Doctor’s Dispatch: Three Unusual Aspects Of This Year’s Early Flu

cdcflu0107

The flu is hitting early and hard this year in Massachusetts and elsewhere.

We share the official data as it comes out. (See that rocketing red 2013 line in the CDC chart above.) But now for a fresh dispatch from the medical trenches — that is to say, in this case, the infectious diseases division of Mount Auburn Hospital. Dr. Robin Colgrove, a virologist by training, underscores that he’s passing along purely anecdotal reports — but they may provide early warning for both doctors and patients. We spoke today; his observations, lightly edited:

Clearly we’re seeing a lot more flu a lot earlier than we usually do. A few other things are unusual this year.

1. Despite the vaccine

It seems to us that we’re seeing more confirmed cases of influenza, using the rapid antigen test, in people who’ve been vaccinated than we would normally see. I was speaking about this at grand rounds the other day and among the primary care doctors in the audience, a number were saying the same thing.

Dr. Robin Colgrove

Dr. Robin Colgrove

Those cases have been mostly mild cases and it may be they have partial protection from the vaccine. (Flu vaccine efficacy has been controversial among researchers for quite some time. In ideal conditions with young healthy people, it may be 80-90 percent effective, but when epidemiologists look at the real world, the numbers have been much lower, maybe 50-60 percent efficacy.) Even in the best years, some people who get vaccinated also get influenza, but they are probably less likely to have severe and prolonged illness.

2. Atypical symptoms

A related point: There seem to be more people this year with atypical symptoms. Clinicians tend to be good at identifying flu: an abrupt high fever and severe malaise, and upper and lower respiratory symptoms. That pattern in the middle of a flu outbreak is almost always flu. Now we’re seeing people [who test positive for flu] with no high fever, maybe scratchy throats, possible gastro-intestinal symptoms.

It’s too early to know what this means, but it’s a real problem for primary care doctors who would normally be able to say, ‘You don’t have the flu.’ And it’s less of an issue for the patients themselves who are not that sick, and can just go home, drink chicken soup and watch TV. What we don’t know is the risk those people might pose to the traditionally vulnerable populations. This person who has just a sniffle and thinks it’s a cold, if they go and visit Grandma in the ICU, could they kill her?

3. Prolonged misery

And the third pattern I find I’m being asked about: People who have what sounds like an initial bout of flu and then prolonged illness for weeks. And that shouldn’t happen — there are only a very small number of viruses and no respiratory viruses that go on for weeks.

Classically, we worry about bacterial pneumonia: You get the flu, you’re getting better on days 6, 7 and 8, then get worse at days 8, 9 and 10. But with this new pattern, you get a febrile illness, your fever goes down and then you continue to cough and feel lousy for weeks. We don’t know what that is, but there’s more of that this year. One possibility is that though there are, broadly speaking, no chronic respiratory infections of normal lungs, you can have chronic infection in the sinuses; so some people may have had the flu and developed smouldering sinus infections whose dripping also causes coughing.

A final note about following flu statistic: One thing that is known historically is that there is a real effect of rumors on epidemics; they can make them worse. There’s abundant evidence that misinformation during the Spanish flu caused a lot of problems. In the Internet era, this is a particular problem, so I advise people to consult the CDC and the WHO, and more or less ignore everyone else.

Readers, does this jibe with your experience? I definitely have the sense that for many people, this will go down as The Winter Of The Endless Cough…

Please follow our community rules when engaging in comment discussion on this site.
  • kish mish

    Oh God. ok I am having flu since 2 months now on a regular basis. I dont have fevers or coughs. but i have a runny nose which is frequent and i get headaches rarely. I didn’t knew the cause of this problem. i supposed it was due to a sinus so i started taking clarinase for a week but my flu got worse got worse. since then i wakeup with a blocked nose, ear pains and throat pains and the mucus just got thicker. Please let me know what this possibly could be?

