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The flu!

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From the Stygian depths of the flu I write. I caught it, I think, from my cousins, who caught it from East Coast visitors. Thus we are all linked in a sort of viral community.

It is truly an awful disease. On Friday and Saturday I thought I would escape only with a bad winter cold, but Sunday brought lethargy and fever, and on Monday it worsened. I got my flu shot 3 weeks ago at Kaiser and had read articles that this year’s vaccine would be particularly ineffective.

Why is this so? I know a lot of people who will not get flu shots because they don’t trust the doctors. This sort of thing will not encourage them.

And now, this morning, I read that the Centers for Disease Control has officially declared this outbreak an epidemic.

How quickly it has come to California! Two weeks ago we heard nothing of influenza. Now it is widespread.

During the height of my illness I could not abide alcohol in any form, not even my 5 p.m. cocktail IPA. The thought of wine made me cringe. It made me think how the appreciation of wine requires a certain balance of the physical, emotional and intellectual parts of humans. Each of those elements was thrown into chaotic disarray by my flu. Physically I felt at the edge of death. It was emotionally draining; one thinks, “Will this go on forever? What if I don’t recover?” with all the associated thoughts of dread. As for the intellect, well, it failed completely. It was as if that part of my brain had had a spoke thrust into it. When you’re that sick you can’t think straight.

Anyhow, it’s all I can do to grind out this pathetic excuse for a blog post but I do trust you will forgive me! Stay safe, and remember to wash your hands a lot.

  1. Steve writes: “Stay safe, and remember to wash your hands a lot.”

    Elaborating on that advice . . .

    From The Wall Street Journal “Personal Journal” Section
    (May 12, 2009, Page D1ff):

    “Put Up Your Dukes:
    Fighting Disease With Soap and Water”

    Link: http://www.wsj.com/news/articles/SB124208945194709049#printMode

    By Melinda Beck
    “Health Journal” Column

    Fear of swine flu [circa 2009] is fading, but there are still plenty of reasons to wash your hands frequently.

    The list of infections that can spread via unwashed hands reads like the Biblical plagues, including staph, strep, salmonella, E. coli, hepatitis, MRSA (methicillin-resistant Staphylococcus aureus), colds, flu and norovirus — the infamous cruise-ship bug.

    The importance of hand washing has been known since 1847, when a doctor named Ignaz Semmelweis suspected that maternity patients were dying in his Vienna hospital because med students treated them right after working on cadavers. When he instituted hand-cleaning, the deaths fell sharply.

    The Centers for Disease Control and Prevention says hand washing is the most effective way to stay healthy. But many people don’t do it often enough, or long enough, to be effective. Here’s a guide:

    WHEN TO DO IT. Wash your hands every time you use the bathroom. Every surface presents an opportunity for germs to hitchhike out. “Who thinks to clean the latch on the inside of the stall door? Try nobody,” says Jim Mann, executive director of the Handwashing for Life Institute, which advises food-service providers around the world on best hand-hygiene practices.

    Also wash your hands whenever you change a diaper, pick up animal waste, sneeze, cough or blow your nose; when you take public transportation, insert or remove contact lenses, prepare food, handle garbage and before eating. Few people are as conscientious as they should be. Mr. Mann recalls being in meetings to discuss hand hygiene: “Everybody shakes hands. You finish the talk, and everybody runs for the food line. Nobody washes their hands.”

    HOW TO DO IT. Soap and water is the gold standard. In a recent study in the journal Clinical Infectious Diseases, researchers in Australia doused the hands of 20 health-care workers with human H1N1 flu virus. Soap and water removed slightly more virus than three alcohol-based hand rubs. When volunteers didn’t clean their hands, most of the virus was still present an hour after exposure.

    It’s the mechanical process of washing that’s so effective. Soap molecules surround and lift the germs, friction from rubbing your hands loosens them, and water rinses them down the drain.

    Experts recommend using warm water — mainly for comfort, so you’ll wash longer. Use liquid soap if possible. Bar soaps can harbor germs, though they’ll likely rinse off with water.

    Use enough soap to build a lather. Lace your fingers together to cover all the surfaces. Rub the fingertips of one hand into the palm of the other, then reverse. Keep rubbing for as long as it takes to sing “Happy Birthday” twice. (Some experts prefer “Row, Row, Row Your Boat.” But any tune will do as long as it lasts at least 15 seconds.)

    “The typical ‘splash and dash’ that most people do doesn’t do anything,” says Mr. Mann.

    Rinse thoroughly. Residual soap can make hands sore. Leave the water on while you grab a paper towel and use it to shut off the faucet. Take it with you to use on the door handle as well.

    DRYING LESSONS. Many hand-hygiene experts are down on hand dryers — chiefly because few people have the patience to dry completely and end up wiping their hands on their clothes. “That’s fine — unless your pants have been down around your ankles in the stall,” Mr. Mann says.

    Air dryers can also blow remaining germs as far as six feet away.

