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Off Topic Heads Up: 2017/2018 Flu Worst in a Decade or More, Killing Young and Old

For more on health, see my articles on health and nutrition at WindInMyFace.com.

We’ve all been vaccinated, but even so, my whole family got some kind of virus that causes small airway impairment for all. Having had low-level asthma for years, I’ve treated it little over the years, but several days I had to triple the recommended dose just to keep it at bay. I’m now on day 3 of 4 of prednisone (a steroid to reduce inflammation/fluid), and that’s helping but it’s still reactive, particularly in the evening.

My point being that we were all vaccinated and a simple "cold" got down deep into the lungs with all of us. But what if you got that and this year’s flu together?

My wife took my daughter to urgent care for an unrelated issue, and it is *nasty* in there—people in bad shape coughing and just looking awful. It’s a good place to pick up a nasty bug—stay away unless something really urgent, at least here in the Bay Area.

Related: few people realize that pneumonia can develop from many causes), and that one cause is viral infections in the lungs that can then run concurrently with bacteria. I’ve had pneumonia twice, including a fist-sized ball of puss in one lung that left it scarred. The thing is, pneumonia never felt like being very ill, just weak. Blood O2 saturation drops and it doesn’t feel that bad, so you don’t pay attention and then it is serious. Pay attention.

2017/2018 flu

Flu is killing the young and the old in California, but in nearby Santa Clara County, of the five dead, none were vaccinated—a preventable tragedy. The vaccine might not always work, but it gives the immune system a head start, thus making it critical for the young and old and otherwise at risk.

Public health officials continued to press the public to get flu shots, saying it wasn’t too late, and that the vaccine offered perfect protection against three of the four strains. Health officials said one strain, Influenza A H3N2, is why flu season seems more severe this year.

Get yourself and everyone vaccinated immediately to have some chance of resistance. And get good sleep for several nights, because vaccine efficacy (in general) is said to be diminished by poor sleep. The immune system takes two weeks or so to respond, so do not delay. Places like CVS Pharmacy and Safeway supermarkets offer the flu vaccine cheaply and on a walk-in basis, so you have zero excuse for not acting.

The H3N2 flu virus is known as the hospitalizer. Here’s why.

Flu-related deaths continue to climb in California. Here’s the latest toll

Vicious influenza strain sweeps Bay Area, deaths up in state

California’s deadly flu season could be worst in a decade

The way it's spreading, an unlikely but possible mutation cannot be ruled out, and what’s scary is a cross-species flu running wild. If that seems melodramatic, see the morbidly fascinating article on 1918 flu in How the Horrific 1918 Flu Spread Across America. One mutation the wrong direction, and all heck could break loose.

A state epidemiologist told reporters that this could be the worst influenza season since 2009, when the H1N1 or Swine flu pandemic killed 12,469 people nationwide.

Influenza A H3N2 is what’s known as “a non-human influenza virus that normally circulates in pigs,” according to the federal Centers for Disease Control and Prevention. In 2011, H3N2 was detected, and it turned out to be a whopper, because it contained genes from avian, swine and human virus, as well as the 2009 H1N1 gene, according to the CDC.

Infected pigs can spread it to humans in the same way humans get it from each other: coughs and sneezes and infected droplets that are inhaled. In general, influenza viruses are always mutating, but the H3N2 virus is especially cunning, some scientists say. It’s not an alien shape shifter, but some scientists say it mutates so quickly so that vaccine makers can’t quite catch up to it.

While H3N2 can cause more severe illness among those age 65 and older and people with underlying medical conditions, it poses a threat to children, according to the CDC, because children born after 2001 have little to no immunity against it.

The first death is troubling and extremely scary if indeed a flu-caused death, but maybe it was botched surgery leading to sepsis. Still, the fact that doctors are “baffled” by the death is disturbing:

San Jose mom is among 42 California flu deaths

The tragedy of her rapid physical deterioration has left them devastated, said her brother Anthony Oxley.

And it stunned physicians at Good Samaritan Hospital who worked desperately to save her life, he said. “They brought in specialists — they were baffled,’’ said the commercial contractor, who lives in Gilroy and had rushed to the hospital’s Intensive Care Unit early Thursday morning to be with his sister.

