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A Pandemic Primer for Parents

August 29, 2009

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: