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The flu cases popping up so early this season have a partner in crime: upper-respiratory viruses that in some cases trigger many of the same symptoms.
And misery, by any name, is still misery.
“I’m calling it flu light,” said Dr. Brian Quigley of the Rex Hospital emergency department. “It’s not really influenza, it tests negative, but the patients still have coughs, body aches, chills, runny noses.”
What’s going around?
The flu: Symptoms often include severe aches and pains, feeling of weakness, headache, chills, coughing, sore throat and fever. Tests positive for the flu. Tamiflu can help.
‘Flu light’: Symptoms can be similar, but may not come on as quickly. Doesn’t test positive for flu. Little effective treatment beyond fluids, Tylenol or other fever medication.
‘Breakthrough flu’: Viruses that test positive for flu but may involve strains that weren’t covered by this year’s flu shot.
How to beat the flu
• Get vaccinated.
• Cover your nose and mouth when you sneeze or cough.
• Get plenty of rest. A weakened immune system generally makes you more susceptible to illness.
• Wash your hands often with warm soap and water. Wash for 15 to 20 seconds. It is the soap combined with the scrubbing action that helps dislodge and remove germs. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.
• Avoid touching your eyes, nose, and mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose, or mouth. Some germs can live for two hours or more on surfaces such as doorknobs, desks, and tables.
• Disinfect your environment at home and in the workplace.
• Try to avoid close contact with sick people.
• Stay home if you are sick until at least 24 hours after you no longer have a fever (100°F or 37.8°C) or signs of a fever.
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
Source: Centers for Disease Control and Prevention
Get more information
• North Carolina Department of Health and Human Services: www.ncdhhs.gov
• N.C. DHHS flu information (includes where you can get a flu shot at a local health department): flu.nc.gov
• Centers for Disease Control and Prevention’s seasonal influenza information: cdc.gov/flu
There are implications for treatment. Tamiflu can help patients with real cases of flu, particularly when caught early, Quigley said. But for the other viruses, little can be done except to ease the symptoms a bit.
“I’ll tell them to get plenty of fluids, take Motrin, Tylenol, multivitamins and chicken soup,” Quigley said. “We’re talking completely old school.”
Adding to the virus stew are cases that test out to be flu, but which apparently aren’t among the three types covered by this year’s vaccine.
Each year, well in advance of flu season, experts take their best guess at the likely strains and formulate the vaccine to protect against those. But there are often at least some cases of other types.
Quigley said every year he sees a few cases of those, what he calls “breakthrough flu.” So far, he has only found two cases, but that seems unusual, given the volume of flu cases generally.
In each case, the person had received the vaccination but developed the illness anyway.
When vaccines don’t work
There are other reasons that people who have been vaccinated still contract the virus, said Nicole Lee, an epidemiologist in public health at the state Department of Health and Human Services.
For one, it can take two weeks for the vaccine to reach full strength, and the early start to the flu season caught some who had just been vaccinated off guard.
Also, the vaccine isn’t 100 percent effective. Still, it’s by far the best way to prevent getting and spreading flu, and public health experts are still urging people to get vaccinated, she said.
Flu season can often last well into spring, so it’s still important to get the vaccine.
Not a mild season
Though it’s still unclear how harsh this flu season will be, it’s getting started weeks earlier than the norm. That could mean a bad season, or it could simply mean a peak that comes and goes earlier in the year, Lee said.
It’s certainly not going to be a mild season, though.
According to statistics released by Lee’s department Thursday, the percentage of outpatient visits to health care providers in a statewide surveillance network that were attributed to flu-like illnesses last week was higher than the peak of any of the past three winter flu seasons.
Already there have been three deaths attributed to flu – also weeks before the typical date for the first death in a flu season in recent years. All three cases were adults living in the central part of the state. Two of those were at elevated risk because of pre-existing health issues.
Viruses in circulation
Some North Carolina hospitals track cases of various other nonflu viruses and feed the data to the state. That shows that at least one type, called RSV, has been closely mirroring the jump in flu cases, Lee said.
Dr. Nicole Parkerson of Raleigh Pediatric Associates said that virus has been popping up frequently. It usually triggers stuffy noses, coughs and sometimes fever.
All told, Parkerson said Thursday, she is seeing about 20 children a day with upper respiratory tract viruses and about three to five a day with flu. The other doctors in her practice, about six on any given day, are seeing about the same amount.
One difference between the illnesses, she said, is that flu usually comes more quickly, with the fever and chills rapidly sapping a patient’s strength.
The volume of flu cases isn’t heavy, at least yet, she said, but it’s obvious that the season began early.
As to the cases that test positive but apparently aren’t a strain covered by the vaccine, the good news is that they seem milder than other cases of flu this year, Quigley said.
A big reason is that, of the two most common strains so far, the oft-harsher H3 type has been identified in 113 of the 117 cases tested so far in the state public health lab, Lee said.
The lab tests only a handful of suspected cases across the state, because the testing is for surveillance of the flu season rather than diagnosis.