The flu is bad in 2019 and 2020. Influenza (flu) is a highly contagious seasonal viral illness that is of two types, A and B, with hundreds of different sub-types. It is spread by microscopic droplets that are formed with each cough or sneeze. Droplets can enter the body directly through the mouth or nose, or indirectly when they dry and fall to a surface where hands then carry infectious material into the mouth, eyes or nose. The illness causes fever as well as headache, body aches and sometimes eye, throat or GI symptoms. It can lead to bacterial infections of the ears and also to pneumonia. It is this last complication that is responsible for most of the deaths due to flu, and these are most common in the very young or very old, or those with underlying diseases such as asthma, COPD, cancer or diabetes.

The CDC estimates that flu has resulted in between 9 million – 45 million illnesses, resulting in 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010. This year is worse than last year at this time and it’s worse in Texas than it is nationally. Of course, the best thing is to avoid getting it, and vaccination is the best way to do that. The vaccine has proven to have a relatively good match this year, especially for Type B which is the Type on the rise and likely to account for most of the cases going forward. If you have not had the vaccine it is recommended that you get it. Next most valuable is to stay away from people who are infectious. After exposure there is a 1 to 4 day interval before the onset of symptoms (average is 2 days). The infected individuals begin viral shedding (transmitting the infection) in 12 to 48 hours after exposure, and that is 12 to 48 hours prior to the time they begin to feel sick. They continue to be infectious for 4 to 10 days, and sometimes longer (especially in older individuals). It is also known that some people have a partial response to vaccination, resulting in them having infections in which they may transmit the disease, but have few or no symptoms. This means that staying away from people who are sick is helpful, but by itself it is an insufficient strategy. There are prescription medications that can be used “prophylactically” to reduce the chance of infection, and these should be considered for people at high risk who have known opportunity for exposure.

If you suspect that you have the flu, and you are at high risk for complications, you should be seen by a healthcare provider as soon as you have symptoms. There are medications to treat the flu, and they all work better if they are started earlier. Usually they are not considered worthwhile if not started within 48 hours after symptoms are first noted. Not everyone who has the flu needs to be seen by a healthcare provider, and not all those who are seen need medication. The costs and side effects of these medications are sometimes quite significant, and you should weigh these against expected benefits. (Typically symptoms last about a day less with treatment.) If you or your child are otherwise healthy and between the ages of 2 and 65 years old, symptomatic treatment is usually sufficient if there is no trouble breathing and fever can be controlled with acetaminophen in recommended doses. Symptomatic treatment consists of controlling the fever, rest and plenty of fluids (about 2 -3 quarts/d for adults with fever). Normally symptoms resolve over about a week, and the individual can return to work or school after 24 hours without fever AND without medication that would prevent fever, such as acetaminophen.

This article is intended to provide general information only, and is not to be taken as medical advice. For advice about a particular case or situation, consult your own physician or other trusted health professional.

Bradly Bundrant, MD, MPH

Medicine, Science and Culture is a service of The Health and Wellness Coalition of Runnels County. Our next meeting will be January 16, 2020 at 7:30 pm at the North Runnel Clinic in Winters.