Tuesday, January 2, 2018

PSA: Flu 2018 - Updated

Thirty-six states report influenza activity as "widespread". That would be all the brown ones in the CDC map, above.
Nota bene the number of states with no influenza activity this year is "zero".
The CDC has identified 648 different active influenza virus sub-types this year, to date.

Anecdotally, where I am, approximately 4 out of every 6 persons swabbed for flu for URIs in the ER are coming back with positive results. (My patient pop. average age is markedly older than most of the county.) Just the other night, I admitted three different people over the age of 60 to the hospital, for flu which had debilitated the patients, who subsequently acquired pneumonia as well, the latter affliction being well capable of killing you deader than canned tuna untreated. Breathing underwater has that effect on people.

Flu symptoms are fever, sore throat, cough, body aches, fatigue, muscle aches, and possibly nausea/vomiting.

If you have a fever, you are infectious to others.
If you're treating a fever with Tylenol/ibuprofen/etc., you are infectious to others.
If either of those apply, keep your dumb ass at home, until you're over it. Period.
Anything else deserves a crotch kick.
(A co-worker was patient Zero at my ER, and another colleague gifted me with the crud for two weeks, followed by another four weeks of dreadfully lingering cough. This year's cold has a horrendous URI "tail" of hacking cough that just hangs on.)

1) Stay the f*** home. Until it's ALL gone.
2) Get plenty of sleep and rest, but get up and move around, if only to use the bathroom, make a sandwich, pee, poop, or puke. Lying immobile increases your odds for bigger problems.
3) acetaminophen/ibuprofen for fever control and aches.
4) Water, water, water. Anything less than an hourly pee trip, and your pee isn't clear and mostly colorless, you're probably not drinking nearly enough water.
5) Soups, Gatorade, Jell-O, popsicles, etc. are also water.
6) And more water.
7) Caffeine and alcohol are diuretics, and dehydrate you more, and faster. Avoid both.
8) Take any number of "snivel" meds to mitigate symptoms, loosen congestion and mucus, suppress cough, etc.
9) If you find homeopathic voodoo meds that help, use them. They likely can't hurt.
10) Stay the f*** home. Until it's ALL gone.

This year's flu outbreak is in addition to normal viral illnesses (a "cold"), which are similarly rampant, especially from Thanksgiving to Easter, when intergenerational family members gather to share diseases and finger-bang everything they touch and cough on, for everyone from snot-monkey age to grandma and grandpa.

1) Keep yourself and your little bastards home when they're sick.
2) Wash your hands.
3) Wash your hands before you eat, drink, or touch your face.
4) Wash your hands.
5) Wash your hands after you poop, pee, cough, or touch anything else in the entire world.
6) Wash your hands.
7) Cover your mouth when you cough.
8) Keep at home all your kids too young and stupid to learn to cover their mouths when they cough.
9) Carry personal disinfectant/sanitizer, and use it vigorously and frequently.
10) Understand that if I catch you or your kids out and about in public, coughing, sneezing, and dribbling your snot-mitts on everything, I may replace or augment my personal disinfectant with OC spray, and I will use it on you. If you can still identify me afterwards, and I'm still in the same area 30 minutes later when your vision clears up, I may express feigned/mock regret over my "mistake" in grabbing the wrong spritzer and using it on you.
11) Or, not.

I doubt I'm the only person who's likely to respond in that manner.

Learn a lesson or two, and live.

Addendum: Flu Shots
As a rule, flu shots work.
1) Suck it up, and get the shot if you're in a risk group (Older than 55/immunocompromised/health worker/EMS/fire dept./etc.)
2) You cannot get the flu from a flu shot; it's a killed form of the virus. If you did, you would be in the Guinness Book under impossible biology.
(But while your immune system is cooking up antibodies in response, you can still get a cold/URI. But that can happen anytime anyways, so qwitcherbitchin.)
3) That said, don't expect great things from it this year.
Say what?

Okay, every year, the Flu Poobahs look at last year's viral strains, and try to guess which way they're going to mutate next year, so Pharma Inc. can start cooking the next year's batch.

So they mix up a batch with multiple strains; this year's has:
  • Flu Strain A/(Michigan) (H1N1)
  • Flu Strain A/(Hong Kong) (H3N2)
  • Flu Strain B/(Brisbane)
  • Flu Strain B/(Phuket)

  • Some years, they nail it; a couple of years back, the vaccine was rated something like 98% effective against the prevailing strains.
    But it's a crap shoot, and this year's shot is only rated around 19% effective, last I heard.
    (If you have the latest MMWR report with better numbers, post a link in comments.) 
    And save the crank-bait about the shots being a scam. They get to pick three to four strains; there are 648 active strains out there right now. It's somewhere between a medical best guess and a lotto pick, every year. If you can do better, get a job at one of the drug companies, and tell us how your picks turn out.

    You should still get the shot if you're at risk, but it isn't the magic bullet this year as in some prior years.

    So if you aren't in a risk group, and under 55, save your $, and spend it on hand sanitizer and N95 masks.
    And wash your hands!


    LL said...

    OC doesn't work on people who are conditioned to it (mostly field type law enforcement and psychos who train like that). Spraying them will just get your ass kicked. It should work great on normal people who have the flu since they're all in some sort of respiratory distress anyway.

    Anonymous said...

    Since I work in NYC, I ride the subway every day with several million of my closest friends (at least close in physical proximity, not necessarily emotionally close). Every day I encounter people coughing/sneezing/nose-blowing and otherwise being walking germ factories, hence my annual flu shot without exception. People have jobs that are MUCH too important for them to stay home you know, despite fevers, coughing up crud the color of split pea soup and eyes that look like piss holes in snow.

    I won't even get into the time I saw a homeless guy peeing down a subway staircase banister, laughing as he did so.

    Interestingly, having spent 30+ years riding the petri dish that is the NYC public transportation system, I seem to have developed a robust immune system. When and I met a big over 20 years go, during our first winter together she got absolutely FLOORED by a cold that barely caused me a sniffle for a few days, she always drove to work so she didn't get my exposure, so my immune system said "Oh, I've seen that before, let's crack open the snot faucet a notch for a couple days, no biggie" while her's responded with "OMG we're dying!"

    Mark D

    Jennifer said...

    It's hitting hard. Last night it seemed like every other person was coming in with flu symptoms- more of those than heroin ODs. We now have a bouquet of swabs at front desk just to expedite things.

    Anonymous said...

    agreed...well, flu still a problem after every corner drug store offers flu shot. big ole scam. magic pharma voodoo not working. lol... first is get healthy, eat right, drink water, do not smoke and drink.

    Phil said...

    Great, I might as well go down and buy a barrel of Nyquil now.
    It's like a Daycare center where I work and the nano second one of the flying monkeys show up at work sick, the whole place gets turned into an infirmary.
    I think I was one of two people out of the whole place to go home and stay there last year when it hit.

    Bonus with the lingering hack, I can't wait.

    Y. said...

    What's the % of people who get the flu but it's not symptomatic in them?

    If their fever is low and passes quickly (within 12 hrs), that means the virus is gone and they're not infectious anymore right?

    Reltney McFee said...

    Dear Aesop: your regimen appears (except for the OC spray) to nearly verbatim from my written d/c instructions for my patients at the u/c wherein I labor. I recommend particular "snivel meds", mostly in order to keep folks away from Expensive And heavily Advertised Guaifenesin, which I loathe. Good luck with the rant. I suspect that most folks will HAVE to go to work.

    tweell said...

    I spent the new year weekend in bed, but had to go to work today. Work, home and back to bed. I'm not spreading the flu, it's already been spread here in the prison. Inmates don't pay much attention to hygiene.
    You won't see me in public, but if you did, OC spray is not recommended. It doesn't affect me much any more, and I have the Good stuff.

    James M Dakin said...

    I'm going to make a statement I know will be mocked and derided, but I enjoy stirring the pot. The medical profession are not a group of gods from on high. Sometimes they are as full of crap as the Bleeders of yesteryear ( how often are you guys going to change your minds on diet? ). Washing your hands all the time is retarded. How are going to build up your immune system? Obviously, avoid people as much as possible. They suck, and can kill you with more than germs. But otherwise, friggin relax, Francis. I wash my hands after dropping a deuce and handling raw meat, and that is about it ( cleaning the toilet is the same as taking a Hilary ). I'm hardly ever sick ( I commented previously on the Vitamin C megadosing-it's not the sole reason. I also don't run screeching from any germ like a Helicopter Mom ).

    SiGraybeard said...

    I get the flu shot every year for a simple reason. The flu is a waste of time. I've had it often enough that there's nothing left to learn by having it again - and really, once or twice is all you need. I've got better things to do with my life than lie in bed oozing snot.

    But if selection pressure and herd immunity mean anything, they mean that the more people who are immune to whatever's going around, the more that the strains not covered by the shot will be selected for. If there are strains going around that aren't blocked by the shot, that's what we'll get.

    Aesop said...

    Not so much mocked as pitied.

    Epidemiology 101:
    Washing your hands frequently is how to not catch viruses spread from surface contact (door handles, shopping carts, and everything you put your hands on that millions of others do too) to your own mucus membranes.

    Last I looked, no one anywhere in medicine or microbiology has ever revoked Pasteur's Germ Theory, but the Nobel Committee welcomes your paper in Oslo if you disagree, and can prove it. I'm pretty sure Semmelweiss is still in vogue as well, and two centuries of Nightengale's Rules seem to have confirmed the efficacy of hand-washing through about a minute ago, so I think we're on pretty stable scientific territory there.

    Don't want to wash your hands, because going down with flu is "building up your immunity"?
    Suture self.

    Stock up on cough syrup and Kleenex, and enjoy the two to four weeks of nature kicking your ass.
    Pray it doesn't progress into something like pneumonia while you're immobile and debilitated.

    And as a bonus, you'll be immune to a virus strain that will mutate to something different, and likely never return within your lifetime. But you'll still be able to catch all the other strains this year, and next year's strains just fine, because biology.
    Science is educational, whether folks listen or not.