“The doctor was saying that he had never seen anything like this, and it was not supposed to happen,’’ Oxley recalled. The results of an autopsy are expected to be released this weekend, he said. His sister had gone into septic shock before she died, possibly linked to a broken hand she had suffered in a recent car accident.

Reader comments

David C writes:

I am not a doctor or other health professional, however I read a lot.

Flu viruses are frightening for two main reasons: they are single strand RNA viruses, meaning no proofreading during replication (none of that double strand machinery we are accustomed to when thinking about DNA copying) which leads to a high rate of mutation (copy errors); and their RNA is in multiple sections (I’ve read “boxcars” as the analogy), which can lead, if more than one strain of virus is present in the same cell, to reassortment, meaning exchange of boxcars between strains. mutations can be thought of as drift whereas reassortment should be thought of as a leap.

The two means of producing new strains of virus are the reasons it is difficult for vaccine development to keep up. the way I read it mutations are not necessarily so bad because the current vaccine may still affect a mutated version, but reassortment produces something entirely new that an old vaccine will not stop. of course sufficient mutation does produce something new, same problem.

You mentioned concurrent pneumonia; from what I’ve read pneumonia was probably responsible for most deaths in the 1918 flu epidemic that killed 50-100 million people worldwide. pneumonia can be caused by viral or bacterial infections and typically is something that hits you when you are down, as you are when you have the flu. in the 1918 edition I’ve read it was a bacterial pneumonia, which we might be able to treat (given sufficient quantities of a suitable antibiotic), but it could just as well be a viral pneumonia or some other nasty virus that we can’t. pneumonia alone (all types) steadily kills an estimated 4 million per year worldwide, a lot, but as far as I’ve read there are no epidemics of it, it is just a steady killer of the young, the old and the otherwise infirm.

One more advantage to the flu bug, you can be infectious for a day or so before showing any symptoms which reduces the effectiveness of the “if you have a cough don’t come to school” strategy.

Flu is one of the things that keeps health professionals awake at night: a leading candidate for “the next big one”. it routinely kills (estimated) 250-500 thousand yearly worldwide as it is, and evolution tries out new versions every year…

DIGLLOYD: there is work going on with a novel approach for a universal flu vaccine. I hope that it will be invented and work and influenza can go the way of smallpox. But with Crisper and modern tech, all that nasty stuff can be made from scratch or taken from a deceased body so there is no assurance of elimination. Still, it would be a major leap forward.

To say pneumonia was responsible for 1918 flu deaths drops too much context: if the lungs are infected by a virus and weakened, all sorts of bugs can move in and set up shop and the lungs can fill with fluid and pus and so on. Thus the root cause was the flu, even if an opportunistic bug dealt the killing blow. Also, pneumonia is a general term referring to a whole host of infections in the lungs—bacterial, viral and both together. At the least, get a pneumococcal vaccine, which prevents certain types of pneumonia.

The major risk this flu season is the trans-species flu going around aka the H3N2 flu. A virus that flexible is a very serious risk and a mutation in just one person (or pig) could kill tens of millions of people. The 1918 flu killed in as little as 2 days and if such a virus emerges again, there will 1000 times more ill people than hospital beds, if the staff themselves are even functional.

Just some advice based on personal experience: pneumonia can just feel like lethargy, with blood O2 levels dropping, no fever or chills, etc—in short, if you get that kind (which I’ve had), you might not get medical care so you wait a day or two, and then it’s an all-out effort in the ICU a few days later. A simple XRAY can generally spot the fist-sized ball of pus I had in my left lung, still scarred which I know because that’s where it hurts if I get a viral infection. But I’ve been very infrequently ill for years now with excellent dental health—signs of a strong immune system. Still, my lungs are the weakest point of defense and I’m vulnerable because of it.

Bob P writes:

I used to get several colds during the winter and usually a bout of the flu, even after getting a flu shot. But I started a new regimen in 2000 and have not had a single cold for flu since—without any flu shots.

I buy a gross of disposable face masks, the simple flat kind you see hospital workers wearing. I wear one of these every time I go to the post office, grocery store, coffee shop, etc. When I get home, I always wash my hands. I started doing this when I realized that many people shop, eat and drink sick and have no problem coughing in front of others. Many shop clerks cough into their hand, and then pass you the receipt or drink with the same hand. The face mask I wear during flu season from October to April. A side benefit is it keeps the nose warm in winter.

