*OTC H5N1 Treatment*
By: Kosh
08 August 2005

Pandemic Hx and Progression of H5N1

Mankind has a long history of pandemics. The CDC and WHO have even defined the stages of pandemic development. Stages 1 through 3 are pre-human-to-human transmission stages and don’t matter for our discussion.

Stage 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Stage 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

Stage 6: Pandemic: Increased and sustained transmission in general population.

It is obvious that H5N1 is at least into Stage 4. Due to the Chinese attempts to cover up the spread of this disease, we are not sure if it has passed into Stage 5. However, the spread to other countries is continuing and some ‘official’ opinions have been mentioning Stage 6 progression.

Historically we know that, a ‘bad flu season,’ caused by a common flu strain, has a tendency to overwhelm our medical system and kill tens of thousands in the US alone. Right now, Australia and New Zealand are experiencing medical system overload from their current, normal, annual flu epidemics. Many people are sick, hospitals are full to overflowing, doctors and nurses are overworked and sick, themselves, supplies are running out. If the strain currently circulating in the Southern Hemisphere comes north for our normal flue season, we can expect similar overload. As H5N1 spreads, it will only multiply the effect.

Unfortunately, we also know that some strains of H5N1 have shown signs of being resistant to the four known antiviral medications - amantadine, rimantadine, oseltamivir (Tamiflu), and zanamivir (Relenza). One of our latest bits of information about H5N1 is that in China, chickens with this form of avian flu are being fed oseltamivir in an effort to prevent their deaths. The expected, though undesirable effect has been that H5N1 is developing resistance to this formerly successful antiviral drug.

In light of these developments, we must consider the possibility of a vaccine. Several companies around the world are trying to develop a vaccine for H5N1. One company actually has one ready for production, but that has been stymied by the determination that the virus had mutated beyond what that vaccine would cover. Perhaps that vaccine would lessen the illness, but they are not sure. That is one of the problems with this particular virus - it is changing rapidly. Once a strain gets to the US so the scientists can finalize the proper, effective vaccine, it will take several months before production can cover more than absolutely essential personnel.



Symptoms and Home Treatment

We know from various sources what basic symptoms H5N1 patients have exhibited. Not surprisingly, they are best described as "flu symptoms." A high fever (101 degrees to 103 degrees Fahrenheit) and headache are usually first. Respiratory symptoms then start - cough, congestion, sneezing and some shortness of breath.

Though gastrointestinal symptoms such as nausea, vomiting and diarrhea have rarely been reported with H5N1, these symptoms have been severe when they did occur. Additional symptoms include aching muscles and joints, sore throat, decreased appetite and lethargy or tiredness.

With normal flu, the strongest symptoms last for 3 or 4 days, with significant tiredness and discomfort for 3 or 4 more days. However, it may take several more weeks or even months until the victim regains usual levels of stamina.

Normal flu seasons kill 60,000 to 70,000 people in the US each year. Most of these deaths are from secondary pneumonia (a different bacteria takes advantage of the weakened immune system and causes pneumonia).

Okay, so we know we have a virus that is spreading human-to-human in an ever-increasing geographical area. We know it will overwhelm our medical system when it gets here. We know that our current ‘miracle drugs’ are not going to stop it and it will be sometime before an effective vaccine becomes available to the general public. So where does that leave us.

No, we’re not all going to die. If we keep our heads and use common sense, we can treat ourselves and our loved ones with publicly available over-the-counter (OTC) medicines that can be obtained now at common drug stores, grocery stores, and department stores like Wal-Mart and Kmart. Caring for a sick person is not rocket science. It takes patience, common sense, and reasonable precautions. It takes the same skills as a parent uses to care for their young children.

Let’s go through the symptoms and list the types of medicines that can be used to treat them. Generic versions of these drugs are often cheaper than a brand name and either one may be effectively used. In several cases I have listed the generic name first and then one or more brand name in parentheses.

Headache, body aches, chills, sore throat and fever: Ibuprofen (Advil and Motrin), and/or Acetaminophen (Tylenol). These can be used safely in combination. The recommended dose for Ibuprofen is 2 to 3 tablets (400mg to 600mg) every six hours. Do not use this if the patient is vomiting because it could make the vomiting worse. For Acetaminophen the dose is two 500mg tablets every six hours. Note: These are the maximum dosages for each and should not be exceeded.

Other measures include cooling down the patient by removing clothing and extra blankets. For a very high fever (>104 F) use a fan and give sponge baths. If the patient is not vomiting give them cool liquids or popsicles. It is not necessary to lower the temperature below 101 F as this is a beneficial level in the bodies defense system. See Blizzard’s article on Fevers for more information.

