Flu fever cold

Sneezing, watery nose, sore throat, body ache, fever?
Swine Flu?

Almost all of us, at least once or twice a year, with season change, get this common
ailment with varying degree of severity, some times lasting for 48 hours, gradually with
waning of symptoms as the days go by. Some times we go to Doctor or more often than
not, we self medicate, some taking happily over the counter “Cold medicines” (most
dangerous!), or some times taking just painkillers lying in our medicine chest
(with expiry date long over!), and claim ourselves to have cured ourselves!! Those of us,
who go to our GP, take his advice of bed rest rather lightly but do take whatever
Antibiotics he prescribes. Some take “homeopathic” pills and scrupulously avoid any
allopathic drugs. Whatever measure we take out of above choices, most of the time all the
symptoms do subside within 3-4 days and everything is forgotten as a “common flu”!!
Even in common medical parlance, it is axiomatic to say that in “flu” if you take
antibiotics, you are cured in just one week and if you do not take medicine, you suffer for
whole seven days!! (Actually antibiotics do not have any effect on Viruses. They only act
on Bacterial infections- which is the next progression of the disease.)
All that changed suddenly, with arrival of novel A H1 N 1 Virus- a subsection of myriads
of so called “flu” viruses but a new strain and a much milder version than the other more
common lethal versions!!
Earlier, so called Bird Flu, which produced Systemic Acute Respiratory Syndrome
(SARS Virus) which was potentially much more lethal, had also created a similar frenzy
world over, but got quickly controlled in its spread, making it endemic, mainly confined
to South East Asia. This time, before one could pinpoint the new virus, it got quickly out
of hand, starting in Mexico, spreading mainly in Western countries and now in over 134
countries world over and in India- making it Pandemic. The problem arose as it took
some time to realize that it was a new virus, it took some time to produce a reliable Lab
test (it is expensive and sophisticated test requiring sophisticated Lab Facilities) and
selecting a specific Anti Virus medicine. Antibiotics do not work. All this, and its close
similarity at initial stage to “common flu” lead to slipping out of control, and spread like
wild fire, making it pandemic. This is true of all the new viruses which affect mainly
upper respiratory tract infection. It is the “newness” of the virus, which makes it long
time to detect, develop effective Lab test and produce particular anti virus vaccine or
treatment- thus making it more dangerous than the usual flu virus.
The media lapped it up as “Breaking News” and now it has become daily news item of
reporting one more death or one more city being affected!! But the fact is at the time of
writing this article in total 69 deaths have taken place, with 3095 confirmed cases, in the
population of 1.2 Billion. In contrast hundreds and thousand time more people are dying
of road accidents, TB, Malaria and even simple diseases like diarrhea, and dysentery. But
then, they are not fashionable diseases, nor are they latest viruses, and hence not a
“Breaking News” item!!

It is pertinent to note, that in any virus infection, including that in “common Flu”
variety, sometimes immunity falls down to dangerous level, and Bacterial infection
quickly takes over, affecting Respiratory System, producing Pneumonia, and if not
treated aggressively at the beginning of Respiratory tract infection with appropriate
antibiotics and with appropriate dosage and for appropriate length of time, it can
lead to a critical condition.

Failure to recognize this development in the course of illness, can lead to serious situation
requiring ICU admission in the hospital. It also requires a constant monitoring of vital
signs, Oxygen saturation and concentration in the blood and if found wanted, to take over
the respiratory function with artificial ventilation (Ventilator). In most of the time with
these aggressive measures, Pneumonia will subside and there is full recovery. How ever
those with co- morbid conditions like failing heart, Diabetes, elderly with poor respiratory
reserve and children- the vulnerable group, may not respond and go into almost fatal
Acute Respiratory Distress Syndrome, with multi organ failure where fatality rate is very
high. Many elderly people who die of Pneumonia every year, have this origin of the
common flu, not recognized early of its Bacterial invasion phase and hence under treated
due to failure to recognize the seriousness of the situation until the final hours , when it
is too late.
This is happening almost daily all over without much of a fuss or mention in “Breaking
News”!! In fact during the seasonal change in weather or at the onset of winter (October,
November December) for this vulnerable group it is worth considering Anti Influenza
(Flu) vaccination. Epidemic of Community Acquired Pneumonia is much more common
in these seasons.
How should then we react to H1N1 scare? Should we brush aside as media hype? Or
should we start going about with mask or handkerchief looking like Bandit Queens!
We should do neither. It is important to realize Flu is a serious situation which should
cause concern, not alarm, H1 N1 not withstanding, - calling for preventive measures and
once infected close monitoring, appropriate bed rest, certain precautions (no aspirin), and
once early signs of Respiratory Tract infection appears, calling for aggressive treatment
with right antiviral drug and right antibiotics for right length of time. More than 98%
chance that you will recover.
It is now well recognized that A H1N1 infection can be detected with specific tests to
pinpoint in affected people and having a specific antiviral drug (Oseltamivir or
Zanamvir)) Tamiflu® to cure it- provided it is given in right time i.e. within 48 hours of
infection to be 100%effective. And there lies the catch-22 question. When do we suspect
that it is not a seasonal flu but the new variety?
High degree of suspicion is the key word.

