Influenza is something unique. It behaves epidemiologically in a way different from that of any other known infection. - Sir Christopher Howard Andrewes

It is generally believed that the greatest threat for any future pandemic is from influenza.

The highly infectious H5N1 avian influenza (AI) virus continues to infect poultry and people (59 percent death rate for known cases) and research suggests that the rapidly evolving virus may only be a few mutations away from causing an influenza pandemic. While not yet pandemic ready, the virus continues to be a public health threat in affected and at-risk countries.

Influenza pandemics occur in waves. In past pandemics, the time between two waves was 3 to 9 months. The second wave can be much more severe than the first or third wave of the series. During the 1918 pandemic, the deadly second wave was responsible for greater than 90% of the deaths for the entire pandemic.

One of the biggest fears of influenza is its ability to combine and mutate to form new strains. The combination of a highly virulent strain with a highly transmissible strain, would have the potential to become a pandemic.

Individual Preparations for Influenza

Get a seasonal Flu Shot

Even though the current flu recipe does not include protection against the avian flu, it is highly advisable to get one anyway. There are two main reasons to do so:

  • Many experts believe that a pandemic is most likely to occur concurrent with the seasonal flu season, which runs between October and March in the northern hemisphere and between May and September in the southern hemisphere. A traditional flu shot can prevent you from developing it during a pandemic flu.

  • Pandemic flu is very different antigenically than seasonal flu, because of this it is very possible to contract flu twice in a single year. The recovery rate for surviving the second infection are reduced if you are still in a weakened state.

Get a Pneumovax Vaccination

You can protect yourself from pneumococcal pneumonia by getting a Pneumovax vaccination. This will be important in the event that we experience a major flu pandemic.

Rural Refuge

Being isolated from large urban areas can provide some measure of protections, but it is no guarantee. Even small communities were affected during the 1918 pandemic. While smaller communities can not provide a guarantee against infection, it is safe to assume they may not be impacted at the same level as urban areas, from breakdowns in government and civil disorder that may accompany a pandemic with high mortality rates.

In addition it is probable that food and water will be easier to obtain in rural areas and people less likely to be hostile compared to metropolitan areas under similar circumstances.

If you do plan on evacuating from the city, you should do so at the earliest opportunity available. Once a pandemic has been declared the government agencies may elect to impose quarantines as a means of containing the spread of the pandemic.

Symptoms of Influenza

  • Fever
  • Sore throat
  • Cough
  • Runny nose
  • Aches & Pains
  • Headache
  • Nausea
  • Abdominal cramps
  • Diarrhea

Patients affected by the flu can be broadly categorized into 3 prognostic types.

Type 1 - Parients have the poorest prognosis and almost all will die within 2 or 3 days of the development of their first symptoms. The cause of death in these patients during the 1918 flu was massive respiratory failure from overwhelming lung destroying viral pneumonia. There was no effective treatment for this in 1918 and there is none today despite all the advances in medicine that has occurred over the last 90 years. Signs and symptoms of type 1 patients include rapid onset of severe shortness of breath, cyanosis (bluish discoloration of the skin of the hands, feet, and around the mouth and spreading centrally), or bleeding from the lungs, stomach and rectum.

Type 2 - Patients are similar to type 1 patients except they do not die after 3 days. Some but not many of these patients would survive if they had access to and ICU, ventilators and expert medical care but if we have a severe pandemic, those resources will not be widely available. Even if they had access to these services, many of them would die anyway. Remember, no matter what you do, they are likely to pass away in a week to 10 days after becoming ill.

Type 3 - Patients make up the majority of those that become ill with influenza. Fortunately, these patients have a good prognosis if they receive timely and diligent supportive care that can be provided well in a non-medical setting such as the home. Most of these pandemic flu victims will be severely ill and weakened by the infection such that they will be too ill to get out of bed. Many type 3 patients will be completely dependent on others for care. Without simple care, some of these patients will die from preventable causes like dehydration but with simple care, most of these patients will recover. No matter how good the care provided, some type 3 patients will die. This is not your fault. This happens usually because they develop a serious secondary condition that actually becomes the cause of death. Examples of these secondary conditions include bacterial pneumonia, stroke, and heart attack. There is nothing you can do but keep doing the best you can and let nature take its course.


Over the course of a major pandemic, predictions are that 25% to 50% of the population could become sick.


