Dan Onion, MD, MPH

Mt. Vernon/Vienna Health Officer

293-2076; dkonion@gmail.com

February, 2018

People, people, people, many of you I meet are not listening, and are giving up about surviving the influenza epidemic we are in the midst of right now. That’s crazy; please don't!  We’ve got several kinds of arrows in our quiver to help us and ours survive if we are smart enough to use multiple strategies at once, as we do with other complicated challenges. Listen up! Here’s how.

Please start by going back and reading my piece last November, 2017 in the town newsletter, Medical Probabilities Exemplified in Influenza and Car Crashes. It is on p10 though the index in front says p9; go back and read those details; they are important. I explain the presence and impact of probabilities of influenza vaccine on the spread and effect of a “flu” epidemic in our community. It never is all or nothing!  I hate the way the media emphasize one artificial number, “the effectiveness”of the vaccine. I am not even sure how they compound that one number, but it ain’t the whole story and it sure seems to encourage people to give up. The number they are disseminating now is "30% effective". That should mean that of 100 people, who are exposed to the flu by breathing the viruses into their nose and lungs, 70 will get the flu while 30 won’t. But those aren’t bad odds to start with. We take what we can get and then go from there. So if you got a flu shot, you are right now that far ahead of your neighbor who didn’t. What they don’t tell you clearly enough, is that of the 70 who get the flu, those who have had a flu shot, nearly all have a better time of it with less severe illness, fewer complications, and not being so sick they are hospitalized or die. Yea, influenza can be a fatal disease and is proving itself to be right now in Maine! Listen up!

Yesterday I talked about influenza with 3 people. One, a 70s year old friend and carpenter, told me he never got flu shots, didn’t believe in them, and wasn’t getting one despite having had severe pneumonia last year in that milder flu epidemic even though he still had left over lung damage and shortness of breath from it. He, of all people, needs a leg up on this year; I begged him to get the shot. Then there was a young woman grocery clerk with a clearly sputum-producing cough, repeatedly turning to cough away from her customers. Now it could be she just had bronchitis from being a smoker, but that would be unusual at her age and in the midst of a flu epidemic. I bet she had an early influenza infection and will get sicker. Coughing in the other direction simply spread the virus more widely; she should be taught how to effectively cover her mouth with her elbow and/or wear an effective mask, or go home until better. Her employer has a responsibility to have effective education to make this happen. Unfortunately the Maine Center for Disease Control (CDC), which tries to do that education, has been budget cut to the bone; and the US congress let the national CDC shut down over the budget fight. So we may be on our own, guys. The 3rd example was a mother of a 1-year old who didn’t “believe in” flu shots for her kid. My God folks, this isn’t a belief issue; it’s the science that got us to the moon, dropped mortality rates in this country so most of us get to see age 75 now, and redesigned cars and roads so motor vehicle deaths have plummeted over the last 50 years!

First you’ve got to understand and recognize two things:

•What influenza is and what it is not. It is not simply a cold with sore throat and temperature under 100 degrees and the person still able to function. Nor is it predominantly nausea, vomiting and diarrhea from gut germs, and which we also call “flu”. Rather, it is a specific viral infection of the lung itself, caused by several related influenza viruses which characteristically change their protein coats as they rip through the population each year. That way people, who have previously been infected, have less resistance because the blue coat antibody (antibodies are the swords our blood cell soldiers use) their body produced by infection with the blue coats last year don’t work as well against the red and purple coats the little devils have switched to. Still, they do work some in slowing down the severity of the resulting illness.

•The vaccine actually immunizes against 4 different types of influenza viruses this year (that’s what “quadrivalent” means) because these sneaky devils run in packs. Each of those shot elements have varying efficacy. But again, you take what help you can get, and shouldn't let the perfect be the enemy of the good.

•We have designer vaccines with higher doses for older people, many times also now on immune-suppressant drugs for our chronic diseases like me, and who are harder to make immune, so we need double doses of the vaccine at a time. Childhood vaccines under age 2 are similarly specific to that age group. Get a flu shot now, if you haven’t already this fall or this month. This epidemic is going to go on until spring, April or even May, guaranteed. They all peak in late March with the maximal snow depth no matter the year.


Second, recognize and know about the 3 ways people get sick with the flu and how to take care of them.

•Super sick fast patients: these are usually young people over 4 but under 40, mostly teenagers and young adults with young families of their own, kids often bring it home from school, who haven’t seen as many winters as us oldies and thus have a narrower spectrum of past body experience with the shifting devils. They get sick one night with chills, sometimes but not always have a fever over 101, become prostrate within hours, always have cough, which may not produce sputum; their lungs “white out” (fill with fluid) by xray, they often get confused, turn blue and will/can die within hours, often overnight. Get thee to an emergency room ASAP, do not delay!! Rare but extremely dangerous, the ones you hear about on TV right here in Maine now.

•Then there is another other group with delayed badness, especially in the young and old patients, who get the flu with fever over 101, productive cough, feel rotten all over, may have some vomiting, rarely diarrhea, who are having bad influenza that then allows a secondary bacterial pneumonia to grow in the lung mess the flu made. They start to get better after 3-5 days then relapse back with high fever, get sicker again, with more cough, more sputum, if they are strong enough to produce it, and can die in a few more days if not diagnosed and treated with bacterial antibiotics. They go to the ER as soon as that bounce back to bad happens

•Finally for the rest of the population, with sore throat, fever chills the next day, feel lousy, try to work still, which exposes more friends and neighbors, then gradually improve over a week and get back in the saddle.

Thirdly there are effective medical interventions that work and help those in the 2nd and 3rd bullet groups. You can prepare for using them by asking your doctor or nurse to consider giving you a written prescription for oseltamivir (Tamiflu) 75 mg to have on hand to fill if you get sick,  taken twice a day for 14 days and started within the first 48 hours of classic symptoms of the real flu; many clinicians will want to test a throat swab before prescribing Tamiflu but when the epidemic gets bad, most will figure hoof beats mean horses and do it even over the phone if your case sounds good enough. Also, by taking Tamiflu when you have been exposed to someone living in your house with influenza, one pill a day for 7 days can decrease the likelihood you get it and certainly reduce the rate of complications.

And finally, think of your family, friends and neighbors. Don’t work or visit with them if you can help it, when you are sick. Not 100% effective because you are spreading the virus a couple days before you get really sick, but still can help others.

That’s all (yea right!)!  Get a flu shot now if you have not. Avoid people sick with the real flu if you can. Know the 3 different patterns of illness when you or family get it. And be prepared to soften the blow with Tamiflu.


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