The only thing predictable about the flu is that it’s unpredictable. The timing, severity and length of the flu season varies from year-to-year, making it difficult for patients to identify if they, in fact, have the flu and, then, how to treat it. Is staying home to rest the best option for most? When is it time to seek treatment? What are the warning signs to watch for to know it’s time to seek emergency medical help?

Dr. Carla O'Day, medical director of emergency services at  St. Vincent Charity Medical Center.. 

Amid one of the worst flu seasons in nearly a decade, Dr. Carla O’Day, medical director of St. Vincent Charity Medical Center’s Emergency Department, provides clarity on these questions based on her decades of experience treating thousands of flu patients throughout her career.  Patients’ best protection against serious complications from the flu is knowing what symptoms to watch for, who is most at-risk and when to seek emergency medical help.

Why is flu season worse this year?

This year’s harsh flu season, with an increase of hospitalization and flu-related deaths, is likely caused by the dominance of the H3N2 flu strain. The H3N2 flu strain, which tends to be more severe with more alarming symptoms, historically has led to higher overall flu hospitalization and death rates, according to the Centers for Diseases Control and Prevention (CDC).

How do I know I have the flu versus a cold or different type of stomach bug?   

You may have the flu if you have some or all of these symptoms:

• Fever of 101 or higher * (Not everyone with flu will have a fever)
• cough
• sore throat
• runny or stuffy nose
• body aches
• headache
• chills
• fatigue
• sometimes diarrhea and vomiting

According to Dr. O’Day, body aches, general malaise and a mild cough are the three most-telling signs that your illness is likely influenza. 

When should I go to an emergency room for flu symptoms?

The emergency room should be used for people who are very sick. The CDC recommends that you should not go to the emergency room if you are only mildly ill.

“It’s hard to define ‘mildly ill,’ but my general advice is that if you are aching all over, feel very crummy, exhausted, have a high fever and generally just feel wiped out, you should get to a doctor as soon as possible,” said Dr. O’Day. “If you have a fever of 101 or higher and fever-reducing medications, such as acetaminophen or ibuprofen, are not bringing the fever down, get to a physician or an emergency room immediately.”

If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about  your pre-existing illness, you should call  your health care provider for advice. Dr. O’Day warns those experiencing emergency warning signs of flu sickness, should immediately go to the emergency room.

What are the emergency warning signs of flu sickness?

In children:

• Difficulty breathing or shortness of breath
• Bluish skin color
• Not drinking enough fluids
• Not waking up, not interacting, not making eye contact or acting lethargic
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In addition to the signs above, get medical help right away for any infant who has any of these signs:

• Being unable to eat
• Has trouble breathing
• Has no tears when crying
• Significantly fewer wet diapers than normal

“With infants and very young children one of the biggest concerns is dehydration because when they feel ill they may stop taking their bottle or drinking fluids. Kids get more easily dehydrated than adults,” said Dr. O’Day.

In adults:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

According to Dr. O’Day, adults with preexisting respiratory conditions, such as chronic obstructive pulmonary disease (COPD) or asthma, or other conditions, such as hypertension and diabetes, are more predisposed to the flu and, possibly, pneumonia. Their immune systems are already suppressed, so they can’t fight off the flu virus as well as others.

“People with the flu often get pneumonia, which can be quite dangerous for someone with a pre-existing respiratory illness,” said Dr. O’Day.

People over age 65 are another population that needs to pay close attention to signs of the flu because their symptoms can differ from younger adults.

“As we age, our immune systems change and our bodies are less likely to mount a fever,” says Dr. O’Day. “With the elderly, we can’t always rely on fever as a way to determine if they should be seen by a physician. Often influenza in an elderly person can present itself as an altered mental state displayed by confusion.”  

When should I see a primary care physician?

Most people with the flu have mild illness and do not need medical care or antiviral drugs. If you get sick with flu symptoms, in most cases, you should stay home and avoid contact with other people except to get medical care.

If, however, you have symptoms of flu and are in a high risk group, or are very sick or worried about your illness, contact your health care provider (doctor, physician assistant, etc.)

“If we see patients during the first 24 to 48 hours after flu symptoms start, we can help shorten the illness with antiviral medications,” said Dr. O’Day. “After two days, we provide more supportive care such a hydration, fever reduction and suggesting lots of rest.”

Certain people are at high risk of serious complications, including young children, people 65 and older, pregnant women and people with certain medical conditions. If you are in a high-risk group and develop flu symptoms, it’s best for you to contact your doctor early in your illness. Remind them about your high-risk status for flu. The CDC recommends that people at high risk for complications should get antiviral treatment as early as possible, because benefit is greatest if treatment is started within 2 days after illness onset.

When is it safe to go back to work/school?

The CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or other necessities. Your fever should be gone without the use of a fever-reducing medicine, such as acetaminophen or ibuprofen. You should stay home from work, school, travel, shopping, social events and public gatherings.

Stay away from others as much as possible to keep from infecting them. If you must leave home, for example to get medical care, wear a facemask if you have one, or cover coughs and sneezes with a tissue. Wash your hands often to keep from spreading flu to others.

How long does a flu shot last?

According to Dr. O’Day, the flu vaccine will last the entire flu season, even if you received it in August, September or October, which is considered early in the flu season.

Where can I get medical attention fast if I think I have the flu?

If you are experiencing a medical emergency call 911 for help. If you have flu symptoms, the emergency department at St. Vincent Charity Medical Center is conveniently located downtown at 2351 East 22nd Street, Cleveland, OH 44115.

St. Vincent Charity’s emergency department also offers Fast Track Service for those with less serious illnesses and injuries. Open weekdays from 11:00 a.m. to 7:00 p.m., our Fast Track service guarantees to get those working, living or just playing downtown in and out in 90 minutes or less. 

Importance of Getting an Annual Flu Shot

Because the flu shot is the most effective means of preventing the flu, health officials  recommend a yearly flu vaccine for everyone ages 6 months and older. Each year, according to the CDC, the three to four influenza viruses in the vaccine are selected based on research indicating which viruses are circulating and forecasts about which viruses are the most likely to circulate during the coming season.  The CDC has reported that the current circulating flu strains do appear to match the flu strains that were selected for this season’s vaccine. 

 However, even during years when the flu strains included in the shot don’t match the ones circulating, health officials contend that getting a yearly flu vaccine is still the best way to prevent becoming ill and developing severe complications. In these years, studies have found that even if a person does catch the flu, their illness is milder if they've been vaccinated. 

 “I always encourage the flu vaccination, even during years when its effectiveness is low,” said Dr. O’Day. “If you got the flu shot and still get the flu, your symptoms will not be as severe as someone who contracts the flu and did not receive the vaccination. Someone who skips the shot one year and is then stricken with the flu virus will likely never skip getting the flu shot again.”