ELEVEN. CHAD DUVALL counted 11 tubes pumping fluids into his son’s body to keep him alive. Luke’s illness had started off mildly enough with chills, headache, a little fatigue. Luke was convinced he was coming down with the flu—a plausible diagnosis, given that the symptoms fit the bill. Nothing a dose of Tylenol and a good night’s sleep wouldn’t fix. But every hour that went by aggravated Luke’s condition. In just five days, he went from being a healthy 15-year-old playing football for Atkins High School to an H1N1 victim unable to breathe without a ventilator in the intensive-care unit at Arkansas Children’s Hospital, where he’d stay for 34 days.
As a parent, Chad knows firsthand how flu-like symptoms run the risk of becoming deadly and how fast that can happen if they’re brushed off. “There were things that we missed because we didn’t know what to expect,” he says. “We didn’t have anybody with the flu before. We’re generally a healthy family. There were signals and signs as we were going along that, had we picked up on those, we wouldn’t have ended up as sick as we were.”
This was back in 2009, when a deadly wave of H1N1, otherwise known as the swine flu, swept through the country, hitting pandemic levels. This year, the flu has been back in the headlines. The virus—more precisely, the H3N2 virus—hit early, and it hit hard. The death toll has been the highest the country has seen since Luke was ill back in 2009. In Arkansas alone, the numbers have climbed to 217 as of April 14.
The telltale signs of H3N2 are the same as any other simple case of flu you’ve tackled with chicken soup in the past, says Dr. Keyur S. Vyas, a physician who specializes in infectious diseases and an associate professor at UAMS. Without getting too much into the nitty-gritty, the “H” and the “N” are merely proteins that lurk on the surface of the virus. Those proteins are what our immune system reacts to and learns to fight off. The number that follows is an indication of the protein type. When a person or animal catches two different strains, the viruses can exchange their genetic information—a process that yields a completely new virus.
That plays into why flu strains are prone to change so much and so quickly—and why, sometimes, we’re collectively unprepared to fight them, especially when a strain breaks out after vaccines for that year have been cooked up. But as Dr. Vyas says, every flu season is different. Sometimes it targets children and the elderly. Other times, it goes after the healthy. And then sometimes, like this year, vaccines just aren’t as effective against particular strains.
But that’s only scratching the surface. As the flu season begins to wind down, we asked Dr. Vyas to explain how flu season works, what makes some seasons worse than others and why we should pony up for a flu shot the next go-round.
Infectious-disease specialist Dr. Keyur Vyas schools us in all things influenza
On how flu season really works
“The state health department monitors how many patients clinics are seeing with flu-like illnesses. Hospitals will report how many patients they’re seeing with influenza-like illnesses. Labs will also report when they have positive flu. The health department looks at other things, too, like school absences in a particular school district or county. The health department tracks when the illness goes above that baseline, and that’s sort of when they define the flu-season start. Some years, like this year, the flu season starts early—we started seeing cases even back in October. If prior years are any indication, we’re probably getting close to coming back down to baseline.”
On why this year’s season was so bad
“If there’s a big change in the flu virus, then people may not have immunity that they may have developed in previous years. It also depends on how effective the vaccine is, as well as how many people get the vaccine. This year, the viruses that the CDC selected for the flu vaccine, which covers three or four strains, was actually a pretty good selection. Unfortunately, the main virus that was circulating this year, H3N2, is a virus that tends to be harder on people, causing more severe disease. It’s a strain that the vaccine doesn’t tend to be as protective against as some of the other strains.”
On the possibility of catching the flu after the end of flu season
“[The end of the flu season] doesn’t mean that the flu is not possible. We occasionally do see persons come in, and they have influenza in the summertime. Oftentimes, that’s because they traveled somewhere or came in contact with someone who may have traveled. So it’s not, You can’t get the flu in the summer—it’s just much less likely.”
On symptoms of flu versus other illnesses
“The flu can mimic a lot of other illnesses, and some of them are not as serious. The traditional, typical flu symptoms we think of are fever, headache, runny nose, kind of a dry cough, body aches and joint aches. All of those can kind of go along with a simple common cold as well. One of the things that people who have the flu will often describe is that they can tell you the hour that they got sick. It’s often—they’re feeling OK, they’re feeling OK, and then boom, they were doing something at work, and they started feeling bad. With the common cold, it’s kind of gradual. There’s nothing 100 percent about that, but that’s one of the things we can kind of see.”
On how it goes from bad to worse
“With some people, it depends on whether they have other underlying medical conditions, such as lung problems or heart problems, or if they have something wrong with their immune system or if they’re at the extremes of age. The virus itself can cause pneumonia. People may develop trouble breathing—more coughing, shortness of breath. It can cause other things, as far as infections of the muscles, even the brain, which is uncommon. It can make us more susceptible to infection. People can get bacterial pneumonia after they get the viral. People get the flu, they feel bad, they may even start feeling better, and then before they get all the way better, they suddenly feel worse, and then they have what they call ‘secondary bacterial pneumonia.’”
On good influenza etiquette
“If you’re coughing and sneezing, cough and sneeze into a tissue or into the crook of your elbow. Wash your hands if you sneeze into your hands, or use alcohol gel. If you’re sick, then it’s all about getting rest, drinking plenty of fluids—kind of the advice that your mom or grandma [gave you]. If your symptoms seem like you have the flu, then really, as much as possible, you need to stay home.”
On rolling up a sleeve for a yearly flu shot
“We used to say that people who are at high risk to have complications from flu should get vaccinated, but we broadened that up to say that everybody over the age of 6 months should get the flu shot. That helps prevent people who are at high risk from getting the flu—if someone in the family has a poor immune system, but everybody else in the household is vaccinated, they’re much less likely to infect the person that’s at higher risk. If you’ve been vaccinated, even if it’s a year that the vaccine isn’t particularly helpful, you do have some partial immunity. Even with 30 percent effectiveness, that’s still a pretty significant reduction. And even if you happen to get the flu, you might not get as sick as you would’ve otherwise.”