Flu-mageddon is upon us. What to do?

Google Flu Trends: United States, As of Jan 11, 2013.

Google Flu Trends: United States, As of Jan 11, 2013. by Ryan Neuhofel

If you've been hiding under a rock for the past week, you may have missed that influenza season is in full effect. We had historically low flu seasons the past 2 years, so this flu epidemic is undoubtedly worse than in recent years. More cases and possibly more severe illness are being reported coast to coast. According to Google trends, Kansas is just now in the midst of it's "spike". It has not yet peaked, but many experts are predicting the worst season in the past decade. In any case the flu is going to be with us well into February.

Is it time to panic? No, but you do need to take some common sense precautions when dealing with the flu.

How can I prevent the flu? Is it too late for the vaccine?

  • If you haven't done so already, get your vaccine NOW. It takes 1-2 weeks for the vaccine to take effect, so if there is any chance it will be helpful it needs to be done yesterday - or preferably October! As I wrote previously, the flu vaccine is not 100% effective but it's safe and the best thing available to lower your risk or severity of illness. Preliminary data shows this year's flu vaccine to be a 99% match for Type A (which account for 80% of the circulating strains), but only 67% for Type B (20% of circulating strains).
  • Your mom was right. Washing your hands frequently and thoroughly can help prevent the spread of germs, including the flu. Alcohol-based hand sanitizer works fine and is convenient, but soap and water may be even better.
  • If a family member has the flu should I start Tamiflu? It depends! See below.
  • Staying at home when reasonable (see below for who should see a doc) will lessen the chances you infect others.

If I get sick should I see the doctor? or the ER?

  • Most people whom get flu-like symptoms do NOT need to rush to the doctor. Otherwise healthy, young to middle age people will typically fight off the flu virus without complication or the need for prescription medications.
  • Several high high risk groups that are more susceptible to severe illness with the flu are the very young (less than age 2), older people (age 60+) and those with chronic diseases (especially lung diseases, low immune states, uncontrolled diabetes.).
  • Although any case of the flu is miserable, "severe" worrisome symptoms would include shortness of breath, wheezing, fever lasting longer than 3 days, not tolerating any liquids by mouth for 24+ hours or passing out.
  • If you do decide to see a doctor most patients can be handled in a primary care physician's office, but more severe cases may require an ER visit or hospitalization.

Do I need to take anti-viral medications (ie. Tamiflu)?

  • FOR TREATMENT: The effectiveness of anti-viral medication in treatment of influenza is a controversial issue. At best it decreases the duration of symptoms by 1-2 days. Also, it must be started within the first 24-48 hours of symptoms to have any measurable effect. I think it’s a reasonable medication to try, but I only strongly recommend it to those at high-risk.
  • FOR PREVENTION: If you have close contact with known, proven influenza, the Rx treatment for flu can also be used to lower risk of transmission (in theory at least). Not everyone whom is exposed needs preventive Tamiflu, but it should be considered in high risk groups.

W. Ryan Neuhofel, DO, MPH is the physician and owner of NeuCare Family Medicine; a Direct Primary Care medical practice. He is a board-certified Family Physician (American Board of Family Medicine) and Fellow-candidate in Wilderness Medicine.

For more information about NeuCare, visit their website or Facebook or Twitter.

Information contained here is intended for general health education only. All personal health and medical issues should be managed by a health professional.

NeuCare Family Medicine is a paid sponsor and advertisor of Wellcommons.com and Lawrencemarketplace.com

Tagged: NeuCare, flu, influenza, vaccine, Direct Primary Care


Boston_Corbett 5 years, 3 months ago

A doctor writing about disease infection rates quoting "Google trends????"

I challenge the conclusions drawn by use of Google trends. As Google explains, their trends are based on internet searches, not real data. Looking at Google trends, the flu is on the upward curve in most all states.

This is not supported by looking at CDC tabulated influenza information. The national data shows although rates are still high, we are for the time being on the downward side of what could be the season peak.

The peak has just passed us by. An article including several of the CDC metrics can be found here: http://www.virology.ws/2013/01/11/friday-flu-shot-2/

More detailed CDC info can be found at: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm

Ryan Neuhofel 5 years, 3 months ago

Not only a doctor, but a physician with a Master of Public Health (MPH). . . from KU!

While crowd sourced disease trackers (such as Google Trends) have some inherent bias and flaws (namely a media effect in my opinion), they are in some ways superior to the burdensome, slow medical-lab based methods (which have their own flaws) when looking at outbreaks and day-to-day trends. I would agree that they provide little in solid quantitative insight (actual prevalence) into an epidemic, but they have enormous potential as a public health tool.

A great academic discussion here . . . http://cid.oxfordjournals.org/content/49/10/1557.full

And more of a light read . . . http://www.slate.com/articles/technology/technology/2013/01/flu_shot_time_google_flu_trends_predicts_worst_season_on_record.html

However, the main reason I choose Google Trends here was because their presentation of the data is much more digestible to the the average user.

Boston_Corbett 5 years, 3 months ago

Google Trends may make things digestible perhaps, but my point is they also lead you to make incorrect statements in the lead of your article.

As the CDC reflects, this year's peak occurred at week 51 of 2012, nearly a month ago.

And as others including Prof. Racaniello of Columbia University have observed, this year's influenza experience is not outside the range of normal.

Therefore use of words like "flu-mageden" are titillating, and inherently misleading. Unless 'mageden' has morphed into the word 'normal.'

I would also be interested in a source for your statement "many experts are predicting the worst season in the past decade." I do not find that from experts, just reporters.

I agree with the purpose of your article: to education and encourage vaccination.

Ryan Neuhofel 5 years, 3 months ago

Titillating? Me? Never! Of course the title was meant to be provocative. I didn’t think titling it “A Review of the CDC Weekly U.S. Influenza Surveillance Reports” would get many clicks! I generally mock the public/media over reaction to health/medical stories, so you’re really criticizing the wrong guy in this case.

There are many different ways to gather epidemiological data. It’s what I studied in my MPH. Each of them have positive attributes and biases, but not one method is the Holy Word or “gold standard.” In fact, the CDC reports flu “activity” in 5-6 different ways - and their “peaks” can differ by 2-3 weeks! But that doesn’t make one or another “incorrect.”

Lab-based testing (apparently your “gold standard”) also has many potential biases at multiple levels. It is based on the collection of specimens from clinical settings - which are effected by many different factors. I don’t know the good Prof’s work, but based on his blog he appears to be a credible “expert” in the field of micro/virology - at least in the lab. But wouldn’t consider him an authority on epidemiology or public health issues.

Is this a “historically” bad flu season? Probably not, but the CDC Outpatient ILI data shows it will probably be 2nd or 3rd worst in the past decade (excluding H1N1 of 2009) and well above the “baseline.” They will likely categorize this season as mod-severe. I think most people are freaking out because the last 2 years were historically mild (and the public has a 5 second perspective on history!)

My expert sources? I could probably come up with a few, but here is Dr. Ranciello’s Columbia colleague in Dept of Public Health . . . .“It’s just about everywhere,” said Jeffrey Shaman, a professor at Columbia University’s Mailman School of Public Health. “It’s a very intense transmission season — probably the most intense we’ve seen in a decade.” (http://www.politico.com/story/2013/01/2013-flu-epidemic-too-soon-to-tell-experts-say-86112.html)

I still don’t believe I “mislead” anyone in my post, but it was good to have a nice nerd sparring session with you! Good night sir.

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