Almost all of us know someone who has had a lousy respiratory bug in the last couple weeks. Children and grownups have been coping with chills, fever, headaches and body aches, coughs that wouldn't end, sore throats, and laryngitis.
Is it the flu?
Well, flu is here, so it might be. But, short of getting a test for the flu virus, it's not as easy to figure that out as you might think. It's simple enough to distinguish the flu from the common cold, which is a much milder illness, but other viruses can pack a flu-like wallop. Children in particular have some of those right now. And, yes, you can get the flu even if you've had the flu shot.
Public health officials say we are definitely in the early weeks of this year's flu season. Tina Tan, state epidemiologist for the New Jersey Department of Health, said flu activity in the state was "moderate" by Dec. 24, the most recent period included in the state's flu report. She described the season so far as "pretty typical," but said many other viruses were also circulating. The report shows more flu cases in the middle of the state. Pennsylvania's Department of Health reported "widespread" flu in the last week. The number of confirmed flu cases rose sharply in the last three weeks of 2016. But many people with the flu do not go to a doctor, and many who do go are not tested for the virus.
The U.S. Centers for Disease Control and Prevention shows flu cases rising slowly in November and much more sharply in December. It found high rates of flu-like illnesses only in Arizona, Georgia, and Puerto Rico. The agency said that it was too early to tell how well this year's vaccine was working, but that the circulating strains of flu virus were similar to those against which the shots should protect.
Most of the flu virus seen so far this year has been influenza A, a type generally associated with more severe symptoms.
Flu often takes off around the holidays, when travel and crowded events foster the spread of viruses. Then children return to school and spread them even more.
Alexandr Zaslavsky, medical director for Patient First offices in Cherry Hill, Voorhees, and Sicklerville, said that he was seeing lots of patients with colds, but that more patients with flu had come in the last two to three weeks. He estimated that they now make up about 20 percent of patients.
He described the flu as "like a cold on steroids." Patients have sudden onset of higher fevers — 100.4 and above — and serious body aches. Typically, their heart rates are 110 or 120. (A normal heart rate is in the 60- to 100-beats-per minute range.) Many are so sick that they would rather lie on the exam table than sit up to talk with him. He has given such patients the flu test, and about 90 percent have come back positive, he said. Some of them had gotten this year's flu shot and had full-blown flu symptoms anyway.
Doctors affiliated with Children's Hospital of Philadelphia are seeing a different picture. They have seen lots of patients with respiratory viruses, too, but very few have the flu even though they have flu-like symptoms. Susan Coffin, clinical director of the division of infectious diseases at Children's, said other viruses, which often are thought to cause more minor illnesses, are to blame.
"Several other viruses can also cause fairly dramatic illness," she said. In babies and toddlers, respiratory syncytial virus (RSV) can be a dangerous disease. Rhinovirus and adenovirus often give people cold symptoms. But, Coffin said, there are almost 100 strains of rhinovirus and 50 of adenovirus. Some of them cause more severe illnesses that look (and feel) a lot like the flu.
John Russell, director of the family medicine residency program at Abington Hospital-Jefferson Health, said that he was seeing a "ton" of sick people, but that most have colds or gastrointestinal bugs. There has been a little flu, but there will be more. "We have not seen the worst of it," he said. Flu usually peaks in February, he said, and his office is hit with a "crushing amount of phone calls."
He said not to write off RSV as a cause of significant sickness in adults, too. A report from the National Foundation for Infectious Diseases last year said RSV kills 14,000 people a year 65 or older.
The particular virus at fault doesn't matter for most people because few treatments are available beyond rest and over-the-counter drugs. "This is an area in which medical advances have been slow to come," Coffin said.
For patients with true flu, however, there is an antiviral medicine, Tamiflu, that can help if given in the first few days. Zaslavsky said he will sometimes give it later if high fever persists. Without insurance coverage, cost could be an issue. He said the drug costs between $170 and $200. There is no benefit to using antibiotics unless there are complications, such as pneumonia.
Doctors said frequent hand washing can reduce the odds of infection. Sick people should stay home from school or work and cover their coughs. "Don't share utensils and toothbrushes," Coffin added.
Experts said flu shots are never 100 percent effective. Flu is challenging because the strains in circulation change every year and can be hard to predict. Under the best of circumstances, the vaccine, which is recommended for everyone over six months old, works better in children than in senior citizens. Older people are the ones most likely to die of the disease. but children are most likely to pass it on. Public health officials hope that broad "herd" immunity will make it harder for the virus to spread.
"There are failures every blessed year," Russell said.
Last year was particularly bad for the vaccine, Coffin said. Overall, it was only 47 percent effective, and the numbers were far worse in some age groups. Usually, she said, the vaccine is 50 to 90 percent effective. Whatever the shortcomings of this year's vaccine, the doctors say it is still good to get one.
Zaslavsky says he and his family are always vaccinated. Even if the shots only work for half of patients, they will prevent some deaths, he said.
Russell made a similar point. The shots could make your symptoms less severe even if you still get sick. "If I got the flu and I didn't die, that's not completely a failure," he said.