AVIAN FLU: TREATMENT OPTIONS
If the H5N1 virus becomes a pandemic, as many as 2 billion people may contract the virus, and many millions will likely die. Right now, we have no way of knowing just how bad the Avian Flu will be, if this should happen. Early indications, however, are not encouraging.
The Spanish Flu of 1918 killed between 50-100 million people worldwide. The exact number is unknown, and for years, a much lower number of 20 million was assumed. Today, historians and scientists still argue over the number, but the consensus is it was much worse, particularly in places like India and China, than we once believed.
The next pandemic, even if it is no more lethal than the Spanish flu, could kill 300 million people, simply because of the increase in the world’s population since then. Of course, we saw pandemics in 1957 and 1968 where far fewer people died. Nothing is certain right now.
But Scientists say the H5N1 virus is the worst influenza virus they have ever seen. There is hope that when it mutates, it will trade lethality for virulence. But nobody knows if that will really happen.
Obviously, if 1 in 3 persons in the world becomes infected, you, or someone you know, will likely become a victim of this flu. You need to know what to expect, what your options will be, and how best to care for yourself or loved ones.
What follows is not specific medical advice. I am not a doctor. You need to do your own research, and make your own determination as to how you will treat this, or any other illness. Caveat Lector.
Why is H5N1 so deadly? And why particularly to the young?
So far, more than 90% of the fatalities from H5N1 have been among those under the age of 50. There are many theories as to why this might be. Historically, the flu kills older people, not the young. But scientists think they have a clue.
H5N1 is a novel virus, and so when a person gets infected, their body throws all of its defenses against it. The symptoms of flu, the fever, body aches, and lung congestion are more a sign of the body’s fight against the virus than the virus itself. When a young person, with a strong immune system, gets infected, their body goes into overdrive to fight it. This can lead to what is known as a Cytokine Storm. The release of millions of antibodies against the virus. And these antibodies can cause the lungs to fill with fluid, and the patient drowns in their own defenses.
Older people, with dampened immune systems, seem to avoid this complication. Of course, this flu can kill anyone, at any age. But the sobering truth is, right now, it seems to kill the younger patients more readily than older ones.
Your first defense: Don’t catch the flu.
The H5N1 virus is so dangerous because it has never been seen in humans, at least not in our lifetimes. So to our bodies, it is a novel virus, and our immune system is not equipped to deal with it. In past pandemics, many people who are exposed to novel viruses don’t become infected, although we aren’t sure why. The Spanish Flu of 1918 only affected 30% of the population. That means that 70% had some form of immunity.
Sadly, you won’t know if you are immune or not until you catch the flu. So your best defense it to avoid exposure to infected individuals, wash your hands frequently (read: obsessively), and consider having masks and gloves, along with hand sanitizers when going out in public.
There are 2 known (and 2 suspected) routes of transmission of Avian Flu. Until the virus mutates, and it can be studied in depth, we won’t know how important each of these is.
#1 Droplet infection : When an infected person coughs or sneezes, they send out tiny droplets of moisture with viral particles. These particles float in the air a short distance, then settle on surfaces. The range of a good sneeze is probably at least 10 feet. Staying at least 10 feet away from an infected person is a good first measure. Masks may also be of some protection, but there will be shortages, and many doctors are in disagreement as to how much protection they will afford.
#2 Fomite Infection: Fomites are inanimate objects which become contaminated when an infected host sheds the virus. These can be door knobs, telephone receivers, shared utensils, and shopping cart handles, among others. We touch them, then touch our face and voila!, We’ve got the Flu. Hand washing and the disinfecting of surfaces are your best defense here. Many doctors recommend using an alcohol hand gel when hand washing is not an option.
#3 Airborne: Suspected, but never proven, influenza viruses could become aerosolized and float in the air for longer than a few minutes. This is controversial. There are no definitive studies yet. During the SARS outbreak in 1993, it was discovered that this was a major route of transmission.
#4 Body Fluids: Unlike other influenza viruses, H5N1 apparently lives happily in the bloodstream, and presumably in stomach contents and feces. The use of gloves and disinfectants when dealing with infected patients is probably a very good idea.
