How does the flu kill people??

lamazeteacher · May 1, 2009

When I was growing up, the flu wasn't a "killer". You got the flu, got sick and some chills, maybe vomiting, and got over it. But it seems nowadays that it had been labeled so deadly that we need vaccines for it every year. My question is, how does the flu go from just making you sick, to actually killing you? What takes place in the body that causes a persons death from it? How does is kill a person??

Most flu viruses don't cause death or profound illness. However the one that's concerning the world now, is a particularly harmful one. However the Mexican cases are more serious than those in other countries (possibly due to late treatment and less availability of anti-virus medications like Tamiflu. In Mexico people are used to treating themselves, rather than going to doctors as medicines are sold over the counter (OTC) there, that can be obtained by prescription only, here. So people there may be getting inappropriate medicine without doctors' advice.

The way death can be the result of any severe respiratory infection, is that inflammation caused by the virus and its toxins travels to the bronchial "tree" and lungs, causing pneumonia with less exchange of oxygen due to swelling there. In some cases the swelling thickens the trachea so much that a tracheotomy must be performed to allow air to get into the lungs. Eventually, if the patient has little resistance to it, the swelling causes too much fluid in the lungs, making breathing impossible. That's what causes death, which is quite rare when early recognition and treatment of symptoms occurs.

RedWeasel, RN · May 1, 2009

If you go to wikipedia http://en.wikipedia.org/wiki/Spanish_Flu and look up the pandemic of 1918 it is quite scary (not to scare you-remember it was about 100 years ago-we have atb to treat the secondary pneumonia/infection, and Tamiflu for the flu). It was H1N1 too-I don't of course know how similar. It states it hit 20-40 year olds hardest. It goes on to explain the cytokine storm, where healthy people's immune systems, being good, go into overdrive and it is very fascinating. Also go to http://stanford.edu/group/virus/uda or something. There is a letter from a Dr on there in 1918 and it is fascinating. It hit fast and hard. People would die the next day. Somewhere I read 4 ladies were playing cards and by noon next day, three were dead back then. There is another man I read about whose father was in the military during this. He found letters written back then by Charles Johnson I think, detailing the events, sent home to his future wife. Fascinating.

azhiker96, BSN, RN · May 1, 2009

When I was growing up, the flu wasn't a "killer". You got the flu, got sick and some chills, maybe vomiting, and got over it. But it seems nowadays that it had been labeled so deadly that we need vaccines for it every year. My question is, how does the flu go from just making you sick, to actually killing you? What takes place in the body that causes a persons death from it? How does is kill a person??

The "regular" flu kills about 35,000 people every year, mostly infants and the elderly. I think pneumonia is the main complication that causes deaths. Those at most risk have co-morbidities. If someone has COPD their respiratory function is already compromised so it doesn't take much more to push them over the edge.

lamazeteacher · May 1, 2009

We need to remember that in 1918 there were no microscopes strong enough to identify a virus, much less which virus was responsible for that flu. There certainly were no anti-viral drugs, either. PPE was rudimentary and hand hygiene was just over 50 years old, when Hungarian Dr. Ignaz Semmelweis recommended that physicians wash their hands before each baby's delivery. However it was written "According to Wikipedia":

"Thus, Semelweiss concluded that some unknown "cadaveric material" caused childbed fever. He lectured publicly about his results in 1850, however, the reception by the medical community was cold, if not hostile. His observations went against the current scientific opinion of the time, which blamed diseases on an imbalance of the basical "humours" in the body. It was also argued that even if his findings were correct, washing one's hands each time before treating a pregnant woman, as Semmelweis advised, would be too much work. Nor were doctors eager to admit that they had caused so many deaths". So what else is new?

Advances in medicine have been great since then, but politics squelches them, as we saw yesterday when Vice President Biden was derrided for stating that he advised his family not to take commercial flights due to infectivity caused by inferior recirculated ventilation. Airlines fearing loss of revenue squawked that planes have better ventilation than (some?) buildings, and the press was told that he hadn't "said what he meant to say".

God forbid that more harm come to business - press releases claim that the financial picture won't change due to this pre-pandemic. So we must have hit bottom?

