Fighting The Flu

How to stay well and recover faster

As we turn the calendar page to a brand-new year with all our hopes and good intentions, we’re facing another less celebratory fact: It’s officially the peak of U.S. influenza season, which runs from December to February. Oh, joy.

Just thinking about getting sick is enough to want to seal yourself and your family in a protective bubble. If only it were that easy.

The flu virus is primarily spread by airborne droplets from as far as 6 feet away when an infected person coughs, sneezes or even just talks. Droplets can then infect others when they land on their nose or mouth.

Contamination is also possible if you touch a surface where those virus droplets have settled and then touch your face, rub your itching nose or do anything else that introduces the droplets to your own mucous membranes.

You might wait for the next elevator rather than board with someone sneezing and sniffling—and that’s a smart move—but unfortunately, a person infected with the flu virus can be contagious the day before they start showing symptoms. Some people can even be infected but have no symptoms, so they can still unwittingly spread the virus to others.

The flu virus is most contagious in the first three to four days after a person becomes sick, but an infected person can spread the virus for five to 10 days after sickness starts.

Antiviral Treatment

You’ve got multiple symptoms. What now?

“Don’t ignore symptoms. The sooner you get treatment, the better off you—and those around you—will be,” says Todd Panzer, APRN-C, of Ocala Family Medical Center. “You have 48 hours from the onset of symptoms to start antiviral medication, so you should be seen immediately when you start feeling symptoms.”

If it is the flu, you’re highly contagious at this point, so do everyone in the waiting room a favor and wear a paper mask to your doctor’s appointment. (If you don’t have one on hand, tell the staff as soon as you arrive that you suspect you have the flu, and they’ll give you a mask.)

Your doctor will take a mouth swab and test it for the flu virus. Once the diagnosis is confirmed, you’ll be given a prescription for an antiviral drug (Tamiflu being the most popular), which you should start taking right away.

Recommended by the Centers for Disease Control and Prevention (CDC) to treat flu this season are the following U.S. Food and Drug Administration-approved antiviral drugs: Oseltamivir (generic versions and brand name Tamiflu), Zanamivir (brand name Relenza) and Peramivir (brand name Rapivab).

In addition, the FDA just approved another antiviral medication, Xofluza (baloxavir marboxil), on October 24, 2018. Xofluza, which is taken as a single oral dose, in intended for the treatment of acute uncomplicated flu in patients 12 years of age and older who have been symptomatic for no more than 48 hours.

In a news release, FDA Commissioner Scott Gottlieb, M.D., was quoted as saying, “This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option.”

All these antivirals are prescription-only medications and, depending on the type, are available in pill form, liquid, inhaled powder or intravenous solution. Your doctor will determine which is best for you, based on your age and health conditions.

Antiviral medication can lessen both the duration and the severity of the illness and may also prevent serious complications, such as ear infections, pneumonia and hospitalization. It’s most effective when you begin taking it within 48 hours of developing flu symptoms, although it can be started after that point and still be beneficial.

A word of caution: Don’t buy Tamiflu online or from a source outside the United States to have on hand “just in case.” It may contain potentially dangerous ingredients and doesn’t comply with FDA regulations for safe use.

Antibiotics Won’t Work

The flu is a virus, not a bacterial infection, which is why antibiotics aren’t effective against it.

“The problem with viruses is that they replicate fast,” says Panzer. “That’s why you feel so terrible so quickly.”

One reason the flu virus is challenging to fight is that it not only replicates quickly, although not equally in all cells, but its genes also mutate. The virus’ genes can also change as they pass from person to person. This creates newly mutated strains of the virus, which is why you can catch the flu more than once in a season.

Cells in your immune system have “memory,” but when the flu virus mutates, its appearance changes so the “immune memory cells” have trouble recognizing it in order to mount a defense. Then, wham, next thing you know, you’re infected and feeling crummy.

And keep in mind, the flu virus doesn’t just infect humans. It would be easier to fight if that was the case, but it’s not. A number of different species can play host to the flu, including horses, birds and pigs.

During transmission within groups of animals, flu virus strains can change significantly. The result is that when those strains come in contact with human immune systems (which isn’t common but does happen), they can spread very quickly because they aren’t recognized.