The Government’s plan to reduce the effects of a pandemic call for `social isolation’, essentially calling for all non-essential workers to stay home, and avoid exposure. They have spoken of closing public venues such as restaurants, movie houses, and sporting events. And they plan on closing the schools, for weeks or even months, if a pandemic should arrive.
I’ve got it. Now what?
Despite your best efforts, you may become infected. You will probably have 3 options for treatment, although after the first few days of a pandemic, you will likely be reduced to only one.
Hospitals : Early on, some patients will be seen in hospitals. But most doctors believe that hospitals will be overrun within days, and will begin turning away flu victims very early in the course of a pandemic. Most hospitals operate at nearly full capacity now, they would be unable to handle an influx of millions of patients. There are only about 10,000 spare ventilators (not in use) in the United States, and estimates put the need during a pandemic around 750,000 ventilators. Clearly, hospitals will become a non-viable option very early on.
Ad Hoc Flu Centers: There is discussion of opening flu treatment centers in shopping malls, community centers, even hotels. This may be an option for some people, but the level of care you will likely receive at one of these facilities will not be very good. They will not be equipped to handle the influx. Think the Superdome after Katrina, and you will have a pretty good idea what to expect.
At Home Care: Most of us will have to deal with the flu at home. We may receive some phone assistance from a Flu Hot line, but beyond that, we will probably be on our own. There is an excellent guide to caring for flu patients available on FluWiki, written by Dr. Gannett Woodson. It is a PDF file, and I recommend it to everyone. Get it now. Read it. And buy the meds (over the counter) you will need before a pandemic strikes.
http://www.fluwikie.com/uploads/Consequences/NewGuideOct7b.pdf
What about Vaccines, Antivirals, and Antibiotics?
There is no effective vaccine against H5N1 right now. There is an old vaccine, based on the Vietnam clade (version) of the virus from a couple of years ago, and they are working on a new one, based on the Indonesian clade. It is in very limited supply, and there is little hope it will prevent infection. An effective vaccine can only be developed once the virus mutates to a pandemic strain. And then, it would take months, perhaps years, to produce enough vaccine to cover everybody.
Antibiotics do not treat viral infections. They can, however, be used to treat secondary bacterial pneumonias which can develop in influenza patients. Your best defense against these infections is to get the pneumovax II vaccine, which protects against the 23 most common bacterial pneumonias.
Tamiflu, Relenza, Amantadine, and Rimantadine are all anti-viral medications that may help reduce the severity of the flu. They are all in very short supply, and their effectiveness on a pandemic strain is unknown right now. Tamiflu has, so far, shown to help in some cases.
Getting Tamiflu anymore is very difficult. Most doctors will not write an Rx for it, as they have been warned not to do so by the AMA and federal government. The Government has a small stockpile, but probably only enough to treat 5%-10% of the country. The old dose of 10 pills over 5 days is no longer viewed as effective. Much higher doses (3 pills a day for 10 days) are being investigated.
That said, I'd rather have Tamiflu than not.
BEWARE: There are many internet scams going on right now, purporting to sell Tamiflu, `generic Tamiflu’, or Herbal Tamiflu, all without prescription. Nearly all of these are fake meds.
What About Alternative Meds, Herbal Remedies?
No one knows. There may be some advantages to taking certain vitamins, fish oils, even elderberry extract (Sambucol), but no one really knows. None of these things have been tested on H5N1 patients. While I might try some of these remedies myself, I would do so with the knowledge that it is a crapshoot. And I would view any claims that they can `cure’ Avian flu with extreme skepticism.
Taking medicines to boost the immune system, while seemingly a good idea, could prove to be counterproductive, particularly for those under 40. Right now, the suspicion is that an overactive immune system can kill you. Once again, these are theories, and we won’t know the right thing to do until the pandemic has been upon us for a while.
Bottom Line: Avoid the flu if possible. Be prepared to stay home and care for yourself or loved ones, and get Dr. Woodson’s guide.