    That's exactly the reason that flu this year is rampant: people are too smart for science.
    For me, it's purely goodwill to offer the basic information, because *I* won't be the one feeling like a flu virus' chew toy.
    I've had enough fun on that score with the common cold this year.

    But I haven't had a case of flu since I started getting the shots, and I got the same immunity as people who don't get the shots, times 4, and without licking handrails at Disneyland.

    Washing your hands doesn't just stop flu, BTW.
    Take a peek at the MMWR reports, and see the shit that's rampant everywhere 24/7/365.
    Hep. A virus and E. coli bacteria, both being fecal-oral transmission, just for starters.
    You don't get immune to bacteria like E. coli, btw.
    You just get sick, again and again.

    Phil said...

    Let's not forget that perennial favorite of mine, that Staph infection lurking on every bathroom door handle you touch.

    Aesop said...

    That's why savvy patrons wash and dry their hands after, then open the door handle to exit with the paper towel wad, and not with their clean fingers.

    Kudos to the few architects who properly design restrooms in public so that you can push the door open to exit (or better, in both entry and exit) with a foot or knee, as is proper.

    Anonymous said...

    Pathetic sickly losers - all of you. I eat right, exercise - A LOT, take in quite a bit more vitamin B and C through tangerines, apples, papaya and bananas. I get lots of sleep by avoiding idiotic late night TV and I stay the HELL away from surrender monkeys pushing stupid flu shots that shove a dead virus into your blood stream that does God knows what to your liver, spleen, lymphnodes etc..And yeah, I wash my hands after using the bathroom and before I eat - other than that, I let my super tough immune system take control. I retired from the US Army 20 years ago this August, have had the Flu exactly ONCE since then - I have had ZERO Flu shots since my retirement because I don't have some jerkoff commander playing NANNY and telling healthy stud warriors to go get flu shots that have a 1 in 10 chance of working.

    Aesop said...

    And doubtless drink nothing but grain alcohol and pure spring water, to maintain your purity of essence.

    Well played self-parody, Jack.

    Anonymous said...

    People are dangerous disease vectors, then they increase your local fee/tax structure with a new school/palace so you have to spend more time near people to make currency. Don't they know an 11 year old girl who can teach the neighborhood algebra and reading up to the 8th grade level in 30 minutes a day for a few months at a babysitting wage?
    Bleeders and leeches are not always bad when used in moderation (drug-free blood pressure reduction!), but when you get paid to drain blood, MOAR! is always better.

    Not compulsive handwashing, but my hands tend to be washed before eating, before making food, after all bathroom visits (shared bathroom), after they get dirty. I still get some kind of fever/crud that lasts a day before being wiped out by 12 hrs sleeping/eating/megavitamins (and more handwashing) as well as hard uphill bicycling.


    Peter B said...

    There's probably a modest (a study with P= 0.05) prophylactic benefit to be had from Echinacea. There's mechanistic support: appropriate concentrations of alkylamides improve phagocytosis – in vitro and in vivo, and in two legged rats as well. But that mechanism means that if you wait to take it until you feel really sick, it may not do you too much good.

    Another but. Most echincacea on the market is crap. You want about 8-10 mg/d of alkylamides from E angustifolia or E purpurea root in divided doses. That'll cost you at least $3-4/day; for some commercial products, 2-3 times that. That buys you maybe 20% reduction in the likelihood of getting sick and some reduction in severity of illness as well.

    With E purpurea alone, you should dose every 3-4 hours due to the short half life of the active compound. Angustifolia alone is pretty spendy but has a second alkylamide that inhibits FAAH and prolongs the half life, so a blend of the two species means you can dose 2-3x/d.

    Interesting, and a whole lot cheaper:

    "Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006)."

    xtron said...

    my voodoo home brew semi prevention is to pound the orange juice, all day, everyday, and to keep my mouth as clean as my hands. that means a through brushing and rinsing with antisceptic mouthwash 3 or 4 times a day. the clean mouth may not prevent the flu, but recent studies show it can help prevent pneumonia....and probably many other UTIs.
    haven't had the flue in 6 years now.

    Peter B said...

    I forgot to mention this, which comes from Paul Herscu, a very smart naturopathic physician in New England. He's saying that in addition to flu, there may be a non-influenza viral respiratory infection out there. This one seems to produce asthma-like symptoms, even in adults with no history of asthma:

    "Physicians end up saying something like, 'I think this is viral, and will pass, so let’s just control the symptoms with a fever reducer,' or 'I think this is viral, but you have symptoms of pneumonia, so let’s give you an antibiotic, even though it does not seem to help all patients.'

    This is an odd presentation and an odd time of year, hence this post. I want to share two ideas. First, what I think is happening. I think what we are seeing is a virus, which in part explains why antibiotics do not work. And specifically, and this is my best educated guess, I think we are dealing with Human metapneumovirus (hMPV). It is similar to RSV. Most people, including clinicians, are not familiar with this bug, even though it was discovered in 2001 and causes a large percent of winter ailments. Clinical work can take years to catch up with science. And second, there is no specific treatment or vaccine to date."

    Aesop said...

    That wouldn't surprise me, Peter.
    What I had was viral, not influenza.
    But the respiratory component hangs on like a tick, for weeks.