Pandemic Flu Awareness Week

Bloggers from every part of the blogosphere are participating in a week-long effort to increase awareness of the coming influenza pandemic, and I thought I'd join them for one posting.

Pandemics occur when a new type of influenza, one which has never infected humans before, mutates and becomes contagious between humans. No one on earth has antibodies to this new type of influenza, which is why it's able to spread unchecked across the globe. Currently, the new H5N1 virus is widespread in wild and domestic birds in Asia, and has occurred in humans in several countries, but it has not been very contagious up to this point. It may now have achieved easy transmission between people in Indonesia, but it is difficult to get much information.

Whatever the current state of things, it is only a matter of time before the necessary mutations occur in some particular strain of H5N1 and a pandemic begins. The trouble is, we can't know which strain, which set of symptoms, which mortality rate will be involved in this looming plague. We had global flu pandemics in 1957 and 1968 which were relatively mild, and basically looked like a worse-than-usual flu season. On the other hand, the pandemic of 1918 was catastrophic, killing between 2 and 5 percent of all human beings alive, in a matter of a few months.

You may hear talk of a vaccine, but there is no vaccine. We don't know which strain will go pandemic, so we don't know how to make vaccine. Also, we have extremely limited manufacturing capability, requiring us to start making vaccine 6 months before we need it, even assuming we did know the genetic sequence of the future pandemic bug. Furthermore, it turns out vaccines even for normal flu are largely ineffective. I hate to be so negative, but there is nothing much people can do to stop this thing. We can only hope that the form of influenza that causes a pandemic is a mild form, with a low mortality rate. That is not how H5N1 looks right now, but it's not in its final form yet.

A lot of people don't really understand what flu is. It doesn't help to have medications labeled "Cold & Flu" as if influenza is just a bad cold. Actual flu can attack not just the respiratory system but also the digestive system and the nervous system. My family had a bad H3N2 flu, the Fuji strain, two winters ago. We had shooting pains in our joints, dizziness, ringing in our ears, spots in our vision, and a bizarre recurring twinge that my husband described as feeling "like your head was suddenly on sideways". Severe depression following recovery is a possible side effect of flu, and I certainly felt depressed while we had Fuji. After about 3 or 4 days, you can start to believe that you are never going to get any better. A few more days and you stop remembering what it is like not to be sick. Depression is a consideration when you think there's going to be a bad flu season. Lay in some P. G. Wodehouse or Janet Evanovich, maybe a copy of Planes, Trains, and Automobiles (gotta be the funniest movie ever).

Two things you can take to boost your immune system are N-acetyl cysteine (an amino acid) and beta glucan (a "glycoprotein" or polysaccharide found in oats, barley, brewer's yeast and other things). Adults can take 600mg NAC twice daily and 100mg beta glucan twice daily. Children can take roughly half that (NAC can be stirred into juice, beta glucan sprinkled on cereal or oatmeal or bread). NAC in particular has been shown to prevent or reduce flu symptoms quite substantially as compared to placebo; beta glucan is more generally known to induce macrophage activity (one of the "front line defenders" of the immune system).

Sambucol, a liquid berry-flavored medication derived from black elderberries, has been shown in clinical trials to reduce the duration of flu by 4 days, as well as reducing symptoms, in double-blind randomized clinical trials. This makes it significantly more effective than Tamiflu, which is the only prescription antiviral that seems to be effective against H5N1. However, at least double the usual amount of Tamiflu is required, which is not how it will be dispensed; and the US has so little Tamiflu that it's essentially irrelevant. Mainstream medicine has got nothin', but you can buy Sambucol fairly inexpensively (try vitacost.com) and it's over the counter. You take 1 tablespoon 4 times per day for 5 days, or about half that for children. This costs less than $15 per adult or $10 per child if you go through vitacost (you need about one 8-oz (large size) bottle per adult). This is perhaps the single best thing you can do to prepare, along with having Tylenol and ibuprofen.

It is safe to take Tylenol and ibuprofen simultaneously, if necessary for controlling fever. Anya was taking children's ibuprofen when we had flu, and she became utterly lethargic and it turned out her fever was 105.1. We stripped off her clothes, put cold wet cloths all over her, and gave her Tylenol. I was taking Tylenol at maximum dosage and I could barely keep my fever below 103, which was very distressing as I was 2.5 months pregnant and had been told not to let my fever exceed 102. My husband's fever was 104. This went on for 4 full days.

You may want to have canned soups, frozen TV dinners, cereal, and bottled juice around if flu comes to your area. It's likely no one will be able to cook for a few days if your whole family comes down sick. Gatorade and Pedialyte are good to have on hand.

When someone starts to recover, they need to behave as if they are still sick for another couple of weeks afterward. They need to rest, push fluids, sleep more than usual, and limit exposure to public places and germs. Flu can recur, and the immune system will take weeks to regain its strength. I had a coworker who got flu, seemed to have recovered, and then went jogging. A few hours later his wife rushed him to the ER, where his blood pressure crashed and he went into a coma. It turned out he had pneumonia, and he then developed septicemia which did not initially respond to antibiotics. Thankfully he came out of the coma 10 days later, against the expectations of his doctors.

Bush has been tossing out the idea of quarantine on TV in the past few days. I don't think this will happen, but some flu community folks have stocked up on canned foods, dried beans, toilet paper, bottles of juice, rice, flour, and so forth. Some simply want to be able to avoid the grocery store if flu is circulating, but others expect quarantine measures and don't want to be caught short of supplies. N95 masks and gloves are also being purchased, for when outside trips are necessary.

Myself, I have one remaining question regarding flu preparations, and it is: How does one sterilize Netflix materials?

You can keep track of what's happening with flu at Recombinomics or read more about pandemic flu at the invaluable Flu Wiki. At the moment there is a mystery illness in Toronto which may or may not be flu (false negatives in flu testing are common, so it is hard to know for sure). It is probably not H5N1, but whatever it is, it's a vicious bug.