Influenza: Signs, Symptoms and Self Care
Guest: Dr. Mike Schmidt - Basic Sciences/Microbiology & Immunology, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: Dr. Mike Schmidt is Professor of Microbiology & Immunology at the Medical University of South Carolina. Dr. Schmidt, you’ve been very actively involved both locally and nationally in the response to H1N1 Influenza. Let’s talk, in this podcast, about what a person should do if they think they might be coming down with symptoms. Sometimes, in the beginning, you don’t really know if it’s the cold or the flu, right?
Dr. Mike Schmidt: That’s correct, Linda. I think the best medicine for this is prevention. How you figure out if you have this new version of flu, H1N1, or Swine Flu, or whatever term we’re using for it this particular week, is to recognize whether or not you flu-like symptoms. First, you may, or may not, have a fever greater than 100 degrees. One hundred degrees is the gatekeeper fever for influenza-like illness. The second item is whether or not you have the upper respiratory thing. That could be a cough, a runny nose, congestion in your chest. And, the third thing is whether or not you have these aches and pains and chronic tiredness, which has a medical term, called lethargy. I heard something very early on in this outbreak about what lethargy feels like. The best definition I’ve heard is, I was too tired to text. And so, if you do have these symptoms, the best thing you can do is to call your physician.
Dr. Linda Austin: Now, just to clarify, Dr. Schmidt, when you say that you may, or may not, have fever, did you mean that if you have flu, you will have fever, or sometimes flu does not have accompanying fever?
Dr. Mike Schmidt: This particular virus, in some instances, is presenting with fever. In some instances, it’s not. It’s one of these peculiar things of the flu virus. It’s got these symptoms that are, in general, taking place. And there are generally the three: fever, cough, and aches and pains. With this particular version of the flu, fever may or may not be present. And you, actually, may present with a GI complication; like diarrhea and upset stomach.
If you have the majority of the symptoms; two out of three, then it’s probably wise to call your physician and ask their advice. Don’t go to see your physician. Call them first. And then, based on their understanding of your medical condition, and your conversation with them over the phone, they will decide the best course of action for you, whether that’s to go into the office, or whether they’re going to prescribe medication. There are two medications available. They’re branded prescriptions; you’ll need a prescription. Their trade names are Tamiflu and Relenza. And the physician may elect which one is best for you.
Dr. Linda Austin: What if you’re in that kind of gray zone? There’s always a gray zone where you’re not sure if it’s a terrible cold or mild flu. Is it okay to just kind of tough it out and not take one of those medications, assuming you’re a pretty healthy person?
Dr. Mike Schmidt: It really depends on your health status. If you have one of those other factors that enhances viral illness; an upper respiratory condition; like asthma, diabetes, hypertension, or something that’s limiting your health status, then it’s best to err on the side of caution and call your doctor to get their advice as to what you should do.
Dr. Linda Austin: What age groups are particularly at risk?
Dr. Mike Schmidt: In this particular case, what we have witnessed, since April, when this flu emerged, is that it’s really our student population, from preschool all the way up to advanced postgraduates; all the way up to 30 years of age. But again, if you have any of these other complicating factors; like asthma, diabetes, or hypertension, you then, of course, can be any age and be especially susceptible to having a bad course of this particular flu.
Dr. Linda Austin: So, this type of flu, H1N1, is a little bit unusual, isn’t it? We usually think of the very old and the very young as being particularly at risk. But it sounds like pretty young healthy people, like college age, could be hit pretty hard.
Dr. Mike Schmidt: We’re getting a lesson in history with this particular virus. We haven’t seen a pandemic, that is, a virus that circles the globe very quickly, for well over 40 years. And so, the majority of the planet is under that age group. So, they’ve never seen this virus, which is why they’re so susceptible.
The other hallmark trait of this virus is that it’s easily transmitted to another person. So, if there are three people in the room and one person has the flu, the likelihood that one of the other persons will get it is extremely high. So, it’s got a 50 percent attack rate. And that’s pretty incredible for a virus. So, the best thing you can do to protect yourself if there’s someone who has flu-like symptoms in your area is to encourage them to leave, you know, go home and rest, or make certain that you practice hand hygiene, and that they practice cough etiquette; cough into their elbow, and contain their sneezes and coughs into a tissue or some other disposable product that you don’t need to worry about. But, it’s hand hygiene and cough etiquette that, really, will protect you.
Dr. Linda Austin: Are people contagious even before they’ve developed symptoms?
Dr. Mike Schmidt: That’s the other aspect of the flu that’s teaching us a great lesson, which is, you’re infectious 24 to 48 hours before you can display symptoms. This particular flu virus has an incubation period between two and five days, which is very different than the seasonal flu, in which if you could almost forecast if you saw someone two days before, you’d then have the symptoms. So, this one has a little longer incubation period. But, generally, it’s about two days when you’ll display symptoms. But, you can be infectious one day before you display a symptom.
Dr. Linda Austin: And, how long after you display symptoms, during the entire symptomatic course?
Dr. Mike Schmidt: The recommendation that healthcare professionals are providing to their patients is that you should not return to work or school until you are fever free for 24 hours. So, you have to make certain that you’re not taking one of these fever-lowering medications; like aspirin, or Tylenol, or Advil/motrin, any of the ones that drop your fever. You have to be off of those meds and fever free for 24 hours before you go back and see your friends and neighbors.
Dr. Linda Austin: Dr. Schmidt, thank you so much for talking with us today.
Dr. Mike Schmidt: Thank you, Linda.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.