Fall and winter are the viruses’ delight. Rhinoviruses (colds) and adenoviruses (flu) prey on people huddled close together in cold weather. They feel right at home on thousands of daily continental and intercontinental flights where they fly for free. Adenovirus transmission often goes from wild birds or bats to chickens, then pigs, and finally to humans. A coronavirus can cause either colds or flu. It loves huddled masses, but in the case of Covid-19’s can readily spread in warm or cold weather.
Flu season usually begins in early December and winds up in late March. One outbreak 1n 1999 began in Alaska in September. Unusual influenzas have also started during the summer over the last few years. On average, adults develop 2 to 3 colds or cases of flu per year, and children as many as 6 to 12.
Knowing when to visit the doctor can be tricky. Here are some criteria to help you make an informed decision.
Consult your physician if:
- a cough gets worse instead of better
- your illness lasts longer than a week
- your symptoms get worse instead of better
- a high fever occurs
- sinus pain, earache, or toothache develops
Viral strains change every year, and about every 30 years, an especially severe outbreak or pandemic occurs. A very deadly variant appeared during World War 1, becoming the Spanish flu pandemic. It started on March 11, 1918, at an Army training camp in Fort Riley, Kansas. (An earlier outbreak or variant began in 1916 at a large British war camp near Etaples, France, where large numbers of live chickens and pigs were kept close to thousands of encamped soldiers.) By late spring of 1918, the flu had killed 48 soldiers at Fort Riley. The following fall, it reappeared with a vengeance, killing more Americans, Europeans, Africans, Indians, and New Zealanders than all the wars of the 20th century combined.
The Spanish flu was unusual in that most of the deaths occurred in people in their 20’s. Most cases of flu, like that of Covid-19, prey on the elderly. In contrast to older people, this virus made people in their 20’s more vulnerable because their immune systems had never been exposed to a similar virus. A pandemic of the same magnitude today would kill 180 million people. However, awareness of the protection offered by facemasks, the availability of vaccines, flu medications (see below), and anti-inflammatory drugs should reduce this toll.
In the USA, an average of 10,000 excess deaths above the number expected for that time of year occurred each winter between 1957 and 1986, with three years showing an excess of 40,000 deaths. During the last pandemic in 1957, there were 70,000 excess deaths in the USA. Historically, virologists believed we were overdue for a pandemic, and Covid-19 shows their fear to be correct.
Sudden onset of fever, headache, sore throat, dry cough, runny nose, muscle aches, tiredness, and weakness. A cough may continue for several weeks. Remember that bacterial infections, such as sinus infections, bronchitis, and pneumonia, often follow immediately after the flu, making them harder to identify. Although they begin more slowly, they are more dangerous.
Anyone with the flu should be careful to cover their mouth and nose when coughing or sneezing, wash their hands often, do not touch the face, do not share toothbrushes and other toiletries, and avoid direct contact with communicable objects like doorknobs or keyboards.
Rimantidine (Flumadine) by Rx: 100 mg 2X a day for about 5 days or Tamiflu by Rx: 75 mg 2X a day for about 5 days.
Most transmission between people occurs through the air following a sneeze or cough. Although less likely, a virus may also be passed through touch. Simple measures such as covering the mouth and nose with a Kleenex or handkerchief when coughing or sneezing and frequent hand washing are some of the most effective ways to reduce viral exposure.
Preventing the standard flu and pneumonia that can accompany it is easy. Get a yearly flu vaccine. Obtaining a flu vaccine is recommended for everyone with diabetes before the middle of November each year, but even a late vaccine is better than no vaccine. Vaccination also helps avoid the spread of the flu to your family. People who “never get the flu” should remember that they may be carriers even though they never “get the symptoms”.
A vaccine is made up of different viruses with no live virus present, so it cannot give you the flu. A flu vaccine consists of altered strains of what researchers guess will be the three most likely candidates to spread during the coming winter months. Their predictions are generally far better than those for the weather. Their guess effectively prevents symptoms in 80 percent of people exposed. Only people who should not get vaccinated are those with an egg allergy or a history of Guillain-Barre Syndrome.
Some 80 million vaccines are created each year for use in the U.S., and it takes a week or two for the immune system to respond to the vaccine before it can begin to provide protection. An injected flu vaccine can be used by anyone over 6 months of age, including those with diabetes and chronic medical conditions. Once flu symptoms begin, a vaccine is of no use.