If fever persists or becomes very high with newer symptoms appearing as breathing difficulty or asthma, vomiting or diarrhea etc, then you require hospital admission in ICU without any further delay. You should have a list of hospitals both Government and Private, where H1N1 Virus detection tests are available and where they can start you with Tamiflu® even before the test results arrive and on high suspicion especially when the results take undue long time to arrive. You should insist on that*. Time is essence. You therefore need to involve your family physician from the early stage of illness, so that he can monitor you closely from time to time and take appropriate steps. Children below 6 and adults with co-existing conditions like asthma, diabetes, chronic heart diseases are more prone to A H1N1 virus influenza. What about Preventive measure? Certainly most positive preventive measure is to have a “Flu Vaccine”- particularly who are vulnerable- children and elderly and those with chronic debilitating disease like Diabetes. At Healthspring Community Medical centers we are armed with Flu vaccine and our Physicians are well conversant to deal with suspected case of H1N1 virus and all other viral fevers. Whenever there is seasonal change, and increased frequency of Cold and Cough cases- the so called “flu” you hear, you should avoid crowded halls or confinement in a crowded space (cinema halls for instance). Stop smoking if you have not done so already, take a daily dose of Vitamin C and do not neglect cold and cough and body ache. You need to take immediate action before it takes a serious turn. This is more so for vulnerable group. If some one sneezes repeatedly or coughs, ask him to cover his mouth and nose with handkerchief and keep a safe distance from the person (minimum 3 ft). Masks are needed for those who are in hospitals treating you and those in isolation ward with established H1N1 infection afflicted. If in your child’s school there are few incidences of absentees in the class for so called “flu” , “cold” and fever, it is better your child is at home rather than in school. Parents therefore should be alert during these seasons- the early part of climate change. Always wash your hands with copious soap and water as often as you can and certainly when you come back home from work. It is certainly better than just using hand sanitizer, though very convenient, but inferior in efficacy than soap water hand washing for 2-3 minutes. Dr Gautam Sen MS (Bom) FRCS Ed FRCS (Glasgow) FRSM (London) Author is Professor Emeritus Surgery, Grant Medical College. Chairman, Healthspring Community Medical Centeres For further query: drgautansen@gmail.com * Personal View. (This article is personal view of author for public general information and purposely dealt in layman’s language. It should not be considered as treatment guideline.)
Tables

Vulnerable Groups

• pregnant women; • household contacts of infants under 6 months; • healthcare and emergency-services workers; • young people between 6 months and 24 years of age; • adults with underlying risk conditions, such as diabetes and chronic lung
Some dos and don’ts in “Flu Season”

Protect yourself with Flu Vaccine

Wash your hands as often as possible (For 1 minute). For children (Complete singing
Happy Birthday 4 times while washing hands!)
Avoid crowded places/ Smoky Rooms
Stop Smoking if not done already
Use Tough Tissue Paper to block mouth and nose while sneezing and coughing and
discard once soiled.
Keep safe distance from person sneezing, coughing (minimum 3 ft)
Isolate family member in a separate room with suspected flu symptoms
Bed Rest, Bed Rest, Bed Rest.

Paracetamol 8 hourly for Fever Not Aspirin. Plenty of Fluids. Vitamin C 1gm daily.
See your Family Physician early.

Source: http://www.healthspring.in/wp-content/uploads/2012/09/Flu-Fever-Cold.pdf