Gargling with hot salt water is a good treatment for sore throat. Hot tea is also helpful. There are also throat lozenges and sprays that sooth the pain.

Cough and congestion: Cough syrup with expectorant (Robitussin).

Nasal Congestion: Pseudoephedrine Hydrochloride (Sudafed). Important note: Due to abuse of this drug, you will probably have to buy one box at a time at a pharmacy or the pharmacy department of a grocery or department store. This is a good reminder to insure you have a supply of all of these OTC drugs now rather than wait until the last minute.

Runny nose: Anti-histamine (Benadryl)

Decreased appetite: Nutrient rich foods are best but anything the patient will eat will do in the early stages. It is normal for a patient to not have much of an appetite with fever. As the fever fades this symptom will subside and the patient will again be normally hungry. For a strong session of the flu, it is common for a patient to lose a few pounds, but will normally regain it as the illness lessens. If symptoms include nausea, vomiting and diarrhea, it is best to follow a clear liquid diet. That will be discussed later.

Lethargy or tiredness: Rest is highly beneficial. The human body does a much better job of combating illness if is gets enough sleep. This symptom can linger for many weeks or months in some flu victims, long after the other symptoms have subsided.

In general, multi-symptom ‘cold and flu’ medicines cover many of the symptoms we expect with H5N1. There are also varieties labeled for ‘Nighttime’ that include ingredients to help the patient sleep. Symptoms can be treated individually as they wax and wane or with these combination drugs while multiple symptoms are occurring at once.

Gastrointestinal Symptoms - Nausea, vomiting, and diarrhea: anti-emetic (Phenergan). Unfortunately, anti-emetics are currently available only through prescription. It would be a good idea to get some now rather than hope they are available during regular flu season or worse, a pandemic. If the patient is only nauseated, they may be able to take an anti-emetic in pill form. If they are actively vomiting suppositories will work better, but in an emergency the pills may also be dissolved under the tongue. Remember that suppositories store best in cool temperatures such as a refrigerator and should be handled as little as possible prior to insertion because when they get warm, they turn soft and may be difficult to insert into the rectum.



Special Considerations for Dehydration

Dehydration: Whether it is due to vomiting and diarrhea, fever, or just decreased intake of fluids, it is common for a flu patient to become dehydrated. This is a significant factor because the body requires fluid to perform many of its normal functions as well as its immune functions.

Signs of dehydration include dryness of the mouth, decreased saliva, lack of or very decreased urine output that is dark and concentrated, sunken eyes, loss of skin turgor (the elasticity of the skin), low blood pressure especially upon sitting up or rising from the sitting to the standing position, and tachycardia (fast pulse).

If you detect or suspect that dehydration is developing, administer fluids by mouth. If the patient 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 a quart of fluids. This could take several hours so be patient. After the first quart, the patient should begin to urinate again. This is a good sign, but don’t stop there. Administering fluids to the patient will be one of the main activities day in and day out until the crisis passes. Try to get 2 to 3 quarts of fluids down the patient every day at a minimum. With sick patients you really need to "push the fluids."

You can use various fluids such as water, juice, broth or tea (hot or cold). Remember that if the patient has a high fever, these fluids should be cool or cold. If there are any gastrointestinal symptoms you should use a clear liquid diet. The diet starts off with clear liquids only. As symptoms abate, the diet slowly adds simple-to-digest, low-residual foods, on step at a time. Don’t advance to the next step until the patient is completely symptom-free from nausea, vomiting or diarrhea in the present step. As the patient progresses through each step, if cramps and diarrhea return, drop back to the previous step they tolerated. This progression is also good for patients without gastrointestinal symptoms but who have been too ill to eat. After several days without much food, the stomach will adapt much more readily to this gradual reintroduction of solid foods.

Step 1: Water, fruit juice, Jell-O, Gatorade or Power Aid, ginger ale, Sprite, tea

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

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

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

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



Mankind being the social animal that he is, it is only a matter of time until we face another pandemic. Our goal is to survive this crisis and push on. Following these suggestions will help us achieve that goal.


Some of the recommendations on symptoms and OTC medications as well as those on dehydration and the clear liquid diet are taken from the paper: Preparing for the Coming Influenza Pandemic by Grattan Woodson, MD, copyright 2005. Other information is from the Center for Disease Control, the American Academy of Pediatrics and the American College of Emergency Physicians.

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