FluMist(TM) is a new influenza vaccine that is given by nasal spray instead of injection. It contains a weakened live influenza virus rather than a killed virus. The live virus in the vaccine is cold-adapted to grow in the nose and throat cavities, but not in the lower respiratory tract where temperatures are higher. FluMist is approved for use by healthy people between the ages of 5 and 49. It is not approved for use in diabetes or other chronic diseases, in pregnancy, nor in children or adolescents who receive aspirin.
- everyone aged 50 or older
- those with diabetes, asthma, heart disease, lung disease, history of bronchitis, kidney disease, anemia, HIV/AIDS, or cancer
- if you live or work in residential or medical facilities
- women past the third month of pregnancy between December to February
- medical personnel and their families
Vaccines against both flu and pneumonia are free for older Medicare patients who are most at risk, but a recent CDC study (American Journal of Public Health 1999;89:1715-1721) found that half of all older Medicare patients don’t get their recommended annual flu shot, and two thirds had never had a pneumonia vaccine. With diabetes, an individual is three to four times as likely to die from influenza and pneumonia, and 10% of all deaths are found in people who have diabetes. Only 30% of those aged 18 to 44 with diabetes get a flu vaccine, and only 11% have received a pneumonia vaccine.
All older adults who have children in the household should automatically get a yearly influenza vaccine. A large study of over 300,000 adults over 65 done by the V.A. and published in an April 2003 issue of the New England Journal of Medicine, found that a simple flu vaccine cut the risk of dying from any cause during the flu months in half among people this age.
Flu symptoms can turn into pneumonia with little warning. An adenovirus infection can trigger bacterial pneumonia, which kills an average of 40,000 people in the U.S. each year. Especially at risk are those over the age of 65, residents of nursing homes, people with heart or lung problems, and anyone with a chronic disease like diabetes or kidney disease.
Everyone with diabetes should obtain a pneumonia vaccine that needs to be taken only once for lifetime protection. Pneumococci are the most common bacterial cause of bacterial pneumonia, and vaccination eliminates this particular risk. A pneumonia vaccine also protects against varieties that are resistant to antibiotics. A pneumococcal vaccine is a terrific investment of your time.
Death rates for the flu are 100 times higher in adults than in children, with the most vulnerable being adults over the age of 50. Remembering their vitality and resistance to cases of flu when they were children, people do not realize how vulnerable they are to the same illness as an adult. The first thing in preventing an unnecessarily early death from the flu is to recognize that you are vulnerable, especially with diabetes.
Someone who is seriously ill, such as with pneumonia, may have difficulty recognizing how ill they have become, especially as they become oxygen-deprived. Others can recognize oxygen deprivation as fast breathing and a greyish discoloration of the skin. With diabetes, an ER visit is needed immediately if oxygen deprivation is seen, the blood sugars become very hard to bring down, you have shortness of breath, your urine shows moderate or large ketones, or your heart rate is high (usually 30 bpm above average, or over 100).
- Get a flu vaccine every year. It’s an excellent investment of your time, reduces your risk of dying during the winter months in half, and helps reduce the spread of the flu to others.
- Get a pneumococcal vaccine now! Needed usually once in a lifetime, it prevents about 80% of pneumonia cases, which in most years will cause twice as many deaths as influenza itself.
Vaccination is always your best medicine.
Once flu symptoms begin, they can be significantly reduced with certain prescription medications. Two agents, active against the more common influenza A-type virus, are amantadine and Rimantadine, which have been used to treat Parkinson’s disease for many years. Both are effective against the active flu, but Rimantadine is less likely to cause side effects, such as confusion and agitation in the elderly. Rimantadine works very well in treating influenza A. Still, it is critical to start the prescription as soon as the flu symptoms begin, especially within the first 24 to 48 hours.
Get a prescription from your doctor to have on hand if you have diabetes, have other health issues, or are a school teacher, daycare worker, or healthcare worker. Rimantadine and amantadine should not be used by children, pregnant women, or with liver disease, kidney disease, or epilepsy.