    ANTIBACTERIAL SOAP? In 2005, a Food and Drug Administration panel voted 11-to-1 that antibacterial soaps are no more effective at keeping people healthy than regular soap. There may be some downside too. Some antibacterial ingredients like triclosan leave a residue on the skin that continues killing some bacteria. Critics worry that the remaining bacteria could become resistant, not only to soap but also to antibiotics. “To our knowledge, it’s not happened, but it’s theoretically possible,” says Elaine Larson, a professor in the schools of nursing and public health at Columbia University. Another problem with antibacterial soap, she says, is that it gives people a false sense of security. “People think, ‘Ah — it’s antibacterial. So the germs are gone.’ That’s a false perception,” Dr. Larson says.

    HAND SANITIZERS. It’s not often that a personal-care product gets a presidential endorsement. Some drug stores sold out after Barack Obama echoed the CDC’s recommendation that people use alcohol-based hand sanitizers when soap and water aren’t available to help stop the spread of swine flu.

    Experts say they must be at least 60% alcohol to kill germs. “Alcohol ruptures their cell membranes — it causes them to explode,” says Dr. Larson, although she notes that if your hands are visibly dirty, soap and water is much preferable.

    Curiously, the FDA does not allow over-the-counter hand sanitizers to claim they kill viruses. The CDC’s recommendations are based on information published since the FDA ruling, showing that alcohol-based sanitizers are effective at killing viruses, specifically the H1N1 strain, says Nicole Coffin, a CDC spokeswoman.

    CAN YOU OVERDO HANDWASHING? Yes. “Try to strike a balance between being obsessive-compulsive and being reasonable,” says Dr. Larson. “And if there is some kind of outbreak like with the flu or SARS, then there is reason for more caution.”

  2. Steve writes: “Stay safe, and remember to wash your hands a lot.”

    Elaborating on that advice . . . here’s “why” you want to wash your hands. Often.

    From the Los Angeles Times “Health” Section
    (January 12, 2009, Page F3):

    “Viruses Travel a Tricky Route;
    Avoiding colds and flu is hit-and-miss.
    Transmission isn’t as clear-cut as it seems.”

    Link: http://articles.latimes.com/print/2009/jan/12/health/he-coldflu12

    By Jill U. Adams
    Times Staff Writer

    Get that flu vaccine if you want, but don’t count on it to keep you healthy this winter. Sure, it can immunize you against scientists’ best guess at this year’s bug, but it’s no guarantee you won’t be confined to bed for a couple of days in the event of an outbreak. And of course, there’s no vaccine for colds.

    Even isolating yourself — from family, friends, coworkers, acquaintances and strangers — might not be enough to protect you from illness.

    Scientists now know, based on recent studies, how long cold viruses can survive on telephones and money and how much flu virus emanates from a sick person’s breath. What they don’t agree on is exactly how colds or flu pass from one person to the next. In addition, cold and flu viruses are different enough that you can’t generalize about prevention. This state of cold and flu knowledge makes science-based recommendations for staying healthy difficult.

    Dr. Martin Weiss, a physician at the VA hospital in Sepulveda, says that influenza doesn’t even follow any known biological model. “It pops up out of nowhere all of a sudden,” he says. “Even 100 years ago when there wasn’t so much travel, it would show up spontaneously in several different places.”

    TOUCH, AIR PATHWAYS

    Rhinovirus, the most frequent cause of the common cold, is shed mainly through a sick person’s nose. In the 1960s, not long after the virus was discovered, scientists demonstrated that the virus could infect after being placed in the noses and eyes of experimental subjects, but not their mouths. So a likely infection scenario is: Joe with a cold blows his nose, gets some viral-laden mucous on his fingers and transfers the virus to a doorknob while opening a door. A while later, Bill opens the same door then rubs his eyes, giving the virus entry to his respiratory passages.

    Drinking from a cup after Joe or sharing a utensil would likely pose a problem only if Joe left mucous on the cup, Bill touched the cup, and so on.

    A 2007 study published in the Journal of Medical Virology showed that sick people leave cold viruses on the things they touch, such as door handles, pens and light switches. In a second phase of the study, those same subjects (now immune to that cold virus) were told to use the light switches and the telephone, upon which researchers had swabbed rhinovirus either an hour earlier or 18 hours earlier. Virus was found on their fingers after two-thirds of contacts with the one-hour-old virus and after a third of contacts with the 18-hour-old virus.

    The mere presence of a virus doesn’t necessarily mean it is still infectious. But a Swiss study published in Applied and Environmental Microbiology in May showed that influenza virus not only can remain on paper money for up to 17 days, but also that it can be alive and ready to infect.

    Washing your hands will remove the virus from your fingertips, and an alcohol-based wipe will kill it on the refrigerator door handle. But washing hands after every instance of contact is difficult and, too often, a newly contaminated hand will wander to an uninfected eye or nose.

    The likelihood of transmission via air is fuzzier. Many scientists believe that viruses may float in the air on tiny droplets or dust and be inhaled, thus bringing the germs into contact with the mucous membranes or lungs.

