Reports that this particular strain of flu, called both "swine flu" and novel H1N1, is susceptible to the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) but not amantadine (Symmetrel) and rimantadine (Flumadine) are causing most people with any flu-like symptoms at all to visit their doctor or emergency room. At the same time, centers for public policy, such as The Hastings Center, are urging Non-Pharmaceutical Intervention (NPI) as well. For The Hastings Center, this translates to encouraging the individuals and communities to voluntarily isolate and quarantine oneself and family if ill, school and work officials to voluntarily close schools or workplaces if an outbreak occurs, and all to engage in social distancing measures such as canceling gatherings and events and closing public transportation.
When one factors in the increasing resistance of the novel H1N1 virus to Tamiflu and the fact that almost 50% of our population has concerns regarding a rushed-to-market vaccine that includes thimerosal (49.6% mercury by weight), prevention and home treatment options become even more important.
For our family, our non-pharmaceutical intervention will go a couple steps further by:
• Building body system health to decrease illness risk;
• Re-stocking our home herbal medicine chest to include remedies appropriate for flu prevention and treatment; and
• Gathering items needed in our home should we need to keep to ourselves for a few days.
What is the flu?
Influenza is a viral infection caused by Orthomyxoviruses. They are divided into three different types: A, B and C. Influenza, types A and B, are the primary causes of epidemic disease. Type C is more of a sporadic cause of mostly upper respiratory tract illness. Influenza, types A and B, are further divided into distinct strains that appear to be prevalent and circulating on a yearly basis throughout the population.
• Influenza, type A, involves animal hosts that serve as a reservoir for human disease. In the instance of novel H1N1, pigs (swine) were the hosts. Bird hosts may be responsible for significant spread of disease throughout the country, and for novel H1N1, we now know turkeys have contracted the disease and are aiding in the spread. Influenza type B has no identified animal reservoir.
Children have fewer influenza antibodies to circulating strains, which makes their infection rate higher than the general population. In addition, they have a much higher and prolonged shedding of the virus than adults, making them very effective transmitters of the disease.
Influenza is transmitted through aerosolized respiratory droplets, meaning all you have to do is breathe where someone is sneezing, coughing, or otherwise expelling their droplets into the air and onto surfaces to be picked up by other unsuspecting hands to contract the disease. Hand-washing and avoidance of folks with “expelling” symptoms is a primary means of avoiding “the flu.” The CDC states you should consider yourself exposed to the flu if you have stood within 6 feet of someone with flu-like symptoms.
Since influenza type A strains with the H1N1 and H3N2 serotypes and type B strains are circulating together in any given year, vaccination with a specific type predicted to be dominant is not a fool-proof way to avoid influenza infection. Variants of these serotypes are possible in different geographic areas, making the flu shot a gamble most years without a known type.
What are the symptoms?
Symptoms of flu typically come on suddenly, making the sufferer feel as though they’ve been hit by a freight train: extreme fatigue, headache, fever, body aches, possibly sore throat and a cough. This particular swine flu appears to also cause possible diarrhea and vomiting symptoms as well.
The best way to tell the flu apart from the common cold is that cold symptoms tend to arrive one per day over a several day period (the scratchy throat leads to sneezing which leads to stuffy nose and sniffles which lead to coughing until all the symptoms are mixed in, coming and going for a 7-10 day period without any self-care). The flu, on the other hand, hits a person who feels fine, perhaps a little more tired than normal at 8:00 a.m., then at 10:00 or 11:00 a.m., Whammo!, their throat is terribly sore, they have chills and fever, they’re head feels like it’s going to explode off a body that is so achy and tired, they can’t imagine feeling well enough to lift themselves out of their office chair to get home to crawl into bed.
When exposed to influenza virus, the incubation period can be as short as 48-72 hours, with viral replication in the body (the virus keeps growing and shedding) occurring for 10-14 days. Primary symptoms of influenza types A and B are in order of relative frequency of reported symptoms:
• Dry cough
• Sore throat
• Prostration (have to lie down due to overwhelming fatigue)
• Nasal stuffiness
• Eye irritation or pain
• Myalgia (body aches).
Signs of “flu” include:
• Sore throat
• Conjunctivitis (mild)
• Runny nose
• Lymph node enlargement in neck
• Lung rales, wheezes or rattles.