Another newer class of influenza medications, called neuraminidase inhibitors, causes a modest reduction in flu symptoms. Tamiflu (oseltamivir phosphate) by Roche Laboratories was the first to receive FDA approval and is available in the U.S. by prescription. This class of drug works on both influenza A and B by inhibiting a virus-specific enzyme called neuraminidase. Tamiflu may be more effective at preventing the flu. The dosage is 75 mg. twice a day for five days. Start this as soon as possible to be effective. A second neuraminidase inhibitor, Relenza, which is given as an inhaler rather than tablets, must be used with caution due to rare cases where it may cause breathing problems. This may occur in people with asthma and COPD, or in those with no previous breathing problem.
Flu treatments cost approximately $5 for generic and $15 for nongeneric amantadine, $25 for Rimantadine, $45 for Relenza, and $55 for Tamiflu. Unless there are other reasons for not taking aspirin, it is the preferred treatment for fever associated with the flu.
Sneezing, stuffy nose, runny nose, sore throat, and cough. Unlike influenza, colds do not cause a fever or body aches, and symptoms usually have a slower onset.
Ask others to cover their mouth and nose when coughing or sneezing, wash your hands more often, don’t touch your face, don’t share toothbrushes and glasses, and avoid direct contact with communicable objects like doorknobs.
For adults, take chelated zinc, 50 mg twice a day for 3-5 days. Have on hand and start as soon as symptoms begin.
Vitamin C 100 to 250 mg. 4-6 X a day
Echinacea capsules, one twice a day
Getting Rid Of Colds: After catching a cold, symptoms can usually be significantly reduced by taking large doses of chelated zinc or zinc sulfate by mouth at the very first sign of a cold. About 50 mg of chelated zinc is needed every 8 to 12 hours to reduce cold symptoms in an adult. Do not take zinc at high doses (the MDR for zinc is 15 mg a day) for longer than a few days when treating cold symptoms. Doses as high as 150 mg a day have been taken for several months to treat rheumatoid arthritis and poor wound healing, but this may cause nausea, vomiting, and diarrhea. Prolonged high doses may also cause a temporary drop in HDL (protective cholesterol) levels and create a copper deficiency because zinc competes with copper for uptake.
Clinical studies looking at the use of zinc tablets to treat cold symptoms are rare, but it’s easy to tell if zinc is going to work. Have 25 mg. zinc tablets available, and at the earliest sign of cold symptoms, take two tablets. If the zinc works on this viral strain, your symptoms will largely disappear within 30 to 60 minutes. If a marked improvement is not seen following the first dose, zinc is unlikely to work for that strain or for whatever else might be causing your symptoms.
Zinc treatment usually causes a rapid reduction in symptoms, which will last for several hours. After 8 to 14 hours, the cold symptoms gradually begin to return. Another dose of zinc will again cause the building symptoms to subside. Twice daily dosing needs to be kept up until your own immune system takes care of the virus, usually in four to five days. Occasionally, an extra 25 mg dose may be needed midday.
Each rhinovirus-14 has 360 binding sites for ionic zinc (Zn +2). Large doses of zinc appear to prevent the virus from binding to cell membranes (Med Hypotheses 1996 Mar; 46(3): 295-302). Zinc is known to have direct antiviral activity, interact with cell membranes, and boost the immune system. Because of the fast onset of action seen with zinc tablets, it is highly likely that ionic zinc directly stops the replication of rhinoviruses.
Zinc lozenges have also been touted for treating colds, but they have a checkered history. One research study showed that some lozenges shorten cold symptoms, while others actually lengthen them (J Antimicrob Chemother 1997 Oct;40(4):483-93). Some zinc lozenges show no effect, possibly because of the contradictory effects from different compounds found in the lozenges. (Arch Intern Med 1997 Nov 10;157(20):2373-6)
Zinc deficiency is relatively common in long-term diabetes, but this does not likely make anyone more likely to catch a cold. Signs of a zinc deficiency include sunlight intolerance and decreased dark adaptation. The first will be suggested if you need to wear sunglasses on sunny days, when you did not need to do so in the past. Decreased dark adaptation is suggested if, in a dark theater, other people pass you by as you try to find a seat in a darkened movie theater).
Zinc tablets are the most effective over-the-counter treatment for colds. Vitamin C (100 to 250 mg. 4 to 6 times a day) and the herb Echinacea may help reduce symptoms. Standard therapy of warm liquids, rest, cough syrups or tablets, and decongestants can all be helpful.