  • Christine Ballone

    started with a dry cough just over a week ago,felt good enough to go and see a client for decorating,the next day i was in bed and did not change position for hours, even tv and light was bothering me,I turned my insides out vomiting , it went on for 3 days then I started to feel better, went to work and even had an easter party for the family, good friday evening i got a full blown bladder infection, horrible, but thank god someone had some antibiotics at home and they helped me to get through the night but the next morning I was back at square one not being able to move or eat or drink, yesterday I forced myself to get up because we have a visitor from europe, did a little cleaning but have no strenght whatsoever, I stopped talking the antibiotics for the bladder because I blame them for my misery and I made an appointment for thursday with the doctor, hopefully this will be gone soon because I am still working and also watch my grand children!

  • shannon

    I got flu night after Christmas, 2013, had flu shot so wasn’t as bad or long – about 4 days – just aches and fever, then cold symptom which stayed for nearly a month. Shortly after flu start, knees started aching every early evening so bad I went to Dr, who referred me to Ortho since I know I have arthritis and gave me vicodin the pain was so severe but it even didn’t make it go away. Got into Ortho in 2 weeks and he said basically I had the virus which can go to other parts of your body after having the flu in my knee joints and gave me cortisone shots in my knees. Then 2 weeks later thought I had flu again but this time severe diarrhea with aches, fever. Was really scared because there have been several deaths here from the flu so went to ER. No flu, got tested, they said I had bad gastritis and was given an antibiotic. So now, not quite a month later I got hit with flu symptoms suddenly yesterday – aches, 101 fever just after returning from a walk with my 3yr. old twins grandbabies I was watching. This afternoon, my fever is finally gone and most of the aches (my knees are still aching), I have a mild headache and cold symptoms. I just got up for a while to see what I could find out online. I’m in good health in general.

  • http://www.ninapak.com Nina Pak

    It started out like allergies, sneezing, endless dripping nose, two days in I realized it was the flu when I got a high fever that went on for three days, chills then heat, I slept through most of it, just could not wake up. I had both head and stomach flu symptoms but no vomiting. I had such a massive headache, it made reading impossible, (which is how I usually spend my time when I get sick.) Every muscle and bone ached, and I was coughing so hard that my stomach and back muscles started to hurt from the contractions. I have had no appetite and if I try to eat it goes right through me. I should be better now. But I feel so weak and I still can’t eat much. I’ve never had this kind of bug. I’ve never felt this weak, it scares me. I’ve been trying to do a few things around the house, but just a simple task make me exhausted and dizzy. I am normally a healthy person, so this is difficult.

  • Jared Blauer

    3 weeks initial flu came immediately sore throat felt like I was swallowing glass. After 2 weeks, I felt better and ready to take on work. I am a substitute teacher so there are a lot of sick kids everywhere. Week 3 comes and my daughter had was having trouble with her ear so I took her to the doctor, but I started having fevers and severe sore throat again with chest problems. Yellow junk fevers I thought going for some exercise a walk and small weights for an hour would help. Came home vomited, dizzy, headache, feel completely worse try again tomorrow. I need to go back to work oh and I am taking some Zpack that the doctor gave me in case I had caught pneumonia does not seem to work on day 4 pills. How long is this supposed to last. I have had typhoid and Ecoli and didn’t feel as bad as I am for such a prolonged period.

  • Terri Dolezal

    I was diagnosed Dec. 27 incorrectly with pneumonia, Jan. 3rd with influenza A, I have been continually ill, cough, temp. body aches. Today I tested positive again, and got a referral to a Pulmonary specialist, I hope he can do something, I’m miserable. I’m a nurse at a nursing home and they have been LESS than understanding and at times threatened my job. I can not understand why they would want someone so ill working with the elderly residents. I’m just frustrated and tired of feeling horrible!