    In 2004, a study conducted in a trio of Boston offices found viral material from cold viruses on the buildings’ air filters. Further, the virus type matched that in some of the office workers. Ventilating fresh air reduced the amount of suspended virus compared with recirculated air. This suggests that sick workers were indeed expelling virus into the air. The study, conducted by Dr. Donald Milton, a professor in the School of Health and Environment at the University of Massachusetts in Lowell, was published in the American Journal of Respiratory and Critical Care Medicine.

    In a more recent study published in PLoS ONE in July, Milton showed that patients with confirmed influenza released some virus simply by exhaling.

    As for the likelihood of transmission via cold viruses floating around your office, researchers have shown that breathing in aerosolized cold viruses through a mask can make people sick. But that’s as much as they know for sure. The best evidence would be showing real-world transmission at a distance, Milton says.

    Thomas Weber, a scientist at the European Commission’s Joint Research Center in Ispra, Italy, which provides scientific information to policy makers, finds it “very hard” to dismiss airborne transmission. He agrees that there’s not enough evidence, but says, “To make any statements about the importance or unimportance of any pathway is premature.”

    DODGING ILLNESS

    Other studies have focused on prevention methods.

    Research has shown that alcohol-based hand sanitizers can reduce the viability of cold and flu viruses on your hands, but washing your hands in a sink physically removes them. The effectiveness of face masks is less clear.

    Researcher Allison Aiello conducted a study of more than 1,000 students living in University of Michigan dorms. Some students were instructed to wear face masks as much as possible around the dorms and to use hand sanitizer regularly, other students only wore masks, and a third group did neither. Results, presented in October at the Infectious Disease Society of America meeting in Washington, D.C., showed that mask-wearers had 10% to 50% less flu-like illness than students in the control group. A similar study based in 128 Hong Kong households and published in PLoS ONE in May found no significant effect from wearing masks or washing hands. The researchers report that in practice, many subjects didn’t wear their masks as instructed. Hand-washing compliance was a little better but still didn’t measure up to typical healthcare-worker practice.

    “It could be that the masks are cutting down on some of the aerosol transmission, but they’re not N95 masks,” Aiello says, referring to masks that filter 95% of airborne particles. Both the Michigan and Hong Kong studies used cheap surgical masks. “It could be that because the students are wearing the masks, they’re less likely to put their hands in their mouth or their nose.”

    Until researchers sort this all out, the best preventive strategies are the same ones you grew up with. Avoid coughing, sneezing people. Wash your hands regularly. Get a flu vaccine. Disinfect surfaces in your kitchen, bathroom and office.

    Ultimately, the only sure-fire way to avoid a cold or flu might be not to touch anything. Ever.

    Write to health@latimes.com

  3. I’ve been down with it, too. I’m impressed you even got one blog post out. I started to feel ill Friday night; by Saturday afternoon, I was down for the count. Fever broke early Tuesday morning. Still can’t really think straight.

    Feel better!

  4. The Flu has lost some respect from the general population because too many people mistake bad colds for the flu… when you have the flu, you know it.

    As a history buff, if you haven’t read “The Great Influenza”, put it on your list. It reads like sic-fi but was only too real.

  5. Dear Pawineguy: I’m sure you’re correct. I have learned to tell the difference between a bad cold and the real flu. A bad cold has all the symptoms, but you still feel like a human being. With the flu, you’re a walking corpse. This was the flu. I will seek out “The Great Influenza” on your recommendation. Thanks.

  6. Exactly. The real flu feels like death as you know… glad you are on the mend. The Great Influenza is made more interesting because of its intersection with the American Expeditionary Force of WWI.

  7. Dear Goddess, I feel your pain. The worst seems to last only 2-3 days. Wishing you well!

  8. PaWineGuy, I ordered the flu book through Amazon and look forward to reading it. Thank you.

  9. redmond barry says:

    One word : cognac. Really expensive stuff, preferably in the less caramelized Delamian style ( like their extra fine champagne). Trust me.

  10. Excerpt from the Los Angeles Times Online
    (January 16, 2015):

    “Just how ineffective is This Year’s Flu Shot?
    CDC experts do the math”

    Link: http://www.latimes.com/science/sciencenow/la-sci-sn-flu-vaccine-effectiveness-20150115-story.html

    By Karen Kaplan

    If you think this year’s flu shot is worthless, think again: People who got vaccinated this fall or winter have been 23% less likely than their unvaccinated peers to come down with a flu-like illness bad enough to send them to the doctor, according to a new report from researchers at the Centers for Disease Control and Prevention.

    That 23% figure is a measure known as “vaccine effectiveness,” and it’s certainly on the low end of the spectrum. In the decade since experts began calculating a “VE” for flu vaccines, it has ranged from a low of 10% to a high of 60%.

    But even at 10%, a vaccine could prevent about 13,000 flu-related hospitalizations among senior citizens in the U.S., the CDC researchers and their colleagues wrote in Thursday’s edition of the Morbidity and Mortality Weekly Report.

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