Where What When

Swine Flu by Dr. Julian (Yoel) Jakobovits, MD

Dr. Jakobovits, how frightened should we be about the swine flu? How careful should we be? Should we avoid crowds, airplanes, etc.?

Dr. Jakobovits: Frequently, fear about an illness is more disabling than the illness itself. While no medical predictions can ever be made with 100 percent certainty, it is unlikely that the current swine flu - or more correctly H1N1 - outbreak will be particularly devastating in the overwhelming majority of patients. Although it is true that there have been some seriously ill patients, indeed some fatalities, these have happened only in special groups of patients. I personally have seen hundreds of cases, and not one of them has been sent to the hospital.

The spread of this virus, as with any respiratory infectious illness, can be curtailed by applying simple techniques that limit person-to-person spread. Transmission takes place through bodily fluids, primarily nasal and oral secretions. Coughing into a cloth, washing hands, and use of single-use paper towels are all useful approaches. Antiviral solutions are commercially available to cleanse hands. In general, avoidance of crowds or public areas will do little to further reduce the spread of this virus.

What are the symptoms of H1N1?

Dr. J: Symptoms are rather non-specific. In general, they are similar to seasonal (regular) flu. In my experience, the dominant complaints are high fever (over 101°F), headache, sore throat, non-productive cough, and occasional stomach upset and diarrhea. By contrast, seasonal flu patients complain more often of feeling total body aches, like "a truck hit me." It is believed, however, that the overwhelming majority of flu-like illness in the past several months is, in fact, swine flu.

Do you recommend taking the vaccine?

Dr. J: The vaccine is not yet generally available. The evidence is that the vaccine - live virus by nasal spray or killed virus by injection - will be effective in reducing the chances of getting H1N1 disease. By the time it reaches the general market, the federal authorities will have tested it for efficacy and safety. Nevertheless, remembering the experience in the 1970s, when swine flu vaccine was associated with some serious side effects, one might want to delay receiving the vaccine till its safety is fully established once it is widely used.

Interestingly, older people are less likely to contract swine flu, because they have acquired immunity over many years of exposure to seasonal flu. On the other hand, flu in an older person can be more serious. For background purposes, it should be noted that in the United States it is estimated that over 50,000 people die annually of regular seasonal flu, mostly among the elderly.

What is Tamiflu, and how is it used? How effective is it? Should people ask their doctors for a prescription, so they can have it on hand, just in case?

Dr. J: Though H1N1 virus is resistant to some antivirals, Tamiflu capsules and Relenza inhaled therapy are still useful in limiting the disease and its symptoms. To be effective, they must be used early, within 48 hours of the onset of symptoms. Widespread, indiscriminate use, however, is likely to cause the virus to become resistant to these drugs. Therefore, they should be used sparingly in persons with the highest risks.

Is there any other substance that prevents the flu or minimizes its symptoms, such as elderberry syrup?

Dr. J: Naturally, when a new illness with media-whipped fear is looming, numerous alternative medicine suggestions begin to circulate. Among the many unproven herbal preparations which have been proposed for swine flu, elderberry extract has been among the most frequently touted. In fact, in an article arising from Hadassah Hospital several years ago, elderberry (Sambucol syrup) was found to exert some immunologic effect that may be useful in suppressing viral illnesses.

Personally, I have no problem with patients using alternative, even unproven, remedies, provided they do not interfere with nor inhibit the use of "orthodox" therapy.

Dr. Julian (Yoel) Jakobovits, MD, has a private practice in Internal Medicine and Gastroenterology, and is an Assistant Professor of Medicine at Johns Hopkins University School of Medicine.

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Article List - November 2009