These symptoms may develop into croup, bronchiolitis and pneumonia. In 77 specimens sent to the CDC from pandemic H1N1 fatal cases, pneumonia co-infection has been responsible for 22 (29%) of those 77 novel H1N1 fatal cases during the period from May to August 2009. The total number of fatal cases during mid-April to August 2009 of pandemic H1N1 virus was 593 of an estimated 1 million cases. As of July 24th, 2009, the CDC ceased documenting novel H1N1 flu as an individual strain to be reported and opted to include for the remainder of the season all circulating flu types in their reporting in the Weekly Morbidity/Mortality Reports.
The duration of the fever illness is generally 2-4 days, although the cough and small airway dysfunction can persist for weeks later. Children and pregnant moms may appear more “toxic,” with vomiting and more severe illness manifestation, while adults generally do not have nausea and vomiting with influenza – though this strain does appear to cause these symptoms in some. Influenza is usually diagnosed during an epidemic by the symptoms of fever, fatigue and respiratory symptoms, though the CDC recommends physicians only diagnose novel H1N1 infections via real time reverse transcriptase--polymerase chain reaction (rRT-PCR) testing rather than rapid-testing for pandemic H1N1 which do not have a reliability factor that can be trusted for accuracy.
What’s the difference in influenza virus strains?
Type A influenza viruses usually cause more significant symptoms and complications than Type B influenza viruses. This strain of swine flu has been identified as a Influenza Type A, novel H1N1 virus, though there are now other strains circulating as well. Since August 30, 2009, the CDC reporting on flu cases now includes all strains, not just the novel H1N1. In this gal's opinion, this will provide some significant lack of being able to know the true death rate for novel H1N1.
The Public Health Risk from Flu
There is no question that this swine flu pandemic is a public health threat. In the past few years, deaths from the flu have increased from around 20,000 each year to close to 36,000 each year. People do die from the flu.
We have had deaths in the US and internationally from novel H1N1 infections. Generally, around 92 children die each year from influenza. Between April 26 and August 29, 2009, 47 pediatric fatalities were associated with novel H1N1 virus infection. Identified swine flu fatalities in the U.S. are pretty evenly divided among males and females. The 593 fatalities in the U.S., associated with pandemic H1N1 infection, reported as of August 20, 2009 out of the estimate of 1 million cases reflects a fatality rate of 0.06%.
Whatever the numbers, as a responsible parent, I must take this year’s flu seriously and consider ways to reduce my family’s risk of contracting the disease.
A Real Public Health Message
The best prevention is reduced interaction or exposure. Yes, this is not the one we like to hear. It’s not a shot or a pill; it’s a lifestyle change. Because it depends upon personal responsibility, you won’t be seeing news coverage focused on lessening exposure rather than the easier route for compliance of vaccinations (odd that we’d rather have needles jabbed into us rather than stay home more), anymore than you’ll suddenly see a national public health campaign for abstinence rather than the false security campaign of so-called safe sex.
Why can we connect the dots of “exposure leads to possible health consequences” where sex is concerned and we cannot when it’s just a respiratory bug or stomach bug (the just is jest as what is not a big deal in illness to one person could be deadly in the person sitting next to them on the schoolbus, restaurant, department store, office, pew, etc.).
There are a number of strategies we can employ to reduce our risk of serious illness, and the following are a few of our methods.
Active Prevention Strategy #1
Unless it is necessary for you to be out, stay home. Carefully evaluate the activity and the risk of illness to both your family and those who may be affected if you become ill.
This requires a careful evaluation of activities. Rather than simply say, “Well, the holiday barbeque is this weekend and I’m supposed to bring pickles,” maybe we need to say, “Is the risk to our family and those who will be affected by our becoming ill worth this event?” A number of years ago, our oldest daughter Emily was about to be in her first Nutcracker production in Fort Worth, Texas. I was early pregnant with Zeb and already threatening miscarriage. I took her to the dress rehearsal due to a feeling of “The show must go on.”
All the other little “angels” were being medicated with fever reducers, cough medications, because, as one mother put it, “she’s got the flu.” I walked out of the room, thought “Is being in this ballet more important than our babe-in-the-womb’s life?” The answer was, of course, “no.” We explained to the ballet director, who had plenty of angels for the show to go on, and left (and yes, we all stayed well, despite a terrible flu year where everyone else we knew became ill).
Another year, almost the whole family was in the Nutcracker. A terrible stomach bug was going around during production, but we performed anyway. We didn’t want the bug, but none of our lives were at risk. We went, and yes, we all got sick (and stayed home until all symptoms had been gone for 5 days). Different years, different situations, different choices.
