We're right in the middle of flu season, which happens every year from October through Feburary, so in this edition of Stayin' Alive, we talked to the doctor about how to deal with the virus, whether you should get a vaccine, and why a Hot Toddy may be one of the best remedies.
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SmSh: What's the difference between the flu, a bad cold, and what people call "the stomach flu" ? Can we differentiate these three?
Dr. Chedrauy: That's a good question. So, the flu is a virus. It's from a family of viruses called . The common cold could also be a virus, and sometimes it's very difficult to differentiate them in the initial stages of the symptoms. Most of the time, the giveaway for differentiating the flu from the common cold is very acute onset of fevers 鈥� very high fevers 鈥� and the patient feels very very ill.
The stomach flu is not a flu. It's pretty much a gastroenteritis. It's an infection of the gut; it gives you diarrhea, etc. The flu can give you nausea, vomiting, and even diarrhea, and that's why a lot of people say, "Oh, it's the stomach flu", but no, they're completely different things. The common cold normally resolves on its own very quick, three to five days, and the symptoms are not as marked as with the flu.
There's a few ways to diagnose the flu that are not available in China unfortunately. Rapid tests are widespread in the US; it takes five minutes, you do a swab, put it in a liquid, and put a couple drops of that liquid on a strip of paper, and if it changes a certain color, it's positive. Very easy. And then, you treat. If you're gonna treat the flu, there is medication for it, but you've got to start it within 48 hours of symptom initiation.
SmSh: It's a viral thing right?
Dr. Chedrauy: It is a viral thing for sure. But there are antivirals that you can use. And the most important one of those is called Oseltamivir, which in the US is called . It's ten pills; twice a day for five days. Some studies say that it really works for patients that have comorbidities, and some studies say that it doesn't work for patients that don't have comorbidities. Normally it shortens the duration of the flu by one day, which may not be too much, but if you've had the flu, you want that to be shorter by one day. It's definitely the treatment of choice, but you have to initiate it within 48 hours after the symptoms start.
[Note: Comorbities refer to other diseases/conditions a patient may have, such as heart disease, cancer, diabetes, or AIDS.]
SmSh: I had the flu once when I was 18 and I lost almost 20 pounds. It was bad, man.
Dr. Chedrauy: Flu is pretty nasty, man. And maybe back then there was no Tamiflu.
SmSh: Is Tamiflu available in China?
Dr. Chedrauy: Yes. The pack of ten pills is 250-300rmb. The thing is that drugs in China are very cheap and this is kind of on the higher end of the spectrum.
SmSh: Why isn't that rapid test available in China?
Dr. Chedrauy: For legal reasons, the Chinese government does not allow [people] to bring tests like that here without approval, and it has not been approved.
SmSh: Do you think in the future it will be approved?
Dr. Chedrauy: I think so. China has been hit by flu many times, and they have been caught off guard many times, so it would probably be a wise thing to do and I think we're gravitating towards that.
SmSh: So if you get the flu, you're gonna know it?
Dr. Chedrauy: No, a lot of times people think that it's a common cold, and they go to the doctor because they want antibiotics, and that happens every day. It's not correct to give antibiotics for the flu. It's not gonna do anything.
SmSh: Or a cold right?
Dr. Chedrauy: The common cold, if it's viral, there's no need. The flu untreated can become bacterial. A bacterial superinfection is what we call it, and that's when you have to give antibiotics. And the way to know is that you have the flu or cold symptoms, and you're getting better, and then all the sudden you get bad again. That sometimes is a telltale sign that you have a bacterial superinfection and you should start using antibiotics.
SmSh: For someone young and relatively healthy, what's the risk of the flu? Can you die?
Dr. Chedrauy: If you're young and don't have any morbidities, you should be ok. Patients that are asthmatic, diabetic, or have chronic diseases, those are the ones that get hit really hard. Otherwise, the flu is pretty nasty鈥f you don't treat it or you ignore it, it can become pneumonia, and that's when things may spiral out of control, so don't ignore it. That's probably the best advice.
SmSh: So you don't ignore it, what should you do?
Dr. Chedrauy: Go to the doctor, make sure you're treated for it, and make sure you get symptomatic treatment as well. If you have fevers, lower the fevers. If you have a cough, get rid of the cough. But make sure that you take care of it, because it can become something really bad.
SmSh: Is the flu more or less common in China than say, the US?
