Can't afford to catch the flu? Move to the desert, alone. Or get a flu shot
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Version 0 of 1. The crippling effect of influenza was brought home to me some years ago when a friend developed the illness. The first time I saw him he was in intensive care, intubated, and perilously close to death. His lungs were straining to breathe despite maximal ventilator support; the specialist watched him with hawk eyes but said there was nothing else to do but bide time. The x-rays looked terrible: a white, water-logged inflammatory sea where there ought to have been reassuring black. The nurse shook her head in dismay. My friend’s wife was stunned at the rapidity of events. She reported that he had had mild symptoms for two days but on the day of admission had developed a high fever and chills. She had never seen him look so unwell so she bundled him into the local emergency department where the staff commended her quick thinking because his vitals had crashed within the hour and he was rushed straight to ICU. Related: Australia's current flu situation: tracking weekly updates on symptoms around the country The most upsetting thing was that he was only 42 years old. He wasn’t a smoker or an asthmatic, wasn’t overweight or unfit and had none of the chronic diseases that could explain the severity of his illness. He was simply unlucky and like most people his age, unprotected by the influenza vaccine because he didn’t think strong men like him could be felled by a mere virus. And yet here we were, on day 14 of his admission discussing whether he had ever spoken about his wishes for the end of life. As a doctor I have these conversations regularly but this really was the stuff of nightmares. “Do they really think he will die?” his fear-stricken wife asked me. “I think they are doing their best to support him but are starting this conversation just in case,” I replied, sounding awfully clinical. But the x-ray on the screen looked as bad as ever and increasingly complex machines gathered at his bedside. At one point his wife exclaimed: “I knew we would both die someday but it seemed like a long way off and not due to the flu. “I mean, who dies of the flu?” Who dies of the flu? According to Australian government statistics 3,500 people last year alone, making the death toll from a preventable illness greater than the national road toll. 68,000 confirmed cases of influenza were reported in 2014 with 18,000 hospitalisations. These figures are thought to be an underestimate because many cases go undetected. A quarter of people who die from influenza don’t have other serious comorbidities. Children are also susceptible to infection and patients who survive influenza can suffer serious complications including pneumonia, myocarditis and nerve damage. The Influenza Specialist Group says that 2.3 million Australians are at risk of complications, yet a third of households don’t plan on vaccination. In Australia, notifications for this year are twice as high as at comparable periods. With the influenza season predicted to peak through July and August, there remains a high level of complacency in the community about this highly contagious and fatal illness. While vaccination rates are high in the over 65 population, experts say that other at-risk groups remain resistant to public health messages. A quarter of people who die from influenza don’t have other serious comorbidities. This year the influenza vaccine became available one month later than usual. While myths quickly arose about the “real” reason, the explanation was simply that the resulting vaccine was a better match for the two new circulating strains in the northern hemisphere, which emerged while the Australian vaccine was being manufactured. The vaccine is a very good match for prevalent strains. It is now readily available and is free to groups most at risk. These include people aged 65 and over, pregnant women, Indigenous children and adults, those with chronic health conditions including heart, lung and liver disease and those with diminished immunity. The list of qualifying conditions is widely available. Doctors, nurses and any healthcare workers who come into direct contact with patients are a large and important group who should be vaccinated. They can transmit influenza to vulnerable patients but also contract it from patients they care for. But here too, compliance has been historically inadequate although it seems to improving with more robust messaging. Like many vaccinations, the influenza vaccination is no stranger to misconceptions. Naysayers query its efficacy but in studies it has been found to provide up to 80% protection against the illness, a figure unmatched by many commonly prescribed drugs. Some people are averse to the risk of getting influenza from the vaccine – their fear is unfounded. The influenza vaccine does not contain live virus – the most inconvenience a small number of people experience is local discomfort and minor malaise, insignificant compared to the damage the illness wreaks on the person. High-dose vitamins, herbal supplements, nasal sprays and cough medicine neither prevent nor treat influenza – they remain a multibillion dollar industry without any scientific evidence of their efficacy. The recommendation from experts is unchanged – it remains plentiful rest, good hydration and hospitalisation where required. The two approved drugs for treating influenza are slickly marketed and extensively prescribed but more than a decade of experience shows that they are modestly efficacious at best. The US Centers for Disease Control and Prevention (CDC) states that when taken within 48 hours of uncomplicated illness onset they reduce the duration of symptoms by one day. For serious illness, there is some observational data that shows a small mortality benefit while the evidence for reducing feared complications is also limited. In other words, it is far, far better to aim for prevention of influenza than relying on a cure. Related: Losing my twin baby boys for ever changed the way I treat my patients | Ranjana Srivastava My friend miraculously made it out of ICU. On the ward, he would become breathless with the effort of standing up or speaking. He took to scribbling the pun that his wife still took his breath away. She was just glad that he was alive. He was flabbergasted that a young man like him was now waitlisted for rehabilitation with people twice his age. But he was too weak to even enter rehab, where he eventually spent many weeks learning how to walk and shower again. It took him half a year to recover, his struggles putting to rest the complacency of all those who watched disbelievingly. Here is Dr. Ian Barr, the acting director of the World Health Organisation’s Influenza Centre at the Doherty Institute on how to avoid influenza. “Move to a solitary location in the middle of a desert, stay away from everybody and lock yourself in a house. “Or more practically, you can get yourself vaccinated.” Even if you are ineligible for the free government program, it may be the best $20 or so you spend this winter. It’s not too late to get a flu shot. |