I've spent the last 2 days dealing with the flu epidemic that hit my community really hard over the weekend. During flu season, I'll usually see 5 or 6 cases a day through the emergency department - but this weekend, we've had 46 cases so far! And, a lot of them are going into severe respiratory problems, including pneumonia, acute respiratory distress syndrome (ARDS) and even respiratory failure. You would think it is the elderly that get so sick, but it's not. It has been the middle-aged folks (40-70) that are being hit the hardest. I'm glad I have my flu shot- even if it is only 10% effective against the predominant strain, it offers some degree of cross coverage for other strains and it certainly diminishes the impact of strains it is not intended to cover. Seeing the patients in the ICU my age and younger on ventilators for respiratory collapse related to the flu makes me want to have all the protection I can get! We are passing out masks to people in waiting rooms and other areas in the hospital to try to decrease the risk of spread, and making people wash their hands like crazy. I've also restricted all kids under 12 from visiting (except healthy siblings coming in to meet a new brother or sister, and even then, there have been some pretty stringent conditions put in place). Today, I told administration we are officially in an epidemic - which means our emergency preparedness team is waiting in the background to enact our hospital incident command. We're not yet at that point, but if we continue to see so many cases, I will have to enact our pandemic plan.
I hear lots of myths about the flu, and flu shots. The biggest one is that people are afraid they will get the flu from the shot, and that is not possible if you get an inactivated or recombinant flu vaccine. It is remotely possible with an attenuated vaccine, but last year's nasal spray vaccine (which was attenuated) is not recommended for use this year. A lot of people get gastro-intestinal viruses mixed up with the flu. The flu is a respiratory disease (which may involve nausea, vomiting, and diarrhea) but there is no such thing as a "stomach flu". Antibiotics DO NOT help the flu, and unless you have specific evidence of a bacterial pneumonia superimposed on your flu (such as a culture or an x-ray study), you should NOT take antibiotics. When that superimposed infection occurs, there is not a specific antibiotic that is always used. Ceftriaxone and azithromycin are usually the big guns that are given for coverage of bacterial pneumonia, but that's like killing a spider on your patio with a flamethrower. Once the physician finds out the causative agent for the pneumonia, then antibiotics can be trimmed down and tailored to the specific pathogen. The only medications that will kill of the flu are antivirals like oseltamivir *Tamiflu). Even then, it needs to be given within 48-72 hours of the start of the infection to be really effective. Other drugs that are given (such as steroids, decongestants, etc.) don't affect the flu virus, but do help the symptoms.
The absolute best things anyone can do to prevent getting the flu are:
1. Get a flu shot!
2. Avoid crowded places. If you can't avoid those places, consider wearing a procedure mask (an N-95 mask is not necessary unless you are providing medical care up close and performing procedures that will aerosolize the virus, meaning cause it to be heavily spread into the air)
3. Wash your hands as often as you can!
4. Consider surfaces in public areas to be contaminated- so wipe down the handle on your grocery cart, and don't handle side rails, elevator buttons, etc unless you sanitize your hands afterwards
5. Stay away from sick people!
Of course, one of my worst case SHTF scenarios is a pandemic of a virus that goes rogue and mutates. As a prep for this consider having on hand the following:
- gloves (nitrile ones are good, and better than vinyl food service quality gloves)
- procedure masks
- N-95 masks
- lots of alcohol hand sanitizer
- isolation gowns or bunny suits (level 2 or greater)
- bleach
- some kind of disinfecting wipes/ sprays. Read the label, though, to be sure the wipes/sprays are effective against viruses!
For the sick patients, I recommending stocking the following:
- ibuprofen to help with fever and body aches
- liquids (tea, broth, juices) for hydration
- lots of kleenex!
- nasal spray (just plain saline spray can be soothing to inflamed noses!)
I hope all of you stay well and don't catch the flu this year!!