Every once in a while I can feel that I am coming down with something, despite my precautions. In these cases, I take 50,000 units of vitamin D3, which is a natural anti-viral. It has no side effects. I usually take it in the evening with with some fat or oil (it is oil soluble) and wake up in the morning feeling completely well.

I see that many people in the Orient wear these face masks. I hope that it will catch on here so we can reduce the loss of time, the discomfort of a cold, and fatalities from the flu.

DIGLLOYD: good advice. I rarely take ill, so long a period passes between that I hardly remember... but with travel and short sleep and hard training, I pick up a cold once a year or so.

I also take Vitamin D high does at such times, such as Vitamin D3 5000 IU. Gargling with salt water as salty and as hot as you can make it seems to forestall a sore throat turning worse.

Don’t forget that paper money, in addition to being based on nothing (fiat currency), can carry all manner of nasty bugs.

Face masks seem like a good idea, and certainly are anywhere someone is sneezing into the air. But I’m not clear how such a mask can stop micron-size viruses floating around. I wore a face mask for dust last spring in a double century and that made all the difference. But dust is very large in terms of particle size.

A vigorously healthy Jeroen B nearly died from pneumonia:

Pneumonia? That’s a disease people died from like 50-60 years ago, right? Wrong! Though it may not be the killer disease it used to be, it should not be underestimated, not at all! Allow me to share my experience with you and your readers.

Last summer I was in perfect health and excellent physical condition (*) when I embarked on a demanding-but-not-extremely-so, off-trail solo hiking trip in the mountains of Norway, a terrain comparable to Gates of the Arctic NP in Alaska in terms of ruggedness. Three weeks without resupplies meant a 60 pounds backpack, and that required a more than average physical condition - and so I had trained for months and I was super fit. I’ve done similar trips for the past 10 years in other parts of Norway, Sweden, Siberia, Alaska and Greenland so I knew that my body could easily cope with the tough conditions.

It should have been fun, 3 weeks alone between glaciers in the snow capped mountains, far away from the rat race. But just a week into my hike I developed a nasty cold that wouldn’t get better after 3 days bunked down under my tarp. I decided to cut my hike short and rebooked an early flight home. Back home that (ordinary) cold turned into a severe pain between my ribs, so I consulted my GP suspecting an inflammation of the pulmonary membrane. He listened to my lungs but concluded that it was just a bad case of the flu.

[DIGLLOYD: a pain between ribs is a waving red flag and IMO incompetence to not immediately order an XRAY. Listening as far as diagnosis goes has strict limits; it’s guesswork at best].

Two days later during the weekend, I saw an other GP because my fever was getting higher and I felt a lot worse. This GP suspected an inflammation of the pericardium, did some tests and examined my lungs, too. But it all came up negative and so he sent me home as well, to just sweat it out.

But two days later my girlfriend had to rush me to the ER because I woke up completely lethargic and hardly responded to anything. That doctor listened to my lungs as well and couldn’t hear anything wrong either. But he ordered a blood test and by then the inflammatory values (sorry, don’t know the correct English term) were so high (> 400) that I was on the brink of getting into a shock.

I was hospitalized immediately and put on the highest possible doses of 2 different antibiotics. On the CT scan 90% of my right lung turned up white (i.e. 90% of my lung was inflamed and filled with puss!). The doctors tried to determine the cause: bacterial or a virus, was it Q-fever, the passenger coughing next to me on the plane, Tuberculosis, lung cancer,… Every possible test was carried out, but a definitive answer never came.

After 12 days in hospital my fever finally receded and I was discharged from hospital. I had always been a very lean guy weighing just 155 pounds at 6 feet tall, but now I weighed a mere 120 pounds. I had lost 35 pounds (!) in body weight (-22,5%) and I looked like an Auschwitz survivor. My GP later told me I had had a ’narrow escape’. My lung doctor warned me that the inflammation would take 3 months to clear, and my stamina could take a full year to recover. A whole year!

But it’s almost 6 months later now and my lungs are still healing. The puss and inflammation has almost cleared, but not completely, not even after a whole 6 months. In a way I have to consider myself *very* lucky as most people would have developed severe scar tissue in their lungs after 3-4 months, but I’m still healing which truly is a small miracle. It remains to be seen how much permanent damage has been done to my lungs - though I have good hope that it won’t be too bad. But my total recovery is now also pushed back to a total of at least 1,5 - 2 years. Just imagine, 2 years to recover from a stupid pneumonia?!? F*ck!!!!

