RODALE NEWS, EMMAUS, PA—As far as swine-flu prevention goes, you probably already know that measures like washing your hands, keeping your hands away from your face, covering your mouth when you cough or sneeze, and urging people to stay home when they're sick go a long way. And many people are scrambling to receive the swine flu vaccine for protection, too. But in some cases, particularly in close settings like classrooms and college dorms, the chances of being infected are pretty high. So what exactly should you do if you or your child gets sick from H1N1? A little TLC never hurts, but our experts say "H&M," hydrating and monitoring, are key in treating swine flu effectively.
THE DETAILS: Nationwide, the incidence of flulike illness is increasing, and it's already equal to or higher than what is typically seen at the peak of regular flu season, which usually occurs between December and February. Flu-related hospitalizations and deaths are also climbing above what is normal for this time of the year, according to the U.S. Centers for Disease Control and Prevention (CDC). The agency reported that 11 flu-related pediatric deaths occurred in the past week; since April 2009, H1N1 has been blamed for 86 child deaths. Overall, more than 15,000 people have been hospitalized in the U.S. due to the virus, and unfortunately, more than 2,000 have died.
WHAT IT MEANS: While those numbers are sobering, it is also important to put things into perspective. More than 99 percent of people infected with swine flu recover without medicine. "We can take some comfort that 99 percent recover uneventfully, but there are some important caveats," says William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University in Nashville, and president-elect of the National Foundation for Infectious Diseases.
Here are the important strategies for treating swine flu:
• Don't shop for meds online. Late last week the U.S. Food and Drug Administration (FDA) warned consumers to avoid buying fake and illegal flu meds online. In an investigation, the agency purchased several products online claiming to be Tamiflu (oseltamivir), an antiviral prescription medicine that can reduce the risk of complications in patients infected with the H1N1 virus. However, the online products turned out to be shady; one shipment came from India in an unmarked envelope full of unidentified white tablets. After analyzing them, the FDA found the pills contained talc and acetaminophen, but none of the active ingredients of Tamiflu. Aside from that, the other products ordered online did contain some levels of oseltamivir, but were not approved for use in the U.S. The orders didn't arrive fast enough to effectively help someone suffering from H1N1, either. Tamiflu is most effective if given within 48 hours of the onset of symptoms. “Products that are offered for sale online with claims to diagnose, prevent, mitigate, treat, or cure the 2009 H1N1 influenza virus must be carefully evaluated,” says FDA commissioner of food and drugs Margaret A. Hamburg, MD. “Medicines purchased from websites operating outside the law put consumers at increased risk, due to a higher potential that the products will be counterfeit, impure, contaminated, or have too little or too much of the active ingredient.”
If your doctor prescribes Tamiflu or Relenza (zanamivir), another antiviral, get it directly from an actual pharmacy.
• Monitor symptoms very closely. If you or your child is showing symptoms of swine flu, call your healthcare provider. They may want to see the patient, prescribe medicine, and/or ask you to monitor symptoms. And while getting a swine flu diagnosis can be scary, generally getting plenty of sleep and fluids is all it takes for a full recovery. However, there is a subset of patients that doctors are very concerned with, including people with underlying medical conditions like asthma or other lung problems, heart disease, or diabetes. Physicians of those with underlying medical issues may prescribe antivirals at the onset of infection. But whether you have some other medical condition or not, it's important to pay attention to the symptoms. "Watch the patient carefully. Make sure fluid intake is good, and that the temperature is managed well," says Dr. Schaffner. "I'd be concerned if people are not improving, they get very lethargic, they have difficulty breathing, are not keeping up with fluids, or if they develop a cough or it gets worse." If these symptoms arise, call a healthcare provider or take the patient to the emergency room.
He says a mild or slightly annoying cough isn't a red flag, but if all of a sudden, you hear them coughing more and more, or bring up phlegm or sputum, it might suggest a secondary bacterial infection is starting.
Also watch for a change in condition. "If your patient seems to be getting better and better, and then all of a sudden takes a turn for the worse, for sure that would be an indication to see someone right away," urges Dr. Schaffner. "At that point, don't delay. Go to the ER. Decisions that put off seeking medical care, even by a few hours, are not good decisions. Once that yellow warning light goes on, you need to see someone quite promptly."
If that's the case, doctors may order a chest X-ray to see if pneumonia or bronchitis is involved, and could prescribe antivirals and antibiotics.
• Hydrate, hydrate, hydrate. If swine flu has sidelined you, it's important to make sure you get enough liquids. That's even more important than usual, because H1N1 tends to cause issues like nausea, vomiting, and diarrhea—things that dehydrate you fast, explains Jamey Wallace, ND, naturopathic physician and medical director at Bastyr Center for Natural Health in Seattle. Patients feeling too ill to eat should frequently sip water, fruit juices, or even ginger ale or Gatorade, says Dr. Schaffner. Warm or hot liquids, if tolerated, can also help ease congestion and loosen phlegm.
• Allow some sweating. With your physician's direction, it can be okay to let a moderate fever run its course. "The body generates a fever to activate cytokine production, chemicals it makes to fight infections. If we suppress the fever, those cytokines don’t get made in as big a volume as the body wants," explains Dr. Wallace. "Naturopathically, we want to support body's healing process. Lots of people will come back and say getting under covers and sweating really does help." Just keep monitoring the patient's temp, and keep your doctor abreast of any changes. A simple pain reliever like acetaminophen can help with aches and fever; avoid giving products containing aspirin to anyone under 19 years of age.
• Know what's up with the flu shot. Supply hasn't caught up with the demand for H1N1 vaccines, and many people are having trouble finding H1N1, and sometimes even seasonal-flu vaccines. About 30 million doses—several million doses less than originally anticipated—should be shipped out toward the end of this month. The shipments go to state health departments, who then distribute it further. Stay tuned to local newscasts and newspaper reports to find out when and where it's available in your area. Dr. Schaffner says you'll have better luck locating a vaccine at a state health department flu-shot clinic than your individual doctor. He adds that no severe adverse reactions have been reported after adults, including pregnant women, and children were vaccinated during clinical trials.
But Dr. Schaffer warns not to forget about the threat of seasonal flu, either. "Being exposed to and developing immunity to H1N1 will not protect anyone from seasonal influenza," he says. "We expect once we get into December, January, and particularly February, we'll see an increase in regular seasonal influenza, and there may be H1N1 mixed into that. But seasonal viruses will go to work at that time. It's a double barrel—first H1N1, and as it abates, seasonal influenza."
• Protect uninfected family members. Coming down with swine flu doesn't have to be a prison sentence, but to protect uninfected family members, it's important to designate a sickroom for the recovering patient to spend most of his or her time in. Fresh air and/or a humidifier can help keep the room from being uncomfortably dry. To boost immunity, uninfected people can also take elderberry extract, vitamin D, or vitamin C, although you should always consult with a physician before doing so. And while herbal flu remedies for the sick have been in practice for sometimes hundreds of years, there have been few peer-reviewed scientific studies examining them. However, a recent study published in the journal Phytochemistry shows some promise. Researchers found that elderberry flavonoids killed the H1N1 virus in lab studies, but the outcome has not yet been replicated in human studies. Also of note, Dr. Wallace says, not enough research has been done to determine if it's safe or unsafe for pregnant women. Always talk to your medical doctor or naturopathic doctor before taking supplements.
Taking nonmedicinal intervention into consideration, some other studies have shown that using flu masks can also lower family member transmission rates within the home.