Influenza - NOT just a "bad cold"

Unless you are Chinese, you have probably never heard of Barbie Hsu, but in the Chinese-speaking world this Taiwanese actress is famous. That world was shocked to learn of her death from influenza while on a family vacation in Japan.

Ms. Hsu was young (48), healthy, rich and treated in a country with an excellent health care system. Why did she die?

People tend to dismiss “the flu” as just another cold, and only a minority of people around the world get their annual flu shot. As of Feb 1, about 45% of Americans have received their vaccination. For younger adults, it is well under 40%.

Influenza is much worse than the run-of-the-mill winter respiratory virus. While it is not usually fatal except in infants and frail elders, Ms. Hsu’s death reminds us that even healthy people do die from influenza.

Even if you rarely die, influenza is a very nasty illness. You have a terrible cough, ache all over, and are usually sick for a week or more. In the U.S., for the 2023-24 flu season, there were 18 million flu-related medical visits, 470,000 flu-related hospitalizations, and 28,000 flu-related deaths.

This year, there have been a larger than average number of influenza cases, office visits and hospitalizations. It looks as if this will be the worst flu season since 2009-2010.

What should you do?

Get your flu shot! While far from perfect, the immunization does reduce your chance of catching influenza by about 40% and reduces your risk of being sick enough to require hospitalization by 60%. It is not too late to get the shot.

Given the surge in cases, you should also consider wearing a mask when you are in crowded indoor environments.

If you are sick, please stay home! Sharing life’s bounties is good. Sharing your respiratory virus is not.

Good hand hygiene is also important.

Remember – the life you save could be that of your best friend or favorite aunt.



Prescription for Bankruptcy. Buy the book on Amazon

Cannabis and health

Marijuana, now most often called cannabis, use is growing. In recent years, almost 20% of the U.S. population have used cannabis, with 4% using it daily or almost daily. What is the impact on the health of regular users?

Advocates describe better sleep, less pain and less anxiety. Unfortunately, these benefits come at a price.

Multiple studies have examined the association of regular cannabis use with symptoms and illness.

I can get the good news out of the way quickly. Regular users are less likely to report nasal congestion than non-users, unlike tobacco users who report more nasal and sinus issues.

Unfortunately, on the key major illness side, the news is not good. Regular cannabis users have more heart attacks and strokes than non-users, with even higher risk among those who use it daily or near-daily.

Regular cannabis smokers also have dramatically more (3-4 times) head and neck cancers than non-users. The highest risk was for laryngeal cancer, but higher rates of mouth and tongue cancer are also seen.

Middle-aged and older adults are increasingly using cannabis-based therapies (CBT) for symptoms, and this population suffers from many CBT-related side effects, including dry mouth, dizziness, balance problems, drowsiness and confusion.

Motor vehicle accident rates rose an average of 15% in states after recreational cannabis use was legalized, and the best evidence we have suggests that regular cannabis use is associated with a roughly 50% greater chance of having an accident and a 30% increase in fatal accidents.

Finally, there is the concern about cannabis’ effects on the developing brain. Cannabis use by mothers during pregnancy has been linked to problems with attention, memory, problem-solving skills, and behavior in their children.

Using cannabis before age 18 may affect how the brain builds connections for functions like attention, memory, and learning.

So, no, cannabis is not harmless. If you use it, do so with the knowledge that you may pay a price beyond the cost of the drug.



Prescription for Bankruptcy. Buy the book on Amazon

What do we know about bird flu?

There are many influenza viruses. A and B are the main causes of seasonal flu outbreaks and while B only infects humans, influenza A can infect many bird and animal species.

A given influenza virus is identified by two proteins found on its surface, H and N. The common viruses causing winter influenzas are H1N1 and H3N2. The “bird flu” is H5N1.

When bird flu first appeared, it was thought to be a risk primarily to birds and was felt unlikely to infect people. Infecting birds is bad enough: the current outbreak among chickens has been a major cause of diminishing supply and increasing price of eggs. The infected flock must be slaughtered, so chicken also becomes scarcer and more expensive.

The story has gotten worse. H5N1 can clearly spread readily to dairy cattle; there have been major herd outbreaks around the U.S. It can also spread to cats, both wild and domestic and other animals.

From cattle, there has been spread to humans, so far rare and sporadic. Since 1997, there have been about 1000 proven human cases world-wide, reported from 23 countries. More than half of these have died, and this number is clearly an undercount, since testing for H5N1 is not routinely done.

In the U.S. since the start of 2024 there have been 66 proven cases of bird flu, most in dairy workers, and one death. One 13-year-old girl required life support but recovered.

So far, no human-to-human spread has been seen, but as we have learned, viruses mutate, and it would not be a shock for a mutation to appear that would allow this to happen.

Oseltamivir (“Tamiflu”) has been approved to treat H5N1 based on very little data. This drug has been available since 1999 to treat seasonal flu but is not that effective for most patients. Studies have shown that it shortens symptoms of influenza by a day. It does have benefit in very sick influenza patients, reducing the death rate by almost half.

A vaccine is available, but there are only a few million doses stockpiled and if the H5N1 mutates to spread human-to-human, the vaccine may need to be modified.

What should you do?

Avoid raw milk, which transmits H5N1 (as well as many other nasty infections!) and raw meat, and do not feed raw meat to your pets. Pasteurized milk is safe, as is properly-cooked meat.

Do not touch sick birds; call your animal control officer, who will know how to safely handle them.



Prescription for Bankruptcy. Buy the book on Amazon