  • jdlech

    Just how extreme is the fatigue you’re experiencing?
    I’ve felt lazy before – just not wanting to get up until the last minute.
    I’ve felt fatigued before – too tired to do much.
    I’ve felt depression before – profound enough that I didn’t go to work that day.
    This felt nothing like any of that.
    It hit me the night after I thought I was recovering. I felt good enough to get up, clean the house a bit, and even go shopping. I kept feeling better all day.
    Then a fever hit me that night – it went up to 103; then broke by morning. But it left me with such a profound feeling of I don’t give a rip about anything except laying there – not even rolling over, not even lifting my head or adjusting the pillow. This was waaaaaaay beyond anything I had experienced before. It’s not that I was too tired to get up – this was not having one iota of motivation left in me. This lasted almost 24 hours before I started recovering. Recovery went quick after that.

    • Marissa Robinson

      I couldn’t have explained the fatigue better myself. I can’t tell you the number of hours I stared at my nightstand while laying in bed feeling like death.
      I’m on day 13 of the flu and I really thought I was almost through it all. Took the family out last night to walk around and see Christmas lights. Then last night was more stuffed up than usual and felt awful again today. Ugh!

    • Terri Dolezal

      This explains the fatigue I have felt EXACTLY, so thankful someone else “gets it” I am not a lazy person but I literally could not go grocery shopping, It’s been -9 here for a week and I just couldn’t make myself go. Too tired to do absolutely anything, then had one day as you described, cleaned, shopped, and felt GREAT, that night temp spiked and cough got ten times worse….thanks for posting.

  • idgicus

    flu shot 1 month ago. sudden extreme fatigue. scratchy throat for 2 days. headache and extreme fatigue – 4 days now. sleeping a lot

    • Janet Sharf

      scratchy throat, tight chest, non-productive cough even with d max cough syrups. went to dr. on day 9 and was prescribed hydrocodone so i could get some sleep. day 11 i started to bring up clear mucus. yesterday, day 29, after much weakness….two hours out of bed, need to go back to bed for the day..finally felt well enough to stay out of bed the whole day. i had a sense that i was on the edge of chills on one day, a mild nausea another day along with intermittent mild achenes. no fever. dr. says that he had 2 others in the same day with the same symptoms and although the powers that be have not described this batch of symptoms as this years flu, (2013-2014) he thinks it might be just that and it does sound an awful lot like the symptoms of last years flu.

      • Terri Dolezal

        Exactly how I feel, and this is the 7th week. Diagnosed three times with Influenza A, I seriously don’t know how to explain it to someone who hasn’t had it how horrible I feel. I have been in the hospital 7 days with this, and total medical bills over ten thousand and still feel horrible. I hope the specialist can help me feel better! Thanks for posting!

  • http://profiles.yahoo.com/u/OKEONAMLFIOS5WI7MPQY6SXBCQ IRMO

    Matches my experience precisely, and makes me glad I didn’t go to work despite being physically able to the whole time. So, how long before I can consider myself not contagious?

  • Sick-n-tired

    Yes! This is what I went through and what my co-workers are going through too.

  • Donna

    I had the vaccine in September. I had close contact with a 3year old and his Dad around 12/15/12, they both had flu like illness, 3 days later I noticed scratchy throat, chills, cough, no fever. These symptoms went away but were replaced by fatigue aches, lightheadedness,runny nose , sinus congestion for the next 2 -3weeks. I felt sick until well after the new year. I did not technically meet case definition for flu like illness, and not show up in statistics but felt the sickest I can remember .

  • WinthropNiki

    I have the “smouldering sinus infection” and a cough that is scaring small children. Had it since 2 days after Christmas. One thing that seems to help — seriously — is hot and sour Chinese soup, spicy Szechuan tofu dishes – anything that’s “hot” on the Chinese menu. My own chicken soup is nothing to sneeze at (sorry), but this time around, the Szechuan stuff has mine beat. Also, saline nose sprays, and making sure that you are not in dry, heated rooms, which feel like death chambers with this particular infection!

