What do I do if I think I have the 2009 H1N1 Swine flu?

I’ve blogged before about “How to Tell the Difference Between a Cold and the Flu (or Swine or H1N1 influenza).” What used to be called the “Novel H1N1 flu,” or the “Swine Fly,” is now officially called the 2009 H1N1 flu. But, no matter what it’s called, if you are coming down with the flu, what should you do?

The flu tends to come on suddenly – you’re fine in the morning and aching and shivering that night – while a cold usually develops gradually over the course of two or three days.

Flu usually causes a fever and aches; a cold usually doesn’t.

Other symptoms of the flu include headache, fatigue, cough, sore throat, nasal congestion, body aches, chills and, usually in children, vomiting or diarrhea.

So, if you think you have the flu, the LA Times has an excellent Q&A on what to do, based upon CDC recommendations.

Q: How do I know if it’s the 2009 H1N1 strain?

Unless your doctor orders a test, you won’t. That test, which involves a swab of nasal secretions, isn’t routinely conducted. Most likely, if your doctor thinks you have the flu, you will be sent home with advice on care.

In some cases, however, doctors will want a more precise diagnosis, which helps inform public health officials about outbreaks. A flu test is also sometimes given to people at risk of becoming very sick, such as hospitalized patients, infants and those with underlying health conditions. Healthcare workers may also receive a flu test.

In general, it’s not necessary for you to know whether your flu is H1N1 or a seasonal strain. They are treated similarly and have similar effects, though this H1N1 strain seems to be transmitted especially easily among children and young adults.

Q: How should I take care of myself?

  • Stay home and rest. You don’t want to tax your body when it needs its strength to fight a virus.
  • Drink plenty of liquids to avoid dehydration.
  • Don’t drink alcohol because it can increase the risk of dehydration and it weakens the immune system’s response.
  • Don’t smoke; that can worsen respiratory symptoms.
  • Do take over-the-counter pain relievers (but don’t give aspirin to children or teens) for head and muscle aches.
  • To avoid infecting others, stay in a separate room in the household and try to use a separate bathroom.
  • Consider wearing a N95 respirator mask, if tolerable, when around other people, even loved ones. You can read more about these masks here: “Experts recommend N95 masks over surgical masks to stop spread of H1N1.”

Q: When should I go to the doctor?

In most cases, a trip to the doctor isn’t necessary because healthy people will recover on their own in about five days.

However, if you have just become ill, you may want to call the doctor to obtain a prescription for an antiviral medication. Taking an antiviral, such as Tamiflu or Relenza, can shorten the course of the illness by a day or two if the medication is given within 48 hours of the onset of symptoms.

Doctors vary in their willingness to prescribe antiviral medications. In a recent update from the Centers for Disease Control and Prevention, doctors were advised to prescribe antiviral drugs only in certain cases:

  • to treat or prevent illness in people who are
    • severely ill,
    • hospitalized, or
    • at higher risk of having serious complications from flu, such as:
      • babies and
      • those with underlying illnesses.

Antivirals are not recommended for prevention or treatment of otherwise healthy people.

These guidelines were issued to alleviate concerns over a potential shortage of anti-viral medications and increasing the risk of resistant strains of the virus.

Consider seeing your doctor if you are at high risk for complications, such as developing pneumonia, sepsis, or having a severe asthma attack. This includes people ages 65 and older, those with chronic medical conditions, pregnant women and young children.

Q: Should an ill person go to the hospital or ER?

Normally, no — unless there are any of the “emergency signs” given below.

Q: What are some emergency signs in children:

  • Fast or labored breathing, indicating pneumonia or sepsis.
  • Bluish skin color, indicating the child may not be getting enough oxygen.
  • Not drinking enough fluids, which puts the child at risk for dehydration.
  • Not waking up or interacting, which can indicate a more severe case.
  • Being so irritable that the child doesn’t want to be held, which can also indicate more severe illness.
  • A return of flu symptoms after the child appeared to be getting better, which could indicate that the child has developed a secondary illness or was misdiagnosed with the flu.
  • Fever with a rash, which can indicate an illness other than the flu.

Q: What are some emergency signs in adults:

  • Difficult breathing or shortness of breath, which could indicate pneumonia or sepsis.
  • Pain or pressure in the chest or abdomen, which could indicate a more serious case or that flu is not the right diagnosis.
  • Sudden dizziness, which can mean the person is not getting enough oxygen.
  • Confusion, which can mean the person is not getting enough oxygen.
  • Severe or persistent vomiting, which can lead to dehydration.

Q: How long should I stay home?

That depends. Your primary goal should be to avoid infecting others. Always stay home if you have a fever or think you may be coming down with the flu.

The CDC currently says, “Adults can spread the flu to others for up to five days after getting sick, so stay home until you feel better and for 24 hours after the fever is gone (without use of fever-lowering medications).”

However, a new report says:

Some swine flu patients are still infected with H1N1 virus that they can transmit to other people eight to 10 days after their symptoms strike, researchers say.

The finding suggests that the CDC’s recommendation for people with flu-like illness to avoid others until at least 24 hours after they are free of fever may not go far enough.

“Three days after your fever subsides, you’re probably still contagious with H1N1 [swine] flu,” says Gaston De Serres, MD, PhD, a medical epidemiologist at the National Institute of Public Health in Quebec.

De Serres tells WebMD that it’s not yet known exactly when it is safe to go back to school or work. “But a couple of days [after symptoms strike] is likely to be insufficient. You’re probably contagious for about a week.”

You may have lingering symptoms, such as nasal congestion, cough or fatigue. That is normal. But if your cough or congestion or any symptom hasn’t abated much from its peak, you could still be infectious.

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