Thursday, August 27, 2009

FAQ Novel H1N1 (Swine) Flu

School is back in session, and the weather will soon get colder. The perfect conditions for a flu outbreak are arriving. We're still a few months away from a vaccine (late October for high risk groups). What can we expect with the Swine flu?

Since it has spread mostly in school age children and young adults, it's going to cause a lot of disruption. That's the main reason the public health community is making such a big deal about it. Students will be absent, teachers will be sick, and the work force will be home taking care of sick people. It's an economic concern for the country. It is far less deadly than the typical seasonal flu. The only thing unusual about it is that it's hitting an atypical age group. But the characteristic of impacting young adults is typical of pandemic flu. We've actually been waiting for a flu pandemic for a while now. From a historical perspective, we're overdue. But compared to previous pandemics, this one has been far less deadly.

Frequently Asked Questions

1) How do you recognize the flu?
I've seen a handful of confirmed swine flu cases early this summer. It strongly resembles the typical flu.
Within 24 hours, you go from not feeling quite right to fevers of 101-103 and coughing. The coughing causes a mild sore throat, but it doesn't hurt to swallow like strep throat. You may have very mild nasal symptoms like congestion and runny nose, but not nearly as much as with a typical cold. Plus, with a cold, the coughing doesn't start until a few days in, after the runny nose starts. The coughing with the flu is usually a dry cough. There would not be as much mucus as with bronchitis or a sinus infection. With fevers, most people will have a loss of appetite, body aches, and mild headaches. You can recognize a fever when you have problems with body temperature regulation. For example, you'll be freezing and piling on the blankets shivering but then throw off the covers 5 minutes later, sweating. To summarize, rapid onset of fever (>100f/38C) with cough and mild sore throat are the cardinal symptoms.

2) Should I take Tylenol for the fever?
If you have a fever and are very uncomfortable, then take some Tylenol. Ibuprofen works fine too. Do not take Aspirin. If you have a fever but are not uncomfortable, then there is no need to take fever-reducing medications like Tylenol. A fever is your body's natural way to kill viruses, so if you can let it do its job, a fever is a good thing. If the fever's not coming down with Tylenol, don't worry about it. It doesn't mean that something's terribly wrong. If your fever is more than 104, then consider a cool water bath to bring down the body temperature a bit. If your fever is more than 105, then consider going to the emergency room. Some people insist that they normally run a temperature of 96 and that 99 is a fever for them. I find that the flu will still cause a fever of well over 100 in those people.

3) Should I take a cough syrup?
Sure, if you want to. It's no longer recommended for kids because it's been shown to not work for them, but if you still want to, that's fine. Delsym is a pure cough suppressant, nothing else added. If there's mucus in the coughing, Mucinex DM is good. Cough drops are soothing but do contain a lot of sugar.

4) What makes it worse for some people?
People with asthma, smokers, pregnant women, diabetics, and people with chronic illnesses would be at higher risk for complications. The most common complication is pneumonia. That would usually result in more mucus and continued high fevers beyond the 5th day.

5) How contagious is it?
It's pretty contagious. A mask doesn't do much to prevent spread. The virus can live on surfaces for hours, so washing hands is very important. You're contagious one day before symptoms start. So if you come down with symptoms on Tuesday, you were already contagious on Monday and should just let people at school or work know. If you are sick, stay home. Do not return until the fever is gone for 24 hours (without taking Tylenol). If your aren't sure if you're sick, just stay home for a day to see how you feel. By the end of 24 hours, you'll know for sure because you'll start running a high fever if you have it.

6) I'm having severe vomiting and diarrhea. Do I have the stomach flu?
No. There is no such thing a stomach influenza. It's a misnomer. Having said that, what's commonly referred to as the stomach flu is just a stomach virus. Most stomach viruses don't cause a high fever but can cause you to spend many hours in the bathroom. The virus that causes the stomach symptoms is not influenza. Influenza is a very specific virus with very detailed specifications that causes the Flu (a respiratory illness). Still, some people have a more sensitive digestive system. If previous fevers and illnesses easily cause vomiting and diarrhea, then it's possible to have some mild digestive symptoms with the influenza.