Active Prevention Strategy #2
Drink a minimum of 2 quarts of water daily. Moist mucous membranes are less likely than dry mucous membranes to allow germs to “set up housekeeping.” If we become infected with the flu virus, hydration becomes of utmost importance due to the typical high fever. Despite feeling like we don’t want to, we must continue to drink. A dehydrated body is one that is highly susceptible to serious complications or death from any illness. Fluids are essential.
Active Prevention Strategy #3
Clean Hands for Health
Contrary to what we are told by marketing experts, antibacterial soap is not necessary for adequate cleaning of hands. Simple soap and water will do the job just fine. Soap contains surfactants that have both a water-repelling end and a water-attracting end. When mixed with water that is warm or hot (cold water doesn’t dissolve the soap very easily), the soap dissolves, and the surfactant molecules lower the surface tension of the water which makes it easier to loosen particles on the object being cleaned. These same surfactant molecules combined with water hold onto the dirty particles so they can be rinsed away.
Thus, washing hands is as easy as: wet the hands, lather with soap, rub the soapy water all over the hands and fingers, cleaning underneath fingernails and in cuticle areas, for at least 20-30 seconds. Rinse and repeat.
Hand-washing should be done several times daily and certainly before eating, after using a bathroom, public or at home, and after they’ve been “contaminated” with a cough or sneeze or after shaking hands with someone.
Ladies have things a bit easier than men in that it is we who are have the option to initiate hand-shaking or not. We can simply nod our heads, smile and utter a polite greeting rather than offering our hand for shaking. If we cannot avoid shaking hands and we cannot get to a sink to wash up, we can use the personal hand sanitizers made with alcohol* or we can simply avoid touching our face or mouth until we can politely excuse ourselves to the bathroom to wash.
In a public bathroom, hands should actually be washed prior to using the toilet if a doorknob or other surface has been touched on the way in. One way to avoid the washing first upon entering rule is to grab a paper towel on the way in if we’ve not had to touch a doorknob upon entering. The paper towel can then be used to open the stall door and lock it. After using the toilet, hands should be washed with soap, the faucet shut off using a towel.
And, just as important, don’t touch the door on the way out. Use a towel to grab the door handle then throw the towel in the garbage on the way out. If there is no waste basket near the door and you cannot figure out a way to open the door without using your hands, open the door with the toel protecting the hands then throw the towel on the floor. Better to teach the establishment the need for a waste basket than risk becoming ill from the myriad of germs that enter that bathroom each day.
*If making use of alcohol-based hand sanitizers, please note it can take up to 10 minutes for germs on the hands to be effectively killed off, so don’t touch your mouth, nose, or eyes during the 10-minute wait period.
Active Prevention Strategy #4
Cleaning Up On Money
After handling change (bills and coins) given in business establishments, wash hands or clean with hand sanitizer. This would also apply to anything else we touch in public.
Active Prevention Strategy #5
Sickies Stay Home
If you have a contagious ailment (signified by sniffling, sneezing, coughing, wheezing, fever, nausea, vomiting, diarrhea, etc.), stay home and try to stay apart from family members as much as possible until after the acute symptoms have subsided. Again, this is the single most effective method of reducing the spread of disease in our communities.
Generally, illnesses are passed in the winter due to close contact with others in work or school environments by those who refuse or feel they simply do not have the freedom to stay home. Teach others to stay home by gently encouraging others who are out and ill to take care of their body by going home and resting. Employers would find greater job productivity if those who were ill stayed home rather than infecting co-workers thus increasing absentee rates.
Active Prevention Strategy #6
If you are ill and going out is an absolute must:
1) Wash hands frequently, following the guidelines for washing above.
2) Cover the mouth and nose with a tissue when sneezing or coughing. If the sneeze or cough hits before you can reach a tissue, direct the cough or sneeze into the crook of the elbow or down the shirt, so that only your own body is contaminated with your germs. Then wash hands as soon as possible.
3) Avoid public areas and close contact with others.
4) Consider a disposable N95 respirator for yourself and those with whom you have no choice but to come into contact.
5) After touching common surfaces with co-workers or co-transit riders, wash hands. Better yet, use some type of hand sanitizer prior to touching to prevent the spread of germs to others.
7) Use a tissue or paper towel to open and close doors. And for community’s sake, don’t shake hands!
