1918 influenza epidemic

Septic Shock in 2018 Type A Influenza

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I recently took a friend to the hosipital with severe septic shock from acute influenza. After one day of typical acute flu– sore throat, fever,  headache, tight cough and prostration– she developed most of the characteristic signs of sepsis.  On registering at the emergency department, the symptoms of sepsis were recognized, and she was admitted immediately. Within minutes after appearing at the registration window,  more than two liters of saline were pumped into her through to IV lines; more would follow. After about 10 hours all her vital signs, pulse, temperature, and respiration,  gradually returned to normal, and she was released. The diagnosis and treatment were immediate and effective.

Septic shock can be the result of any overwhelming infection that   causes the body blood  circulation– and therefore multiple organs– to fail. It is seen most often with a bacterial infection, but in this case  was caused by  a virus: type A influenza. When someone comes to the ED with fever over 100, heart rate over 100, and respiratory rate over 20, (an important but often overlookied vital sign!); and in the worst cases,  mental confusion and low blood pressure– it is Sepsis, septic shock requiring  immediate treatment,  just as with heart attack or stroke or poisoning or respiratory failure;  it’s that urgent. Accurate diagnosis and multiple lab tests are  far less urgent than immediate treatment, based on symptoms and findings. Over the next few hours  her lab tests did come back, consistent with influenza, including  a nasal rapid test for type A influenza.

Sepsis  sometimes kills people during the current flu epidemic, or pandemic… It can also kill from influenza pneumonia, or complications of preexisting  heart or respiratory problems, especially in the aged, and  paradoxically, the very young.  Type A flu constantly mutates, changing so much that the  old flu vaccine is little help, precisely because it’s derived from the last few epidemics, while influenza has moved on, evolving and changing ever since. So in this and most epidemics, people are almost all on their own, even after a flu shot, although arguably that immunization does no harm.

With symptoms of influenza, one should go to bed and stay there,  drinking at least a  liter of liquids three times a day, until you are  without fever and well hydrated. If the symptoms of sepsis are suspected, go to the nearest hospital.  Tylenol/ acetaminophen/ ibuprofen/Motrin,  may relieve symptoms some, but aspirin is not advisable. If one get by for 4-5 days, expect gradual  recovery over a few weeks, with  productive wet cough.  Tamiflu (oseltamivir)  helps at the very first.  It’s expensive,  and requires a prescription, unfortunately. Of course the manufacturer suggests it be taken for much longer; in my opinion, that is profitable,  but isn’t as effective as taking it on the very first day. ( I confess. My bias is: ‘follow the money’. )

It is curious that the last great worldwide lethal influenza epidemic took place almost exactly 100 years ago: The pandemic of 1918 killed many  tens of millions,  then a great part of the world  population; deaths were comon among people with ongoing  serious chronic health problems, or malnutrition, when treatment was less effective than it is now, especially treatment of  secondary bacterial infections.

Well, that’s my take on the 2018  flu. But then, thankfully,  I am only an old ex-doctor, ( I love that!)  So you,the reader,  must realize this is just gossip, worth  less than what you pay for it!