing did not make the transfer with the accuracy of the original version.


  3. Holly Says:

    Thanks Dr. Roy. I have a couple of questions. First, now that we are hearing that the new vaccine is going to be ready earlier than expected, and that the test results are good, who are you going to recommend should get the shot? I’m a little nervous about giving a brand new vaccine to my 3-year-olds (or myself). How do we know it’s as safe as the regular flu shot?

    Also, I have to fly twice in the next couple of months. One of those times will be with my two children. Are there any extra precautions I can/should take while trapped in the ultimate germ factory?

    Thanks as always,


  4. Dr. Roy Says:

    Holly, there’s no reason to think it isn’t as safe as the regular flu shot– it’s made the same way, and year-to-year flu shots are tested the same way this H1N1 vaccine was. I’ll post a more detailed answer about this on the home page.

    Flying? Try to keep to yourselves, don’t touch surfaces– or better yet, wipe down areas that will be touched with Clorox wipes, or something similar. Almost all transmission of flu is from contaminated surfaces and hands. Good luck!


  5. Sheri Flink Says:

    Thank you, as always, Dr. Roy for such useful information. I have two questions.

    -I am pregnant so my 2 year old can only get the injection. Will he only need one or will he also need a booster?
    -Once we get the vaccine are we guaranteed to not get the flu until at least the strain changes?

    Thank you,


  6. Dr. Roy Says:

    Hello Sheri,

    Though you are pregnant, your 2 year old can safely get the mist vaccine. Having a pregnant household contact is not a contraindication to any vaccine, and it’s safe for him to get the mist (as long as there are no other contraindications.)

    Current recommendations are for children who have not reached their 9th or 10th birthdays to get two doses of H1N1 vaccine, separated by 28 days or more. Additional support for this info just came out today with the release of further studies showing that two doses will be far more effective than one: http://www3.niaid.nih.gov/news/newsreleases/2009/interimpedsdata.htm.

    However, it’s very important for as many children as possible to get this vaccine as soon as possible, so health authorities do NOT recommend that your pediatrician “hold back” or hoard doses of H1N1 vaccine to be used as second doses in children. The guildelines suggest to get as many doses out as possible, and IF there are doses available, give those second doses when practical and possible. This strategy was just reiterated by the World Health Organization: http://www.who.int/csr/disease/swineflu/notes/briefing_20091030/en/index.html.


  7. Dr. Roy Says:

    Regarding Sheri’s second question, is the vaccine a guarantee? Of course it can’t be. No vaccine is 100% effective. But studies show that children vaccinated with this H1N1 vaccine are less likely to catch the illness, and if they do get it they’ll get a more mild disease. They’ll also be less likely to spread the virus to their families and in the community.


  8. Kinley Says:

    Dr. Roy,
    Thanks for your article. My question is regarding my 3-year-old. He received his first dose of H1N1 vaccine in the nasal mist form 29 days ago. We just went back to the county health department today for his second dose, and after waiting 2+ hours, learned they had run out of the nasal mist and had only the injectable version. Is my son still protected even though his first and second doses were in two different forms?
    Thank you, Kinley


  9. Dr. Roy Says:


    Two doses are needed for best protection for children under 10, but the two doses can be both mist or shots or a combination. They don’t both have to be the same kind.


  10. Amy H. Says:

    How is it not possible to catch a case of the flu or spread the virus since it is in your body(regular flu or H1N1) when receiving the Flu Mist if you have live flu virus? I don’t think it makes sense that it WOULD be spreadable or that you could get it, otherwise, it wouldn’t be considered safe and there would only be the killed version, but I don’t understand how it works either.

    We got our vaccines last week at another clinic and it looks like we picked up more than shots and mists….we all got a virus too and now my kids have Croup and I am sick, but that’s another story 😦


  11. Dr. Roy Says:


    The Flumist is made with a live virus, yes, but it is designed very cleverly to be unable to spread in a way that could make people sick.

    The virus in Flumist has been “attenuated,” or weakened, in a specific way that makes it unable to survive at normal body temperatures of 98.6 degrees. It can only survive in the cold, at about 91 degrees or so (an older name for this same technology was called “CAIV” for “cold adapted influenza virus.”) The only place on your body that’s that temperature is just at the tip of your nose! So the virus gets squirted there, and triggers an immune response, so your infection-fighting system gets a glimpse of it. But the virus cannot live in your blood or down in your lungs, which is where wild-type flu invades your body and makes you ill. Very slick!

    Although live-virus based vaccines like the Flumist should not be used around people with immune deficiency, it’s only the most seriously immune-deficient individuals who are excluded from contact with individuals who’ve had the Flumist. Only people in a restricted environment need to worry. And even then, it’s only three days; and even then, there hasn’t been a case of illness transmitted by Flumist. It’s just a precaution.


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