Dr. Chedrauy: Because [of] the mere population, it's worse in China. I don't know if you've heard about all the variants of the flu and how things are managed here. It was pretty bad. There's 1.3 billion people here compared to 300 million in the States, so in those terms it's gonna be worse here. There's an important thing about the flu that a lot of people don't know: The flu virus can morph. It's something called antigenic shift.
That means that one strain of the flu can combine with another strain and produce something else. For example, in 2009, the swine flu. Swine flu is a virus that came from a duck, and another virus from a human. And right down in the middle there was a host, which was a pig. So the pig got infected with both viruses, and that virus replicated in all the cells in the pig, and then went back to a human. We don't have vaccines for that, because it's a new strain. We don't have treatment for that. That was called H1N1, and that was the last time that the World Health Organization (WHO) called it an epidemic level 6. That is something that people should be aware of. It's very easy for the virus to change.
SmSh: So in that regard, is the flu almost worse than say鈥bola?
Dr. Chedrauy: I don't think ebola for us鈥攖he US and China鈥攊s gonna be a major issue. Ebola is a very weak virus. It affects people really fast and it's killed pretty easily. Containing the ebola virus is what they're doing and they're doing a good job. I don't think it's gonna hit us, especially with all the controls at the airport and all that stuff that's happening. I think the flu is much worse because it can cause pandemics like the one in 2009. That's a much bigger health issue than ebola is right now.
SmSh: was really bad right?
Dr. Chedrauy: Spanish Flu was another variant 鈥� another morphing of the virus. That killed a lot of people.
SmSh: Could that happen again easily?
Dr. Chedrauy: It can happen. Once again, the virus is changing all the time, it can definitely happen. I think people are getting a little more prepared now, and I think China has grown a conscience on how to deal with this stuff without hiding information. I think we're on the right track, and yeah, pandemics can happen anytime, but I think we'll be a little more prepared now.
SmSh: What about the flu vaccines, are those available in China? Do you offer them in your clinic?
Dr. Chedrauy: The flu vaccines are available in China. [But] in clinics, they need a special permit by the Chinese government. We don't have that permit. Most of the vaccines in China are given by governmental offices.
SmSh: It's the same as cats and dogs鈥�
Dr. Chedrauy: Yeah. So there's a flu vaccine available. It's recommend for everyone six months and older. And it's specially recommended for people that have comorbities. It's recommended even for pregnant women. If a pregnant woman gets vaccinated, the baby is highly protected for six months at least.
The vaccine is really important. There's two types of vaccines. There's an intramuscular vaccine and a nasal vaccine. I don't believe we have the nasal vaccine [in China]. The intramuscular vaccine is a shot, and they're called trivalent vaccines because they have three strains 鈥� two influenza A's and one influenza B strain. The one that is intramuscular is inactivated, but there's an important thing 鈥� if you're allergic to egg, you shouldn't get it. The medium where it grows is egg-based, so if you have allergies to that we don't recommend it. The nasal vaccine is called FluMist, and it's recommended for people over two years old.
SmSh: So every year there's a new flu?
Dr. Chedrauy: That's a good question. The flu vaccine of this year is coming from the strains of last year. So the most prevalent strains of last year, the WHO chooses those strains, sends them to the pharmaceutical companies, and it takes them, like, six months to do the whole batch. So it depends on the strains from last year, so you're not gonna be 100% covered. Maybe the strain this year is a new strain, but at least [the vaccine] has the most prevalent [strains] and you'll be able to be fairly well protected.
SmSh: Why is it that flu season is always October through February?
Dr. Chedrauy: It's the season changing, the winter, the cold weather鈥t all has to do with that. It's always like that.
SmSh: So, a lot of Chinese people say that if you have the flu, you should only drink hot water, not cold water. But when I was sick as a kid I would always drink cold water. Is it really better to drink hot water [laughs]?
Dr. Chedrauy: There is kind of a physiological explanation to it. The flu also creates this inflammatory process, so if your mucosas are really bad, and [you've got] runny nose and your throat hurts, you'd much rather do warm than cold. It helps you with inflammation. If you take a hot shower, it opens up your nostrils, etc. You won't feel as good if you drink cold water instead of a hot tea. I like Hot Toddys, too. I actually recommend those.
Herbal tea with honey and a shot of bourbon works wonderfully. Don't do more than one, but it works very, very well.
SmSh: But doesn't the alcohol affect your immune system?
Dr. Chedrauy: Not one shot. One shot won't do much. It will help you relax, sleep a little, and the hot liquids will also help you with all that. For the cold they're also very good.
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Dr. Jorge Chedrauy is the Director of Family Medicine at the and is also part of the American Board of Family Physicians.
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