The most effective method of protecting against influenza is vaccination, and overall is considered 70% effective in prevention of influenza.

The World Health Organization (WHO) has a stated short term goal of by the year 2015, to be able to produce enough vaccine to immunize two billion people; this vaccine should be available on the market six months after transfer of the vaccine prototype strain to vaccine manufacturers. They also have a medium and long term goal (no date): produce enough vaccine to immunize the world's population.

Even though vaccination is the best hope of avoiding catastrophe, given that the world's population has now exceeded 7 billion, and because of the lag in creating and manufacturing a vaccination. It is clear that when the first wave of the next pandemic occurs there will be a not be enough vaccine to meet demands.

Anti-Viral Drugs

Tamiflu an anti-viral antibiotic tablet, is effective against Avian Influenza H5N1. The WHO recommends that nations should stockpile enough to treat 20% of its citizens, for a possible Avian Influenza pandemic. For the most effective results, Tamiflu should be taken as soon symptoms are observed, optimum treatment is to administer within the first 48 hours.

While it is possible to prevent infection by using Tamifu tablet immediately after exposure, and daily until the pandemic has past. The availability of the drug during any event makes this a very risky course of action. It is generally advised to wait until symptoms are observed to begin treatment. The recommended dosage is one tablet twice a day for 5 days.

The Flu Survival Kit:

Medical skills caregivers need to learn how to obtain vital signs like pulse, blood pressure, temperature and respiratory rate.

OTC products to have on hand for home treatment of one person with severe influenza:

  • Table salt: 1 lb
  • Table sugar: 10 lbs
  • Baking soda: 6 oz
  • Tums Ex: 500 tablets
  • Acetaminophen 500mg #100 tablets
  • Ibuprofen 200mg # 100 tablets
  • Caffeinated tea, dry loose: 1 lb
  • 2 Electronic thermometers
  • Hand pumped automatic blood pressure monitor
  • Notebook for recording vital signs and fluid intake and output
  • Kitchen measuring cup with 500 cc (two cup) capacity
  • Diphenhydramine (Benadryl) 25mg capsules # 60: 1 tablet every 4 hours as needed for nasal congestion, allergy, or itching.

Prescription products for home treatment of one person with severe influenza:

  • Tamiflu 75mg # 20: take two tablets daily for 5 (or 10) days for flu
  • Promethazine (Phenergan) 25mg tablets # 60: take .5 to 1 tablet every 4 hrs as needed for nausea
  • Hydrocodone with acetaminophen (Lortab-5) # 60 (5mg/325mg): .5 to 1 tablet every 4 hrs as needed for cough or pain
  • Diazepam (Valium) 5mg # 60: .5 to 1 tablet twice daily as needed for anxiety, muscle aches, or insomnia

Supportive Treatment of Influenza

Caring for severely ill flu patients is something that anyone is capable of doing. No advanced medical skill is required. The basic principals are to keep the victim clean, dry, and warm. In addition to providing comfort and reassurance. The most important medical treatment is to make sure they have plenty of fluids. Dehydration must be prevented, as this can be fatal in a patient who would otherwise survive.

By recognizing the symptoms a victim has or the signs of the disease in the body, you can use the chart below to guide your treatment.

For the purposes of this chart, ibuprofen means aspirin, Advil, Aleve, or Nuprin since they are all alike. Acetaminophen means Tylenol. Remember that acetaminophen can be used at the same time and in full doses as ibuprofen because they are in different drug classes and have different drug side effects.

Symptom or Sign Likely Assessment Remedy
Low urine output Dehydration Push fluids
High pulse rate (>80 but especially > 90) Dehydration or fever Push fluids
Shortness of breath Pneumonia Push fluids
Shaking chills and shivers Viremia (virus in the blood) or pneumonia Keep warm
Cyanosis (skin turns blue) Respiratory failure, death likely Keep as comfortable as possible Give hydrocodone with promethazine for comfort, give diazepam for anxiety
Bleeding from mouth, coughing up blood, passing red blood per rectum. Severe bruising. A severe blood clotting abnormality has occurred due to the virus (DIC). Death is likely Keep as comfortable as possible. Give hydrocodone with promethazine for comfort, give diazepam for anxiety
Vomiting Virus affecting GI tract Use promethazine for vomiting, push fluids
Diarrhea Virus affecting GI tract Push fluids, clear liquid diet
Severe stomach cramps Virus affecting GI tract Use hydrocodone and promethazine for comfort
Headache   Ibuprofen and/or acetaminophen or hydrocodone if very severe
Fever   Ibuprofen, acetaminophen, push fluids, keep warm or cool, consider tepid water baths if above 101 F. OK if less than 101 as this may help kill virus.
Sore throat   Gargle with hot salt water, drink hot tea or hot water, ibuprofen and or acetaminophen.
Cough   Push fluids, drink hot tea for affect on breathing tubes, use hydrocodone .5 tablet with or without .5 promethazine to suppress cough if needed


