As we head into winter, we are once again seeing the circulation of influenza viruses. Whilst most people who become infected with influenza will recover uneventfully, it’s important to look out for the severe cases and get appropriate help if this occurs. Charity medical director Dr Andrew Conway Morris has taken the time to respond to news of an early surge in ‘flu cases with the following advice.
Influenza viruses are the group of viruses that cause the ‘flu – a typically unpleasant viral infection often accompanied by fever, fatigue, muscle aches, sore throat and dry cough. The challenges with ‘flu are:
- that it is hard to distinguish clinically from other respiratory infections
- whilst most people will recover rapidly and need only rest, fluids and painkillers, a small minority will become very unwell and need hospital or even intensive care admission.
Influenza circulates all year round, but has seasonal peaks in the winter. This year’s ‘winter surge’ has come earlier than in recent years and is being driven by a particular subtype (termed A(H3N2)). People may remember that the swine flu pandemic of 2009 was driven by the subtype A(H1N1), and although we are still seeing this in circulation it is not the dominant strain. The A(H3N2) strain is important as it tends to produce more severe disease in the elderly than other strains that are circulating at the moment. This makes it all the more important that people who are eligible (over 65s, those with long-term conditions, care home residents and staff, health staff and school children) get vaccinated to help prevent infections.
Severe ‘flu can be hard to distinguish from other respiratory infections, such as bacterial pneumonia, and indeed can be complicated by secondary bacterial chest infections. Both severe ‘flu alone and ‘flu complicated by secondary bacterial infections can result in sepsis, where the body’s own immune system starts to damage its own organs. In this situation its really important to seek urgent medical attention, as organ support and antibiotics can be life-saving. If you, or a loved one, are experiencing the following symptoms then you should seek urgent medical attention. Don’t be afraid to ask “could this be sepsis?”.
- a very high or very low body temperature, especially if not responding to simple agents such as paracetamol
- uncontrolled shivering
- increased breathing (respiratory rate)
- very cold hands and feet
- mottled rash on the skin
- confusion or drowsiness
- not having passed urine for 6-12 hours
If you or a loved one feel more unwell than you have ever done before, this is a key symptom. An infection which starts with mild symptoms can get more severe, so never just dismiss it as “just the ‘flu” if it’s getting worse or the above symptoms are seen.
Researchers are actively looking into how we can prevent flu becoming more severe. Two large trial platforms, RECOVERY and REMAP-CAP, which were used during the COVID-19 pandemic to identify treatments, are studying a range of treatments including anti-viral drugs (as antibiotics don’t work on viral infections but are useful when there is bacterial infection at the same time), steroids and other drugs that modify immune responses. These trials are being conducted in patients hospitalised with severe ‘flu and – as with their COVID-19 counterparts – will help give us the answers about how to manage this in future.
What can people do to protect themselves against ‘flu? If eligible and offered the vaccine take it, studies show that seasonal flu vaccinations reduce the risk of severe illness and death in people at risk. If you feel ill with fever or unable to undertake your normal work activities, stay at home and avoid spreading the infection further, and especially avoid contact with frail and vulnerable friends and family until your symptoms have improved. As with COVID-19, enclosed spaces are where respiratory viruses like flu are likely to spread. Whilst these are hard to avoid if you are vulnerable or have symptoms, you may wish to consider wearing a mask. Regular hand-washing and catching coughs and sneezes in tissues and then disposing of them can also help limit spread.
Seasonal ‘flu comes round every year, more severely some years than others, and the early signs are that this year may be a bad one for ‘flu. If you do become unwell, do look out for the signs and symptoms of sepsis, and if you are concerned about yourself or a loved one then seek urgent medical attention. Self-care advice can be found here. If you are concerned but not severely unwell then NHS 111 can provide telephone advice. If you or a loved one are severely unwell then call an ambulance via 999 and tell the operator that you are concerned it may be sepsis.
Dr Andrew Conway Morris, Medical Director Sepsis Research FEAT