7) Should I take Tamiflu?
If you are sick and are able to get to the doctor within 48 hours, then Tamiflu may be able to help a little bit, at a cost of about $100 for the course. It typically decreases the severity by about 20% and shortens the duration by about a day. So instead of running a fever of 103, it may be only 102. Instead of being really sick for 5-7 days, it may be more like 4-6 days. I think it's important for people at higher risk to take it, but it's certainly not mandatory for an otherwise young healthy person. It is not like an antibiotic where you often feel better within 1-2 days. The flu will still have to take its course even with Tamiflu. Tamiflu doesn't work as well if you start it after 48 hours of illness, so it's usually not recommended under those circumstances.

8) How long will I be sick?
Most people will run a fever of 101-104 for about 3 days. By the fourth to fifth day, the fever is about 100-101. The coughing will last 7-10 days. Most people feel at least 80% better by the tenth day.

I still remember my bout with the 2003-2004 flu. I was a resident at the time. The flu vaccine had the wrong strain, so despite getting the shot in November, I still got sick in January, at the height of flu season. The day I got sick, I started feeling not quite right in the morning, but I continued to work. I figured I was just sleep deprived. I went to the nursing home in the afternoon to see my patients there. But since my throat was starting to feel more raw and I had a slight cough, I decided to wear a face mask just in case. I went home early that afternoon and took a nap. I woke up sweating and achy around 7pm. My doctor's office had late hours until 8pm, so I called and drove down immediately. My fever was 103.5, and my doctor told me I didn't have the flu. I was pretty darn sure of what I had, so I insisted that she write an order for a flu swab. The office didn't have the rapid flu test there so I had to get it the next day at the hospital. One of my fellow residents stuck the long flexible metal cotton swab down my nose into my throat for the nasopharyngeal rapid flu test. That hurt my throat more than the flu ever did. I continued to work around the hospital that day until I was paged to report immediately to the infection control nurse. Apparently I was "strongly" positive for the flu. I took Tamiflu for 5 days and was prohibited from working those 5 days.

The CDC has extensive and up-to-date information about the flu as well.

This information is not meant to replace personal medical attention or advice. It is provided only as an opinion based on my experiences. If you are sick, please go about your medical care as you normally would.

Addendum: There is speculation that the swine flu started in Mexico at a gigantic filthy pig factory. That giant pig company is one of the largest pork distributors in the US. If you have access to local organic meat, I strongly recommend paying extra for it. You can't catch swine flu from eating name brand pig products, but you would be giving the big companies money to pollute and spread disease. I get my bacon from Musser Farm Market in Bellefonte. Good local organic stuff.


  1. What's your opinion on getting the H1N1 vaccine should it become available to us? Especially for kids? I am concerned b/c it was developed so quickly with so little opportunity for testing...

  2. Yes, that's a good question. The flu vaccine industry makes a new vaccine every year, so they are pretty good at producing in short notice. I will have to get it as soon as it comes out. But if I had a choice, I would wait two weeks to make sure there aren't a lot of problems with it. I would give it to my own kids after watching and waiting for 2 weeks.

    In the 1976 swine flu scare, the vaccine given to 40 million people caused 50 cases of a debilitating neurological disease called Guillain-Barré Syndrome. Mortality of the swine flu in the US is 0.7%. If the swine flu eventually infects 15% of the population, and assuming this vaccine still causes high rates of GBS, 1000 times more people will die from the swine flu than contract GBS. So from a public health perspective, benefits of the vaccine far outweigh the risks.

  3. Vaccines are not without risks. Severe irreversible problems are extremely rare. Milder problems like a sore arm from tetanus and mild fever (100) from chicken pox are common (maybe 20%?). I guess it all depends on risk. If 1 in 3 children will contract the swine flu, then it's a 20% chance of vaccine related mild illness vs. 4% chance of swine flu hospitalization + 0.2% swine flu death.