Preventing dehydration in flu victims will save more lives than all the other treatments combined. When patients have a fever or diarrhea, they loose much more water from the body than is commonly appreciated.

Symptoms of dehydration include:

  • Weakness
  • Headache
  • Fainting

Signs of dehydration include:

  • Dryness of the mouth
  • Decreased saliva
  • Lack of or very decreased urine that is dark and highly concentrated
  • Sunken eyes
  • Loss of skin tugor (the elasticity of the skin)
  • Low blood pressure especially upon sitting up or rising from the sitting to the standing position.
  • Tachycardia (fast pulse) when laying or sitting up.

If you detect or suspect that dehydration is developing, administer fluids by mouth. If the victim is too ill to drink, someone should sit with the patient giving him or her fluids drop by drop if needed. Work up to using a teaspoon if possible. Don't stop until the patient has been able to keep down at least quart of fluids. This could take several hours so be patient. After the first quart, the victim should begin to urinate again. This is a good prognostic sign and when this happens you can assume you have restored their fluid level back to a safer level. "Safer" should not be confused with safe. Don't stop there. With sick patients like these, you really need to "push the fluids" so don't let your guard down.


A simple Basic Fluid Solution (BFS) made from water, sugar and salt will be very beneficial to a victim of dehydration. Fluids can be served cool or hot depending on the climate, patient symptoms, and fever status. You can drink the BFS plain or flavor it with just about anything like citrus, mint, or herbs.

The BFS formula is:

  • 4 cups of clean water
  • 3 tablespoons of sugar or honey
  • .25 tsp table salt

If juice is available, you can substitute 1 cup of it for 1 cup of the water and cut the sweetener in half. Boil the solution to purify it if needed. Administering fluids to the victim will be one of the main activities of the day until the crisis passes. Try and get 2 to 3 quarts of fluids a day at a minimum consumed by the victim.


Eating is not really important because the patient will be breaking down their own muscle and fat for energy. The flu takes your appetite away so the victim probably won't be hungry. If the victim is hungry and asks for food, this is a sign of improvement. Feed the victim, but your food selection needs to be appropriate. The Clear Liquid Diet is an excellent way to acheive this.

A clear liquid diet is used to treat certain intestinal diseases, especially infectious diarrhea. Patients suffering from diarrheal illnesses often experience abdominal cramping and frequent, loose stools if they eat solid foods. In addition, a great deal of water and minerals (sodium, chloride, and potassium) are lost in the watery portion of the diarrheal stool; if you are not careful this can lead to dehydration. Victims of diarrhea have to drink considerably more fluid than usual to prevent the dehydration. This is especially important if the victim also has a fever. In most cases, patients with diarrhea can tolerate a clear liquid diet without cramping or diarrhea. This is because the small intestine can absorb water, minerals, and sugars pretty well even when infected.

The diet starts off with clear liquids only. As symptoms abate, the diet slowly adds simple-to-digest, low-residue foods, one step at a time. Don't advance to the next step until the patient is completely symptom-free in the present step. As the patient progresses through each step, if the cramps and diarrhea return, drop back to the previous step they tolerated.

Step 1 - Basic Fluid Solution (BFS), Water, fruit juice, Jell-O, Gatorade or PowerAid, ginger ale, Sprite, or tea.

Step 2 - Add white toast (no butter or margarine), white rice, and cream of wheat, soda crackers, and potatoes without the skin.

Step 3 - To Steps 1 and 2 add canned fruit and chicken noodle soup.

Step 4 - To Steps 1 through 3 add poached eggs and baked chicken breast without skin, canned fish or meat.

Step 5 - To Steps 1 through 4 add milk and other dairy products, margarine or butter, raw fruits and vegetables and high-fiber whole grain products.