There are few things that can make you feel lousier than the flu, and the 2018-19 season is expected to be particularly brutal.
“The flu makes me nervous,” said Dr. Mark Bustamante, of Oak Street Health in Indianapolis. “Many Hoosiers die each year as the result of the flu or the after-effects of the flu.”
During the 2017-18 season, more than 300 people died in Indiana, according to the Indiana State Department of Health.
Every year also brings new strains of the virus, and this flu season, which lasts from October to May, is no different.
In addition to fever, fatigue, coughing and sore throat, new research shows that even heart attacks can also be brought on by the disease.
A deadly past
This year is the centennial anniversary of the beginning of the Spanish influenza pandemic. An estimated 675,000 Americans died as a result of the disease, part of the at least 50 million fatalities worldwide.
Howard County was one of the lesser affected counties. In mid-October 1918 there were 22,000 cases reported to the state. By Dec. 31, there were 200 deaths in the county.
On Oct. 7, 1918, a story in the Kokomo Daily Tribune notified readers that basically every possible public meeting place, including churches, theaters and businesses, were closed.
“The pandemic was so severe that from 1917 to 1918, life expectancy in the United States fell by about 12 years, to 36.6 years for men and 42.2 years for women,” according to the Centers for Disease Control. “There were high death rates in previously healthy people, including those between the ages of 20 and 40 years old, which were unusual because flu typically hits the very young and the very old more than young adults.”
What is the flu?
Influenza is the result of a series of related viruses, referred to as strains, according to the Centers for Disease Control and Prevention[CDC].
The notable strain last flu season was H2N3, which was flagged as particularly dangerous and included higher rates of pneumonia after exposure.
Identifying the strains helps scientists create a vaccine to battle the spread of the flu.
“The composition of vaccines for other diseases can stay the same year after year. But because influenza viruses are constantly evolving, and the viruses that circulate among people often change from one year to another, new flu vaccines need to be made every year,” according to the U.S. Food and Drug Administration. “To that end, scientists around the world collect samples to identify which flu strains are most likely to be circulating in the next flu season.”
These strains are consistently changing as they move through the population, making the response to them a mixture of research, calculation and guesswork. A major part of research is watching what strains appear in Southeast Asia, where many strains develop before moving to the United States.
A vaccination is created from three or four strains that scientists expect will be prevalent in the upcoming flu season.
Each strain carries its own “flags,” known as antigens, which the immune system uses to recognize and destroy the virus. The idea of the vaccine is to expose the immune system to the flags.
After a flu vaccination shot, the body responds to the new antigens, including a partial activation of some of its defenses that can feel like the flu, such as muscle pain or a sore throat.
That’s what Bustamante calls the immune system “revving up,” and is why some people notice mild flu-like symptoms after the injection or pain near the site of the shot.
“Personally, I experience that when I get the flu shot every year,” he said. “I take that as a good sign.”
Although the most extreme complication to influenza is death, particularly among the elderly and small children, it can include a variety of other factors.
“Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria,” according to the CDC.
“Other possible serious complications triggered by flu can include inflammation of the heart, brain, or muscle tissues, and multi-organ failure,” according to the CDC. “Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection.”
Dr. Peter Nechay, a cardiologist with St. Vincent Health, said one area of particular concern is pneumonia. After fighting influenza, the body is sometimes weakened enough that pneumonia will set in, he said.
That’s why Nechay encourages his at-risk patients to also be immunized against pneumonia. Unlike the flu vaccine, it is normally given every five years.
Even the heart can be affected. New research shows there is a connection between the flu and heart attacks, according to an article in the New England Journal of Medicine.
"We found that you're six times more likely to have a heart attack during the week after being diagnosed with influenza ," study author Dr. Jeff Kwong, an epidemiologist and family physician with the Institute for Clinical Evaluative Sciences and Public Health Ontario in Canada, told National Public Radio.
How does the flu bring on a heart attack?
An influenza infection involves a great deal of inflammation in the body, said Dr. Anil Ranginani, a cardiologist with Howard Community Regional Health in Kokomo. That inflammation can make naturally-occurring plaques in the circulatory system less stable. If one of these plaques breaks, its pieces can clog the arteries and cause a heart attack, he said.
Dr. Nechay described the problem with influenza and heart attacks as an “Achilles heel.”
“We see people all the time that come in that have a heart attack that is unmasked by another illness,” he said.
Additionally, a weakened heart or damaged circulatory system may suddenly get worse if stressed.
“The flu is not the only sort of stress, but this is something we can prevent,” he said.
Dr. Jared Miller, a pediatrician with St. Vincent Medical Group in Kokomo, said the vaccination is not perfect and some people may still get the flu. However, with the vaccine, most people will have less severe symptoms and a shorter recovery period.
"People don't realize that family, close friends, people you go to church with, that when you get the shot you protect them," said Karen Long, the immunization director at the Howard County Health Department.
Last season was the worst she's seen in her 18 years at the department. “Last flu season was horrendous and long - lots of people were sick," she said.
The goal is to get as many people immunized as possible, she said, so that the disease doesn't have a chance to get a hold in the community like it did last season.
She said the health department has been booked solid conducting vaccination clinics at health fairs, care facilities and other locations. Some companies are even offering on-site flu shots.
Although organizations like the health department and hospitals are responding, the general public can help prevent the disease from spreading.
One of the most important things to do is also the most basic: Wash your hands regularly with soap and water.
The proper procedure is to wash the hands in clean running water with soap for 20 seconds. Dr. Miller said the best way to time it is to run through the ABCs. After reaching the letter “Z,” it’s time to dry your hands.
The use of hand sanitizer is also helpful. For that, the proper procedure is to cover the hands with the sanitizer, then allow it to dry completely.
As a pediatrician, Miller said it’s important that parents of young children get immunized, because children under 6 months cannot get the injection, while younger children may not have gotten one yet.
“Do your part and protect them as well,” he said.
Tonia Gaines, a nurse at Miller's office, has given hundreds of shots this year, particularly to children.
She suggested that parents think ahead about how their children will respond to getting a shot. For some children, that can mean explaining ahead of time. For others, it may be best to delay it until just before they get the shot.
"Distraction is a great tool," said Gaines. “That can mean bringing along a stuffed animal or having the child look at pictures on a cell phone.”
The CDC advises that vaccinations begin at 6 months old and continue getting the shot every year.
Despite decades of effective vaccines, there are still people who are unwilling to get the shot.
Kate Mills, a clinical nurse specialist with Howard Community Regional Health, said much of the resistance comes from a poor understanding of the vaccination and disease.
She's heard people say they never got the flu before, but that doesn't have any particular indication for the future, she said. Additionally, they may have had a mild case before and written it off as nothing.
Sometimes people will blame the vaccination for later getting the flu.
But Mills and doctors all say the same thing: Get the shot!