Active Prevention Strategy #7
Disinfect House Hotspots
Don’t forget to disinfect all the doorknobs, all handles used, light switches, telephones and remote controls weekly to remove the germs that have taken up residence during the week. If anyone has a cold or other illness, they should avoid touching community items or surfaces unless they have washed their hands first to help keep from passing on their germs.
Also, toys should be cleaned regularly with solutions of soap and water or hydrogen peroxide. If there’s been a serious infectious illness in the home, it may be necessary to clean toys with one part bleach to nine parts water. Whenever using bleach or significant germicides on children's playthings, always rinse thoroughly before allowing the children to play with them again. Another method of disinfection we have employed on bright, sunny days is to place the toys in the sunlight and let the sun’s sanitizing rays do their work.
Active Prevention Strategy #8
Elderberry supplements taken as daily preventive
Elderberry, Samubucus nigra
Parts used: flowers, fruit
Active Constituents: Flavonoids, rutin, quercitin, hyperoside, isoquercitin, astragalin, nicotoflorin; Glycoside, sambunigrine; Volatile oil, palmitic acid; Tannin; Mucilage; Anthocyanin; Vitamin C; Caffeic acid, chlorogenic. The mature fruit or berries do NOT contain cyanogenic glycosides; the bark, leaves, unripe/raw fruit may.
Biochemical Actions: Diaphoretic, Increased bronchial secretion, Binding to H1N1 virions and block the ability of the viruses to infect the host cells.
Medicinal Uses: Colds; antioxidant; one study showed insulin-like activity; and increased urine flow and sodium excretion. Some early studies on elderberry show a reduction in the risk of contracting the flu if given twice daily as a preventive, increasing to four times daily upon exposure. The maker of Sambucol states that elderberry reduces the flu virus’s ability to penetrate our cells. The latest studies show a reduction in the duration of the flu if elderberry is taken (from 6-7 days down to 2-3 days).
Safety Issues: No known contraindications, side effects or interactions with other drugs.
General dosage: 10-15 grams of elderflower daily; 1.5-3 grams fluid extract daily; 2.5-7.5 grams of tincture daily. Use only cooked berries for syrups, teas, tinctures, or TincTracts: Syrups: 1-2 Tablespoons for adults daily; 1-2 teaspoons up to three times daily for children; Tea: 1/2 - 1 cup up to four times daily for children or adults; Tinctures or TincTracts: 2 teaspoons up to four times daily for adults or 1/2-1 teaspoon up to four times daily for children.
Our favorite for children is Yummy Yarrow and Elderberry from www.trilightherbs.com. Sambucol from your local health food store is a choice, though it is thick and not-so-great tasting.
Active Prevention Strategy #9
Echinacea supplements upon exposure or onset of symptoms
Echinacea, Echinacea angustifolia, E. pallida, E. purpurea
Parts Used: Above-ground parts harvested at flowering time; root
Active Constituents: Phenylpropenoids, echinacoside glycosides; caffaric acid; chicoric acid, aynarine; Alkylamide, tartaric acid; Alkaloids, tussilagine, isotussilagine, tetraen acid, isobutylamide; Polysaccharides, inulin, heteroxylin, arabinorhamnogalactans, fructose; Essential oils, palmitic, linolenic; Flavonoid, rutin.
Biochemical Actions: Immunomodulator; Antiinfective; Inhibits hylaluronidase, found in pathogenic organisms.
Medicinal Uses: Supportive therapy for colds, influenza, chronic infections of the respiratory and lower urinary tract. May also be used externally for poorly healing wounds and chronic ulcerations.
Safety Issues: Contraindicated in progressive systemic diseases, such as tuberculosis, leukosis, collagenosis, multiple sclerosis, AIDS, HIV infection, and other auto-immune diseases.
General dosages: Tincture (1:5) with 50% ethanol, corresponding to 900mg of herb daily. For fresh-expressed juice or equivalent preparations, 6-9ml daily. External semi-solid preparations should contain at least 15% pressed juice. TincTract: ¼ to ½ teaspoon every 2 hours upon exposure or onset of symptoms.
