nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, April 28, 2009


This is for those who are watching the swine flu saga on television.


As of 11 AM Eastern today there have been 64 cases.  No deaths (a little early to tell in many of the current cases).  The points of outbreak are evolving.  Initially there were a handful of cases in California, and two cases in Texas (both states in proximity to Mexico).  Over the last week, there have been no new cases in Texas, but 45 cases have appeared in New York, with 1-2 in Kansas and Ohio.  This is WWAAY too early to tell where this is going.  So here are some useful facts to keep in mind.


  1. In a typical year with very low levels of influenza (1-2 million cases), there will be 20,000 deaths.  This is routine and isn’t a marketable media story.  In a “bad” year, there will be 2-3 times this many deaths.  Bad years come from a slightly different strain than what was expected, and therefore the shot doesn’t match exactly, OR people start getting lax about getting the shot and more people are vulnerable.
  2. We’ve had 12 cases of swine flu in this country (total) in the last several years.  There was one death over this period.
  3. The great pandemic of 1918 killed somewhere between 20 and 60 million people world-wide.  This was a H1N1 virus (more on this below).
  4. The terms “swine” flu and “bird” flu come from the source of the new strain of virus.  Hogs get flu every year (as do birds and others)…it just doesn’t jump to humans very often.  Occasionally a random mutation occurs that opens a window to other species, and the virus then propagates though that new host…in this case, humans.


There’s no shot for this new strain, because there’s no way to anticipate a random mutation.  There are some drugs that can lessen the severity of (but not cure) the disease when you get sick.


90% of what people call the “flu” is not influenza.  It’s cold viruses, sore throat viruses, bronchitis, pneumonia, and a hundred other respiratory diseases.  So just because you get “flu-like” symptoms doesn’t mean you have influenza.  As doctors, we often just put “FLS” under diagnosis, which stands for flu-like syndrome, because there’s no way to distinguish among all the different viruses without doing thousands of dollars worth of tests in a specialty lab. 


BUT, there are some symptoms that increase the likelihood of influenza:


  1. SUDDEN onset.  Anything that takes several days to crank up is not influenza. (scratch throat first day, runny nose the second, cough the third…not influenza)
  2. SEVERE HEADACHE (co-incident with the onset).  This is not like a sinus headache, or a tension headache, or any of the common head pains we all get.  It’s clearly not there one minute and there the next…and it’s really uncomfortable.
  3. FEVER.  By this, I mean something over 101 at least, and preferably 102-104.  Anything less is trivial.
  4. PAINFUL COUGH.  This cough hurts…in your chest.  This is not a post-nasal drip cough.


As you can see, the classic case knocks you flat.


Not everybody gets the whole menu, and some people have other symptoms in addition…but these are the signature ones.



I don’t recommend meds—there are side effects—unless you are (1) in close contact with someone who’s sick, and (2) you have another medical problem that puts you at risk.  Herbals don’t do squat.


  1. Avoid close contact with anyone who has a respiratory febrile illness.  “Close contact” means “within six feet.”
  2. Wash your hands frequently…and I mean really wash them:  15 seconds (one potato, two potato…).  It’s not the soap that’s doing the job, it’s the mechanical scrubbing.


Transmission of viral illness by contact is under-recognized.  There’s some evidence that direct contact causes more illness than aerosol spread.  So, scrub away, all day long.


You can use the hand sanitizers, but they are not as effective as hand washing. 


The classification scheme:


--There are three types of influenza virus:  A, B, and C


A causes the most severe disease in humans, and all the HN sub-types are in this group.


B has one species, specific to humans, but it’s less severe and we all carry some partial immunity to it for longer periods of time.


C has one species, humans are the only host (except seals, for some reason).  It’s less common and causes mild disease.



--Under the “A” type, the strains are named by referring to two enzymes coded by the virus:  Hemaglutinin and Neuraminidase, hence H and N.  They are just markers.  So there’s:

H1N1, which caused Spanish flu in 1918 and is the sub-type we are dealing with now, H2N2, which caused Asian Flu in 1957, H3N2, which caused Hong Kong Flu in 1968, H5N1, the avian flu we all got worried about in 2007, H7N7, H1N2, H9N2, H7N2, H7N3, H10N7…

Confusing, isn’t it?

Lastly, watch the pattern of spread.  I’m not sure if this one’s going to peter out or really get rolling—SARS looked like a good bet to accelerate, but reached a peak quickly.  It’s unusual in a number of respects, not the least of which is that it’s almost summer, well past the usual season.  Another interesting feature is the quick growth of cases in New York:  I’m told there was an index case from Mexico that arrived through the airport.  Throughout history this is how plague, cholera, and their ilk have jumped from one city or continent to the next.

Doc D



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