Summary:  Seek medical care immediately if you have significant underlying medical problems and you develop a flu-like illness (i.e., fever PLUS cough or sore throat) at a time when flu is actively circulating in your community. All people with flu symptoms should seek medical care if they develop breathing difficulty, inability to drink fluids, or if their fever extends more than five days. Most otherwise healthy people with flu-like illness will recover fully with symptomatic care at home and will need no special medications or interventions from a doctor if they are improving after 4-5 days of the illness.

Influenza can cause severe symptoms, and a small proportion of infected people even die from flu. However, most people with flu, even the currently circulating H1N1 “Swine Flu”, recover fully from their infection without any special medications or interventions from a doctor. Here are several key points to be aware of to help you to decide when you should seek care for yourself or a family member.

How dangerous is this virus for my child?   There were approximately 114 deaths due to novel H1N1 in US children from April to November 2009. For family and friends of these children each death was  tragic.  However, that number represents an approximate rate of less than one death for every half-million US children. It is helpful to consider that many more children die in backyard swimming pools each year than have died from H1N1. Two thirds of the children who have died from H1N1 had severe underlying medical problems such as cerebral palsy.

How dangerous is H1N1 in adults?   Flu kills an estimated 36,000 people every year in the United States, almost all during the three or four month “flu season” from December to March.  Ninety to 95% of those who die from flu are over age 65. The mortality rate from the H1N1 Swine flu that is causing our current pandemic is quite different. Very few people over age 65 have been infected by Swine flu, and fewer still have died from it. Almost 90% of the deaths from Swine flu have been in people under age 65, and a large number have been under age 25, a highly unusual development. However, as of November 2009 it appears that the number of deaths due to the current pandemic strain of  flu is substantially  lower than for a “normal” flu season.

Are there medicines available to treat flu?     There are antiviral medications available for flu, but they are only marginally helpful for most people. Studies have shown that antiviral medications can shorten the duration of flu by 12-36 hours if taken within 48 hours of the first symptom. This means that for most people, the illness can be shortened to four or five days with antiviral medications compared to five or six days without them. There have been only a few studies demonstrating that these medications save lives, but those studies were conducted  in older people with significant underlying health problems. There are no studies showing that antiviral medications save lives among young, healthy people under age 50, although it is possible there is a benefit.

It is critical to note that antibiotics are completely useless against influenza, since antibiotics kill bacteria, not viruses. Antibiotics may be helpful if complications such as middle ear infection or pneumonia develop during the course of the flu.

So when should I see a doctor?   The curent recommendation from the CDC is to use antiviral medications for people with flu symptoms who also have underlying medical problems. Click here for detailed information from CDC about who should be treated for flu. These people should see their doctor immediately if they develop fever PLUS either cough or sore throat.

In general, use of flu antiviral medications for otherwise healthy people who have acute symptoms of flu is not necessary, so medical evaluation is also not necessary for these people. Many people who have a flu-like illness do not have flu at all, but instead are infected by another respiratory virus that mimics flu. Flu antiviral medications are not helpful for any of these other viruses. For otherwise healthy people, treatment of a flu-like illness primarily consists of:  bedrest; lots of fluids; medicaions for fever and pain such as acetaminophen or ibuprofen; and time. Well over 99% will recover fully.

The fever from flu typically lasts up to five days, and the cough may continue for a week or longer. People should seek medical care if  fever persists longer than five days, if  breathing difficulty develops, or if they are unable to drink fluids.