The Cytokine Storm Controversy
In answer to the current controversy over cytokine storms if using echinacea and elderberry during pandemic flu, I think authors Eric Yarnell, ND, Kathy Abscal, B.S. J.D., and Robert Rountree, M.D. say it best in their excellent book Clinical Botanical Medicine (a highly recommended book, by the way):
"Herbs in fact act as inflammation and immune modulators rather than as stimulants or suppressors (Yarnell, Abascal, Alt Comp Ther 2006). There is one interesting study that strongly supports our view, and shows that herbs may be capable of moderating the influenza 'cytokine storm.'"..."In the study, echinacea down-regulated, or normalized, the cytokine production in infected cells and up-regulated cytokine production in healthy cells."(Sharma M, Arnason JT, Burt A et al. Echinacea extracts modulate the pattern of chemokine and cytokine secretion in rhinovirus-infected and uninfected epithelial cells. Phytother Res 2006; 20:147-152.) Though the study was done on rhinoviruses, or colds, these authors and other herbalists feel confident in using herbs with historical benefit shown for flu due to clinical evidence of symptom reduction being the likely result of these herbs being used to quiet the cytokine storm.
Active Prevention Strategy #10
Do not take any medications that do not say “Non-aspirin pain relievers” during the flu. Some researchers are trying to ascertain whether the higher death rate in children could be due to encephalitis and wondering whether this may be partly due to the administration of aspirin or other pain medications such as ibuprofen during a bout with the flu. There is a rare but real risk of Reye’s syndrome if anything other than non-aspirin pain-relievers are given during the flu. Just don’t do it!
Active Prevention Strategy #11 and #12
Daily probiotics have a positive effect on immune health, and vitamin D at a dosage of 1,000 to 5,000 IU daily, depending on your current D status and age, supports immune system health as well.
Your greatest ally is accurate information, which is sometimes very hard to find. Be informed. Research influenza, vaccines, and self-care and medical intervention until you are able to make an informed decision for your family regarding your plan for the rest of the flu season. Even the most rational of voices can get the data wrong or be moved by personal experience to color an argument in such as way as to sway even the most discerning of readers or listeners.
We can be a pinball that merely reacts to the forces impelling us, or we can be a cue stick, directing our efforts effectively, recognizing that Providence can re-direct as He wills.
Specific Protocol for Influenza:
• Increase fluid intake to 8 ounces of water every hour during acute phase of illness.
• Limit food to light foods: fruit, steamed vegetables, broth. We’ve often fasted during the acute phase of the illness (1st 48 hours), with the exception of water and herb intake, and we usually recover completely within those 48 hours.
• Bed rest is imperative for full and quick recovery. Taking either over-the-counter pharmaceuticals or herbs to be able to “keep going” with the flu will only backfire on the individual with more lost time due to slower, full recovery or relapse or complication of the flu.
Botanical and Nutritional Supplement Recommendations:
• Ginger root (Zingiber officinale), Cayenne fruit (Capsicum ), Goldenseal (Hydrastis canadensis), Licorice root (Glycyrrhiza glabra): Taken as a combination product capsule: 1 gram every 2-3 hours during the acute phase of the illness (may also be used during stomach viruses or for those strains of flu that involve diarrhea and vomiting).
• Echinacea (Echinacea purpurea, E. pallida, E. angustifolia), three to four times daily dosages follow: dried root (or as a tea): 0.5 – 1 gram; freeze-dried plant: 325-650 mg; juice of aerial portion of E. purpurea stabilized in 22% ethanol: 2-3 ml; tincture (1:5): 2-4 ml; TincTract: 2-4 ml; fluid extract (1:1): 2-4 ml; solid (dry powdered) extract (6.5:1 or 3.5% echinacoside): 150-300mg.
• Elderberry (Sambucus nigra): As syrup or TincTract: ½- 1 teaspoon six times daily during acute phase of illness. For prevention, take recommended dosage twice daily. Upon exposure, 3-4 times daily of recommended dosage.
• For a combined echinacea/elderberry product, consider Quick Defense by Gaia Herbs for older children and adults and Yummy Yarrow and Elderberry by Trilight Herbs for young children. Another combination product we find useful for families is Esberitox by Enzymatic Therapy. The tablets are chewable, making it usable by even small children. In one mouse model of Influenza A, using Esberitox (Echinacea purpurea and E. pallida roots, Baptisia (wild indigo) root, and thuja leaf extracts) significantly prolonged survival compared to placebo.
• In addition to the elderberry and echinacea, I like to add a berberine-containing herb product to our flu regimen. This year, I am prepared with Rainbow Light’s Counter Attack Immuno Response or Echinacea/Goldenseal by Gaia Herbs.
Copyright © 2009 Shonda Parker. All rights reserved.
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