Surely a way can be found to allow clean air into planes, so stale air won't spread infection! Oh well, it's probably "too much trouble", costing too much money.

cursedandblessed · May 1, 2009

i've learned a good bit about ppe usage. my recent rotation required, gloves and gown with all patients before entering the room, some required masks. everything was wiped down with the purple topped disinfecting wipes if it left the room (dynamax machine) each patient had their own stethoscope, thermometer, and bp cuff. and pretty much nothing entered a patients room and came back out except as trash. and of course hand hygiene. this is the first rotation i haven't come down with something vile.

i wouldn't fly unless i absolutely had to(not that i ever have had to). i thought the vp made good sense.

azhiker96, BSN, RN · May 1, 2009

Advances in medicine have been great since then, but politics squelches them, as we saw yesterday when Vice President Biden was derrided for stating that he advised his family not to take commercial flights due to infectivity caused by inferior recirculated ventilation. Airlines fearing loss of revenue squawked that planes have better ventilation than (some?) buildings, and the press was told that he hadn't "said what he meant to say".
God forbid that more harm come to business - press releases claim that the financial picture won't change due to this pre-pandemic. So we must have hit bottom?
Surely a way can be found to allow clean air into planes, so stale air won't spread infection! Oh well, it's probably "too much trouble", costing too much money.

Actually, VP Biden advised against air travel because it's an enclosed space, close proximity to people who may sneeze spreading droplets. While some droplets might be inhaled the more usual route is they land on surfaces which others touch and then touch their food, lips, nose and gain the infection. He advised against travel in any small enclosed space and used airlines and subways as examples. The airline industry is unhappy with any suggestion not to fly. I think the backpedaling by his office and the White house is funny, how they're making up what they think he meant to say.

psalm, RN · May 1, 2009

Actually, VP Biden advised against air travel because it's an enclosed space, close proximity to people who may sneeze spreading droplets. While some droplets might be inhaled the more usual route is they land on surfaces which others touch and then touch their food, lips, nose and gain the infection. He advised against travel in any small enclosed space and used airlines and subways as examples. The airline industry is unhappy with any suggestion not to fly. I think the backpedaling by his office and the White house is funny, how they're making up what they think he meant to say.

Let the man say what he says without airlines and the WH editorizing it! He's an adult. He was giving his opinion. The White House makes him look like he is stupid and can't say anything without the WH imprimater (sp)!!

Multicollinearity, BSN, RN · May 1, 2009

Biden was being vintage Biden...the man is a lovable windbag who tells you exactly what he really thinks. And apparently he thinks he doesn't want his loved ones on airplanes right now. Can't say I blame him.

However, in a couple weeks I will be on a plane, and I honestly wouldn't mind getting this flu right now and building up some immunity while it appears to be a mild strain.

talaxandra · May 1, 2009

The flu has alway killed vulnerable populations (very young, elderly, immunocompromised, frail and unwell), while making young and healthy people feel dreadful for a few days. The flu viruses mutate easily, which is why getting the flu once doesn't stop you from getting it again. Until recently the only measures we had were supportive, but vaccination programs allow a degree of protection from some strains.

Flu vaccination programs are aimed at reducing productivity loss (from sick leave) and reducing the infection reservoir (the fewer people affected the smaller the spread). If you're young and healthy most flu strains will make you feel dreadful for a few days but won't make you seriously ill. If you pass the virus on to a vulnerable person, though, they can become very ill or die.

Because people with flu often get a secondary bacterial pneumonia, flu mortality statistics (30-50% of the total) are often conflated with pneumonia - together they're the 7th biggest cause of death in the US, with some 65,000 deaths a year. Globally around a million people die of flu (+/- secondary bacterial pneumonia) a year.

From a morbidity and mortality perspective (at least for the purposes of this thread), the only differences between other flu strains and a pandemic strain are that contagiousness of the virus and the fact that young and healthy people are as likely to be seriously affected as the usual targets.

talaxandra · May 1, 2009

However, in a couple weeks I will be on a plane, and I honestly wouldn't mind getting this flu right now and building up some immunity while it appears to be a mild strain.

If this goes the way of the 1918 pandemic, which came in three waves of increasing severity, the time to catch it is definitely now.

indigo girl · May 1, 2009

From a morbidity and mortality perspective (at least for the purposes of this thread), the only differences between other flu strains and a pandemic strain are that contagiousness of the virus and the fact that young and healthy people are as likely to be seriously affected as the usual targets.

Bingo!