It is now Saturday November 10th, and it's my first weekend off since Hurricane Sandy came through. When I woke up today I was struck by the thought that I haven't had any phone calls for influenza yet this season. We are well into flu season. Usually, by now, there are a ton of calls. I wondered "what was up with that?" Why no calls for influenza? So I did what I usually do with these kinds of influenza questions. I opened my iPhone and surfed over to Google's flu tracking tool at http://www.google.org/flutrends/ Immediately I discovered that the United States is having a bad flu year. Here is a screen shot of my iPhone page: (Hint: If you click on this picture, it gets much bigger and more readable):
The line for the present year is a darker blue than prior years. This years line ends at about November first, because that is the most current data. You can see that the present incidence of influenza is well into the moderate range, and it it well above prior years. This years line is above all prior years, with the exception of the really high H1N1 year. That tall peak was the year that H1N1 happened. Google's web service tracks influenza by analyzing search terms that people type into Google. Google's flu tracking technique is statistically validated, and their results are published in the scientific journals. It turns out that Google's technique gives us flu data about two weeks sooner than the old way. The old way was just collecting case results from emergency rooms, and things like that.
So, if the US is having a bad flu year, why am I getting no calls? I decided to look at New Jersey's results. When I clicked on New Jersey on the map, I got this:
You can see that New Jersey's incidence is not only low, but has dropped off quite a bit over the last week. So Google's flu tracker seems to confirm my suspicion that we are having an anomalously mild flu season. Either that, or people with influenza are neither calling me about it, nor are they searching Google for answers. It seems to me that we are actually having a mild year.
Could it be hurricane related? Maybe so. There was no bus or train service for a very long time. Maybe no one is spreading flu on the bus, so the incidence is very low and dropping. It could be that no one was going to work, and therefore not spreading the flu at work. Or, a big factor might be that the kids are out of school for more than a week. If the kids cannot spread influenza at school, that might be enough to lower the incidence of influenza. Are there any other factors? Maybe all of the houses without heat were inhospitable to the influenza virus.
So, you heard it here first. This is headline news. Catastrophic Hurricanes during flu season causes a reduction in influenza incidence. The evidence is the strong dip in the dark blue line on the second screen shot above. This is a tiny silver lining in the cloud over our heads. If no one has noticed this effect before, maybe I can get the hurricane effect named after me, :). The Marcus effect, maybe? If it hasn't been named before?
If this reduction is real, then I would like all of you to consider the lethal nature of influenza. Every year, 25 to 50 thousand Americans die of influenza. Please compare that number to the 200 or so people who died in Hurricane Sandy. Maybe the silver lining isn't so small after all. If these statistics hold true, it may be that Hurricane Sandy saved more people from influenza than died from the storm. If you look at the yellow picture of the United States in the above two web pages, you can clearly see that the northeast states have a much lighter shade of yellow, compared to, say, the south from Florida to Texas. The northeast may have been affected by the hurricane, whereas the south is having a normal flu season. Maybe someone can compare this with prior years to see if the effect is real.
In my office I try to immunize all of my pregnant patients against influenza. All of the professional groups, such as the American Congress of Obstetrics and Gynecology, recommend that pregnant women get a flu shot ASAP. In fact, pregnant women should be first on the list if there is a shortage of vaccine. When H1N1 happened a few years ago, there was a severe shortage of that vaccine. Who was offered the vaccine first? Those most at risk were offered first. And that meant pregnant women were offered the vaccine first.
When the power went out in my office I took my boxes of vaccines home. I did that so I could keep them in a fridge at home, and keep them safe in the power outage. But I missed a box in the dark office. It warmed up and I had to throw out the whole box. That was a shame because I had the single dose vials. These have no preservatives and are better for pregnant women.
Back in 2009 I was a speaker at an influenza symposium given by our hospital, The Valley Hospital. At that time, influenza type H1N1 was running it's course. H1N1 is unbelievably evil. There were two giant epidemics last century that each killed millions of people. H1N1 came back again in the year 2009, and there were worries that we would once again have millions of people die. Well, that didn't happen. Our public health measures were very successful at averting the mortality rate of prior pandemics.
What is influenza? It is a virus that infects humans via microscopic airborne droplets. It doesn't just infect the lungs though, it gets loose into the blood stream as well. The major signs that one has influenza is high fevers and muscle aches. There is usually profound fatigue, some respirator illness such as a sore throat and cough, and maybe some intestinal discomforts.
Whenever a person has high fevers and muscle aches, we call that illness an Influenza Like Illness, or ILI. An ILI does not require a visit to the doctor or the emergency room, but a phone call to the doctor would be a great idea. The doctor can phone in a prescription for an antiviral medicine. One such medicine is called Tamiflu. Pregnant women with an ILI really should take the Tamiflu. In my experience the Tamiflu sometimes stops the virus in it's tracks. A persons energy then pops right back. The Tamiflu really avoids the prolonged fatigue that one gets while recovering from this nasty virus. Also, when one is recovering from an ILI, one should be resting and drinking plenty of fluids. This is especially true of pregnant women. Pregnant women simply don't have the reserve energy that non-pregnant adults do. Some of them cannot possibly recover from the profound fatigue unless they take the time to rest.
So the lesson for influenza is this:
Get vaccinated to prevent it.
If you get an ILI, then push fluids, rest, and maybe take Tamiflu.
If you are pregnant, then you must stop working, rest, push fluids, and take Tamiflu.
Call your doctor.
You won't need to go to the doctor unless there are other complications.
Once again, thanks very much for reading my blog. Please post links to my blog. It is really great to see all the people who are reading this from all over the world.
Sincerely,
Doctor John Marcus MD
89 North Maple Ave
Ridgewood NJ, 07450
phone 201-447-0077
fax 201-447-3560
blog at doctorjohnmarcus.blogspot.com
I am soon to start twitter as well, as it was one of the only services that actually worked during the height of the storm. I do have an account, I just never really used it. I am still not sure if I tweet to other people, or if they tweet to me. In any case I just tweeted that I have a new blog post up. Where that tweet goes, I have no idea.
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