It’s now six months later, and my former body weight has returned, is now even over 160 pounds. I take extremely good care of myself. My body demands 3 hot meals a day and they *must* be home cooked meals prepared from fresh ingredients, preferably biological. My body easily overheats under a very light load, yet my feet or my head often freeze at the same time. If I get caught in a rain shower, I *must* take a long hot shower, as I can’t allow myself to catch a cold, and so I carry rain trousers & jacket wherever I go. And, just in case, a towel and dry clothes. I just can’t be too careful!

It’s now six months later, and I still need at least 9-10 hours of sleep a day. Even then, I need an additional afternoon nap. Or two. But just a month ago, I needed 3 naps a day, so I am progressing…

It’s now six months later, and I can work 15-20 hours a week again. I can’t perform beyond that, no way. Hopefully I’ll improve over time, but so far I see no indications…

It’s now six months later, and I can do short walks again, 75 minutes at most and in easy terrain. Any longer (like 90 minutes) and I’ll regret it for the next 2-3 days as I’ll be exhausted and feverish. Will I be able to do hike again like I used to do? I don’t know, but I have severe doubts…

So don’t underestimate pneumonia. It’s still a disease that wreaks lives, not just for infants or the elderly. I thought I was mean and lean, invincible. I’ve always been able to rely on my body for the full 100%, but that’s no longer true… I’m every bit as vulnerable & mortal as any other sucker on this planet - I’m living proof. It’s an extremely confronting fact of life, and I’m having great difficulties accepting these facts. I’ll have to learn and live with this new reality somehow, there’s just no other option.

(*) I’m a 49 years old Caucasian male with a higher than average income, living in The Netherlands where health care is at least as good as (but probably slightly better, and definitely much more accessible than) in your US of A. I’m lean and mean, or so I thought, but it turns out I’m mortal like any sucker.

DIGLLOYD: - lean is not so good when recovering—gain 10 pounds. I mean it—extra body fat sets the body up to accept more training in early season (I know from experience), and helps keep the body more resistant to problems. I'd say aim for 15% body fat (which for me feels horribly heavy)—but that is what you need right now. Eat a lot of fat like olive oil, nuts, plus lean protein and lots of nutritious veggies too— and put on some weight—your body will thank you. Hell, eat a ton of chocolate if you like that (I do!).

The idea that anyone including a trained physician can listen to lungs and call it the flu doesn't even pass the giggle test for competence; see 12-year-old girl dies after flu misdiagnosis, family says.

Babies are particularly at risk; my youngest brother went “code blue” (not far from death) due to pneumonia type infection early in life. He survived, barely.

Hospitals are extremely dangerous places; I should know after watching my own daughter for 3 months in the NICU and seeing a baby alive one day and dead the next from infection. Get the hell out as soon as you can. My own daughter (now 19) would have been dead within hours had we not demanded the nurses check her out right fucking now—she was limp as a rag doll (from sepsis). This physician and nurses in charge had not noticed.

And then there are the lying doctors so ignorant they will not or cannot even answer questions truthfully. That’s why I still suffer mild lingering nerve damage (two years later)—and that doctor is safely retired and to my knowledge never learned of the issue (or at least never bothered to respond)—and thusnever reported it, perpetuating the “rare” bullshit he learned about 40 years earlier, never bothering to update his knowledge. Doctors are great, doctors are terrible, doctors are strong and truthful, doctors are weak and stupid. Judge them as you would judge any human being but do not blindly assume or trust and ask lots of questions and observe the response and reactions—that’s your best protection—awareness.

You must be your own advocate: doctors screw up all the time. If you are two weak, find the most skeptical asshole (in a good sense) friend you can, and make him/her your medical advocate. S/he can press doctors for answers and so on.

Doctors these days are harried and hurried, forced by our wonderful ACA act into a few oligopolies because going along carries huge costs and risks, so they are allotted 7.385 minutes per patient or in effect are reprimanded for inefficient care (made-up number to make the point, but that’s the system now). I pay a modest annual fee for same-day visits if I have an issue, including weekends, but such doctors with classical medical integrity are few and far between now.

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