Dr. Marc Siegel: Flu fears and facts

The flu scares people. In one respect, this can be a good thing – fear can be a great motivator to action. But it can also cause people to freeze, and take fewer precautions.

In the case of this year’s severe flu season, we may be looking at more than 50,000 deaths in the U.S. with over 50 million cases of the flu and 500,000 hospitalizations.

These numbers are truly and rightly frightening. In the short term we must worry about and mourn the 37-plus children that were taken from their families, often in the prime of life. In the longer term, we worry about the larger threat that flu presents to our entire society.

So, what do you need to know to protect you and your loved ones?


The first order of protection remains the flu shot. According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases who I interviewed last week, the flu shot is expected to be 30 percent effective this year at preventing the flu with an additional benefit in terms of limiting spread and decreasing severity. That makes it well worth getting, even though, as Fauci says, the process of inoculating this strain in eggs led to an antigenic drift (slight mutation) away from the vaccine target. Dr. Fauci is overseeing efforts to come up with a universal flu vaccine. Targeting the stalk of the H (hemagglutinin) protein on the surface of the flu has improved chances of an effective vaccine dramatically, and clinical trials are underway.

In the meantime, the current vaccine is still well worth taking. People need to understand the concept of herd immunity. If you take the flu vaccine, you are not only protecting yourself, you are also decreasing the risk of spreading flu to a young child or elderly parent or pregnant woman you may come in contact with. Those with chronic illnesses are at much higher risk of flu complications from secondary infections (i.e. pneumonia, ear infection, meningitis, etc.) or a heart attack, which is several times more likely if your body is stressed from fighting the flu.


The flu virus is much more powerful than most other respiratory viruses, and common symptoms include fatigue, muscle and joint aches, headache, sore throat, and sinus congestion. In a young child, your first tip that he/she has the flu may be a behavioral change or the fact that he/she may stop drinking fluids. Rapid flu tests are not entirely accurate but can be helpful in confirming the diagnosis in unclear cases.


Everyone with the flu should stay home, and though many experts recommend keeping the child home until the fever resolves, I believe that this may not be long enough, since your child may continue to shed flu virus and infect others even after his/her fever resolves. Schools are closing when a large number of cases appear in both students and teachers, since there is at least a 25 percent chance of contracting the flu from someone who has it. This risk may be even greater in schools, where kids are constantly touching their noses and each other and surfaces, and coughing or sneezing into the air. When a school is closed, common surfaces (which may harbor the flu virus) are disinfected.


If your child is confused or not responding normally, not eating or drinking or peeing, has a high fever or is short of breath, then the hospital is in order. Intravenous hydration may be necessary with a severe case of the flu. Flu can occasionally cause a hyper immune response (cytokine storm) which can be life threatening. Associated infections like pneumonia are more common at times like this, and must be treated with antibiotics at the same time as your doctor is treating your flu with Tamiflu.


The second line of defense against severe flu are anti-viral drugs including Tamiflu, which Dr. Fauci told me is underutilized. The flu virus has two proteins on its surface, the aforementioned hemagglutinin, which allows it to attach to your cells, and neuraminidase, which cleaves the virus (after it has reproduced inside) from your cells and allows it to jump to a neighboring cell. Tamiflu blocks neuraminidase from working. Tamiflu has been shown to cut down on severity and duration of flu and perhaps most importantly, it decreases spread. I prescribe it liberally for those with the flu but at the very least it should be given to patients who have high risks of complications (including pregnant women) as well as those with the flu in households where others are at risk. I also give it prophylactically to those with chronic conditions who have come in contact with the flu.


This flu season peaked early and is currently widespread throughout the continental United States. It is likely to rage on for several more weeks. I and others predict that it will be the worst flu season since 2009, a pandemic year. There are many things we can do to minimize the terrible threat the flu poses, beginning with remaining informed and staying calm.