Remember, the immune system must be familiar with—or “recognize” a virus—in order to fight it. (That’s why vaccination is so effective.)

When your doctor prescribes an antiviral medication, it doesn’t kill the virus but rather “puts on the brakes” by slowing its progress, stopping it from multiplying and spreading in the body.

“An antiviral stops the virus replication in your body so you don’t become as sick as you could without (medication) and shortens the duration,” says Panzer, noting that when treatment begins within 48 hours of showing flu symptoms, antiviral medication can reduce symptoms and shorten the duration of illness by about a day.

Who Needs Antivirals?

The average healthy person who catches the flu doesn’t necessarily need treatment with antiviral medication, although they’d likely appreciate it. However, people at high risk of complications from the flu should see their health care provider right away in order to get antiviral treatment. This includes:

Adults 65 years and older

Children younger than 5 years old but especially those younger than 2 years old

Pregnant women and women up to two weeks after the end of pregnancy

American Indians and Alaska Natives

People living in nursing homes and other long-term care facilities

People who are obese with a body mass index (BMI) of 40 or higher

People younger than 19 years of age on long-term aspirin therapy

People with a weakened immune system due to disease or medication, such as those with HIV or AIDS or cancer or those on chronic steroids

In addition, the following conditions are known to increase the risk of serious complications from the flu:

Asthma

Neurological and neurodevelopmental conditions

Blood disorders, such as sickle cell disease

Chronic lung disease, such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis

Endocrine disorders, such as diabetes mellitus

Heart disease, such as congenital heart disease, congestive heart failure and coronary artery disease

Kidney disorders

Liver disorders

Metabolic disorders, such as inherited metabolic disorders and mitochondrial disorders

Staying Well

If reading this makes you swear to not leave your house until spring, take heart. There are things you can do to markedly lessen the chance you’ll catch the flu. For starters, if you haven’t gotten a flu shot yet this season, get vaccinated. Then make it a habit to:

Wash your hands thoroughly and frequently.

If soap and water aren’t available, use alcohol-based hand sanitizers liberally and avoid touching your eyes, nose and mouth too much.

Take a daily multivitamin.

Get enough sleep (for adults, a minimum of seven hours).

Stay well hydrated.

Eat healthy.

Exercise regularly.

Avoid close contact with people who are sick.

And don’t underestimate the effect of ongoing stress in your life. It’s debilitating to the immune system, making you more vulnerable to illness, including the flu.

Not Too Late To Vaccinate

October is the optimal time to get your flu shot for the coming season. But any time after that can still be helpful.

“January is not too late to get vaccinated, because here in Florida we often see a later season of flu outbreak,” notes Panzer.

There’s a reason we’re bombarded with messages about getting flu shots.

“We’re trying to create ‘herd immunity.’ The more people who get vaccinated, the less people will get the full outbreak of the virus. The more people who are vaccinated, the more widespread the protection and less severity of any outbreaks,” explains Panzer.

You’ve probably heard someone say they caught the flu from the vaccine. Actually, that’s not possible because the shot contains an inactivated virus.

“There are people who have immune responses to the vaccine and can feel symptoms as their body is mounting a response,” says Panzer, adding that in some cases a person was exposed to the virus before vaccination and then gets ill. Some people have side effects after vaccination, which can include soreness, headache, fever and nausea.

Learning From Last Season

Last year’s flu season was widespread, leaving many people saying that getting the flu shot was useless because it didn’t address the right strains.

The problem with developing the flu vaccine each year is that flu viruses don’t stay the same.

“Only a few viruses stay alive from year to year. Most die, so you shouldn’t have a flu outbreak with the same virus several years later,” notes Panzer. “Viruses are also tricky because they can mutate from person to person and place to place.”

Based on how flu viruses have mutated and adapted in the past, the CDC has to create vaccines based on how they historically mutate. They do this using research from hospitals and clinics to determine which flu strains were most common last season.

Panzer explains that the CDC took the most common strains from last year’s flu season and modified them to make the essential component for the 2018-2019 vaccine.

There’s some comfort in the fact that even if the current vaccine doesn’t turn out to be a perfect match for the most common strains this season, if you do get sick, you’ll have a less virulent response than if you hadn’t gotten a flu shot.

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