It is going to be an unusual year for winter viruses. First, it is normally the elderly who are at greatest risk but this year, thanks to swine flu, it could be the young. Then we may have seasonal winter flu to contend with as well as swine flu, though that is still uncertain. On top of that we can expect all the other winter viral illnesses – colds, coughs, bronchitis, vomiting and diarrhoea. Hospitals are likely to come under pressure, as they do every year, but this winter the burden on intensive care is expected to be particularly heavy – again because of swine flu. Winter is never predictable, but this year especially it is important to be prepared.
What is the threat of swine flu?
Less than we feared – so far. It looks as though cases have plateaued. They may go up again but they may well now head downwards – we could already be over the worst of swine flu for this winter. Equally the virus may mutate and come back in a third wave of illness (the first wave happened over the summer) later this winter or next. Scientists such as Wendy Barclay, professor of Influenza Virology at Imperial College, London, think the likelihood of this happening will increase as more people are infected with the existing strain, making it harder for the virus to find new non-resistant hosts, increasing the pressure on it to mutate.
Why all the worry about it?
Because it is the first flu pandemic for 40 years. The "novel" H1N1 swine flu virus is the first wholly new flu virus seen in a generation. That alarmed virologists around the world and caused governments to prepare their defences – the UK's preparations were bigger and more extensive than most. As things have turned out it causes only mild illness in most people. That is the good news. The bad news is that it is very nasty in a few people – especially the under-fives. Their hospitalisation rate is four times higher than the rest of the population. It is also nasty in pregnant women and people with chronic illnesses – asthma, diabetes and the like.
So is it worth having the swine flu vaccine?
Definitely – if you are offered it. The first supplies being distributed to hospitals and GPs are being reserved for front line NHS staff, people with chronic conditions and pregnant women – 13 million in all. Once they are done, the vaccine may be rolled out to children – a decision has yet to be taken. It is worth having because although the disease is mild in most people, there is no way of telling who may react badly to it – so badly that their life may be threatened. Perfectly healthy people have died from swine flu.
What about seasonal flu?
It is still early days – seasonal flu does not usually take off till shortly before Christmas or, more often, in January or February. The question is whether the swine flu now circulating will push out other seasonal flu viruses. That appears to be what has happened in the southern hemisphere, whose winter is just ending. According to Douglas Fleming, of the Royal College of GPs (RCGP) Birmingham Research Unit, there is very little sign of seasonal flu viruses circulating at the moment , though there will be some "hangover" from viruses circulating in previous years.
Is it worth having the seasonal flu vaccine?
Tricky one, this. It is recommended for the elderly, who are more vulnerable to seasonal flu, and for those with chronic conditions – asthma, diabetes, as before. But if there is not much seasonal flu about, why bother with a vaccine? It will not give protection against swine flu – you need swine flu vaccine for that. Douglas Fleming of the RCGP says: "Technically it is worth having because you can never predict what may be around the corner." But for healthy people not in the risk groups who are offered the vaccine by, say, their employer, it may not be worth the candle.
Why do the elderly need vaccinating against seasonal flu, but not swine flu?
Because they are less likely to catch swine flu. In general, elderly people who become infected with flu of whatever kind tend to have worse illness than younger people, because they have lower immunity and less reserves of strength and energy to fight the illness. However, in the case of swine flu, people over 60 appear to have some resistance to the infection. The "novel" H1N1 2009 virus, as named by the World Health Organisation, is not quite as novel as it first appeared. Scientists have speculated that it may have some similarities to the H1N1 virus that was circulating from 1918 until it was replaced by the HN2 virus in the 1957 pandemic. Laboratory investigations in the US show that around 30 per cent of people born before 1950 appear to have had their immune systems primed against it.
Can you have both vaccines at the same time?
Yes, but it is not currently being done widely although there does not appear to be any technical reason why it should not be. The problem has been a lack of trial data showing it is safe. Last week GlaxoSmithKline published results of a small study in 168 adults who were given the swine flu jab Pandemrix and the seasonal flu jab Fluarix simultaneously, one in either arm. The immune response to both vaccines was good and the side effects no worse than when they were administered separately.
How can I protect myself against other winter viruses?
Wash your hands often and try not to touch your nose and eyes when out and about – they are the key route of access for viruses. Your fingers can easily become contaminated with viruses by touching door handles and shaking hands, which are then transmitted to the mucous membranes of your nose and eyes (tears from the eyes drain into the nasal cavity, passing viruses to the nose). Social kissing is OK because the cold virus is lodged in the back of the throat and is unlikely to be transmitted via a kiss. Cold viruses are spread by touch and by large particles expelled at close range by coughs and sneezes.
Have we been spared by the mild winter so far?
Yes. As the weather gets colder, viral illnesses increase. It is partly that we huddle together for warmth, in crowded offices and buses and trains, encouraging viruses to spread. The nose dries in low temperatures or in dry air-conditioning and respiratory viruses get trapped and reproduce. Wearing a scarf round your nose and face protects them from plunges in temperature just as you protect your body temperature with coat.
Should we be taking Tamiflu?
There is debate about this with some doctors arguing that only those at risk should be treated – young children and people with chronic health problems. Others argue that, when taken early in the illness, the drug can alleviate the severest symptoms in those worst affected and even save lives. As we have plenty of it – the UK has stockpiled 32 million doses, enough for half the population – we may as well use it and be safe rather than sorry.
Are Vitamin C and Echinacea any good?
There is no good evidence either can prevent a cold. Only a very small proportion of people in the West are likely to have any deficiency of vitamin C and it is unlikely a daily dose will provide any benefit. Echinacea is the most popular preventive treatment for colds and helps prevent infection by boosting the immune system. It could, in theory, abort a common cold infection and prevent the development of symptoms, but there is no evidence of this.
How do you tell the difference between a cold and flu?
With difficulty. Severe, genuine flu is characterised by an irresistible and often sudden desire to lie down. It is accompanied by fever, muscle aches and pains and a general feeling of malaise. It's nasty. The complicating factor is that the symptoms of fever, aches and malaise can also occur with a heavy cold, though this is unusual. A further complication is that flu and colds may also be mild. If you suspect flu take Tamiflu. For a cold, the best treatment is hot drinks and paracetamol.
What can cure a cold or flu?
The immune system. In most cases, it will take four to seven days and will not require any other treatment. The same goes for flu but because of the risk that it could turn nasty it is worth taking Tamiflu. Aspirin, paracetamol and ibuprofen are very effective for relieving headache, sinus pain, sore throat and aches and pains. Nasal drops to clear a blocked nose can be very helpful before sleep. Any hot drink will relieve a cough and sore throat – but standard cough medicines are no better than a placebo. Spicy foods and hot soups are also beneficial.