Last week I went to bed in the evening feeling rather proud, having beaten some crazy work deadlines that had been causing me sleepless nights. I was looking forward to a blissful, worry-free night. This came to an abrupt halt at four in the morning, thanks to the flu.
I woke up feeling extremely cold. I was trembling, my muscles were hurting and my joints were on fire. The mother of all headaches was brewing and there is nothing I could do to stop it. I dragged myself out of bed and checked my temperature. We were already at 38.7°C. I found a couple of paracetamol tablets, popped them and washed them down with some water. The flu had just checked into my life.
The next 48 hours were a repeat cycle of the same, every six to eight hours. I wasn’t eating much as I had lost my appetite and I had developed an irritating, dry cough. I toughed it out for three days before the recovery started. The fever broke, the muscle and joint pains eased and I could finally tolerate food.
Most of us interchangeably use the term flu and common cold. The two conditions are worlds apart. A common cold is a viral upper respiratory tract infection caused by adenovirus or rhinovirus. The flu refers to infection caused by the influenza virus. The infection affects the whole body with symptoms such as chills and rigours, headache, fever, loss of appetite and malaise. It is, therefore, not uncommon for us, coming from a malaria-endemic zone, to confuse it with malaria.
The influenza virus comes with an apt title as described by the World Health Organisation (WHO), a most predictably unpredictable infection. The virus has multiple strains and mutates so efficiently that vaccines made become obsolete within a year.
Over time, the flu virus has managed to sneak out and cause massive damage. In 1914, the world’s worst flu epidemic struck. Between 1918 and 1920 a disturbingly deadly outbreak of influenza tore across the globe. One third of the world’s population was afflicted, with more than 500 million people losing their lives. It is reported that up to 25 million of these deaths happened within the first 25 weeks of the scourge. No other epidemic or pandemic can hold a candle to the damage caused by this one outbreak. It left the world shaken.
The Hong Kong flu of 1968 managed to take out at least a million people, half of whom were residents of Hong Kong. Its predecessor happened to originate from China in 1957, causing a death toll of a million people too. More recently, we have had to deal with the “swine flu” that took about 300,000 lives in 2009.
The influenza virus infection can range from a mild form that quickly clears off, to an intense, highly contagious, life-threatening epidemic. Some strains, such as the avian flu, are transmitted by other animals. It is not a new disease, but it is one that should cause concern, in view if the nature of the virus itself.
There is nothing more frustrating to a doctor, than attempting to treat the flu. A patient cannot comprehend why they can feel so bad and they are only offered pain and fever medication and encouraged to rest it off.
Sammy* was one such patient. He came to the outpatient department feeling sick and was seen by the doctor. He was reviewed and had a few tests done to ensure he did not have malaria. He did not believe that the doctor was sending him home on just paracetamol. He opted for a second opinion and that’s how he ended up in my consulting room. It was no mean feat trying to reassure Sammy he was fully taken care of.
It is critical for patients to understand that a flu infection does not respond to antimalarials or antibiotics. The body’s immune system will have to fight it off by itself. All we can do is relieve discomfort as much as possible, encourage fluid intake and prescribe lots of bed rest to give the body a fighting chance. In severe cases, antiviral drugs may be given, but this is not routine treatment.
The most susceptible age group comprises the extremes of age — the young ones below the age of five and the elderly. This group does not benefit from the annual flu vaccine. The vaccine does not eliminate the risk of getting the flu, but ensures the episodes are fewer and milder.
As a country, we are not out of the woods with the possible flu epidemics. WHO, on the spotlight about the flu virus, warns us that the unpredictability of the infection means we are staring at an outbreak. The only question is when it will happen.
As a country, Kenya may not be too ready to handle an outbreak. Flu vaccine is not yet routinely available to all. Our reporting system for flu infection is non-existent and there are every few laboratories that have capacity to test for the various strains of flu. It, therefore, becomes difficult to plan for a coordinated response in the event of an epidemic.
Everyone in their personal capacity can help curb the spread of the flu this season. It is important to wash hands well and frequently, avoid unnecessary contact with infected people, get vaccinated for the new season strains.
Further, we all need to put a stop to antibiotic misuse in the treatment of flu. Antibiotics have absolutely no role in flu treatment. It does not matter whether the fevers go up to 40°C or not!