    • Jared Blauer

      WinthrophNiki I have been sloshing down ghost and scorpion chili hot sauce on my food. Everything else is pretty much bland and doesn’t really help the chest or nasal congestion.

  • Molly

    I’m a usually healthy 40-something, but I got sick in late October and it lasted for almost 8 weeks–feeling better some days and thinking I was on the mend, then feeling totally exhausted. I didn’t feel horrible, just “all used up” as someone else has described it. Cough, fatigue, and light-headedness were the biggest symptoms. I went to the doctor and it wasn’t pneumonia. Now (January) I’m finally feeling better. Flu or weird virus? I’m not sure but I hope it never comes back. That’s the longest I’ve ever been sick.

  • Alex

    Was feeling increasingly weaker for the 2 weeks before Christmas with dizziness, chronic head aches, fatigue and just feeling “all used up”. By Christmas Eve on antibiotics for sinus infection and pretty much in bed for next week actually believing I was getting better. However, yesterday there was a sudden return of the weakness, lightheadedness and icky feeling. Yes, did get flu shot as did most of my coworkers but most of us have this with one guy reporting he’s had it for over 6 weeks! Ahhhhhhhh….

  • BOB GRIFFITH

    THIS ARTICLE ABOUT WINTER OF ENDLESS COUGH IS EXACTLY MY EXPERIENCE AND MANY MANY OTHERS I KNOW IN SOUTHERN CALIFORNIA. SEEMS LIKE “WALKING PNEUMONIA” INSTEAD OF FLU. NOW PAST 2 MONTHS. MALE 64YEARS OLD. USUALLY VERY HEALTHY. COULD HAVE CONTRACTED FROM 1 YEAR OLD GRANDSON. HIS SIMILAR SYMPTOMS ALSO GOING PAST 2 MONTHS OF THIS.

  • Martian Minisculio

    I was sick with the flu, including intense weakness and a dry, hacking cough, for 3 weeks in November. Got it again (!) Dec. 26 and have been sick ever since–2 weeks and counting. In both cases went to bed for much of the time, which I never do. No sinus involvement at all, head clear (but by the end of most days a headache from coughing). This is not pneumonia, nor pertussis, nor a sinus infection (sputum is clear). Sorry Ms. Goldberg, it’s the flu. And twice–which has been the experience of others I know as well.

  • ssp

    No flu shot. Got the chills and aches sat nov10. Much better after ~1week. Back to working out(swim/spin/yoga). Spin class is notorious for sickos exercising anyway. Sick again early dec, aches, pains and upper respiratory ~1.5 weeks. Start feeling better and no symptoms go back at it. Last week in dec major aches pains chills for 3 days and now major lower respiratory hacking coughing, was dry and now coughing up the yellow junk. I take 5000ius vitD3/day etc and have not been sick for 3+ years. My thoughts are after getting sick in nov, never got completely well and then picked up another strain in spin(sucks) and the 2 virus’s combined into this major issue. Feeling better now but still coughing up the yellow and hacking. Not real big on the flu shot etc. Hope to get back at it within the week.

  • http://www.facebook.com/janealicewallace Jane A Wallace

    I was very sick for 2 days – not really a high fever, just slightly elevated- but malaise, chills, weakness, some congestion. It felt like the flu – not a cold, however, I did have a flu shot in late November, about a month before this happened. Now, 13 days later, I am still sick, and there is no sign that I am getting better. Today I feel quite ill again, not that I was ever 100 percent better, but I was getting there and the horrible flu weakness part was not so bad. Today, I could barely work, my body aches again, the malaise has returned to a lessor extent, and I am exhausted and coughing with more congestion. :-/

  • Reasonable?

    Well, I stand corrected.
    What I though was a cold, was probably this year’s flu.
    Stuffy nose, malaise, chills which lasted for 4 days.
    There was a residual intermittent cough that lasted for 4 to 5 days longer.

    I upped the vitamin A, C, D and Zinc during the bout, but I’m not sure if that made any difference.