How Does the Flu Kill People? | Hacker News Reader

How Does the Flu Kill People?

scientificamerican.com

154 pointsdigital5573 comments

A few years back I got the flu, I think I was 16 or 17 at the time, I was healthy and in good shape before I got it.

I was literally bed bound for 3 or 4 days, it was a struggle to make it to the toilet and back to bed. I was sweating so much that my pillow and sheets were soaked. I think the worst part was actually the muscle aches, it wasn't painful but it was constant and unrelenting.

I was quite amazed at how violently it struck me down. There aren't many common diseases these days that will actually strike someone down in a developed country.

In retrospect it may have been a good idea to go to the doctor, especially after reading this article. Instead my parents left me at home to sleep it out and drink lots of lemon and honey, which is actually a completely ineffective cure.

I had a similar experience when I was 15 or so (mid 90s, it would have been). I couldn't even stand up, and had to crawl on all fours when I needed to go to the bathroom or to the kitchen for more water/juice.

Normally, if I were home sick from school, I'd be playing video games, or sitting in front of my computer (Amiga!) hacking on something. Alas, with my head pounding and my vision blurry, all I could do was lie on the couch and stare blankly at the tv, and there was nothing but soap operas on during the day (not that it mattered).

P.S. - got my flu shot this year

Same thing happened to me in college when I was 21. Two days nearly completely bedridden and coughing so hard I thought I was bursting blood vessels.

I did manage to make it down the block to the college clinic, where they verified that I was their first influenza case of the season, prescribed me some cough syrup, and told me to take way more ibuprofen than it says on the bottle.

I was disappointed at the prescription, but after my first dose I was as happy and energetic as if ever been. Turns out the “cough syrup” was hydrocodone in corn syrup. Powerful stuff.

Opiates are cough suppressants.. which is also why in large enough doses, they're breathing suppressants.

That's not why they're breathing suppressants...opioids work at a part in our brainstem that modulates our breathing rate, slowing it down. You still breath, just less times per minute. That can be really bad for obvious reasons.

That sounds like mono aka infectious mononucleosis aka "the kissing disease" (https://www.healthline.com/health/mononucleosis). Got it myself once.

You were lucky to have it for 4 days only. Those in more mature age keep sweating for weeks.

It feels like a violent flu, but it's not a flu.

Thankfully, mono is the worst sickness I've had to suffer through (in high school). I remember smelling _really_ bad after sweating in bed for five days.

It would be helpful if people could stop using the flu - or, outside the anglosphere, influenza - as a blanket descriptor for the common cold and all sorts of minor malaise.

Influenza is serious and relatively rare. Not something you get several times a year, one or two days at a time.

Their are several types of Influenza, but most cases last less than a week and 1/3 of the time people have no symptoms.

So, being really sick for 2-3 days is not uncommon, though your right that many other things can cause similar symptoms.

Why do so many US articles sound like a story frim Grandpa Simpson?

"It was a cold Wednesday, with the wind blowing from the north..."

I'm curious if this is commonplace, and if its native audience find it irksome in the online medium. I can understand this style in print, but very often I click an HN link, and hit back before finishing the first paragraph as it becomes clear the article is not written in the pyramid style.

I'm curious which part of the story you're referring to in particular.

If it's this opening:

"One Sunday in November 20-year-old Alani Murrieta of Phoenix began to feel sick and left work early."

US articles often intro with things like that, on the premise that it constructs a human narrative aspect to the story that wider audiences prefer, rather than strictly / only focusing on the scientific aspect of it. It's basically an attempt by a scientific publication, to reach a little beyond its core readership and appeal to eg social media click-throughs (one viral uptake on Facebook and they probably triple their audience for a given article).

It's the new standard for long form writing. They're trying to craft a story to keep the reader interested, they're trying to make it more human.

Which, in turn, has resulted in people learning to automatically skip several paragraphs of text, much like how people skip the intro portions of YouTube videos.

It's commonplace for long form stuff, which I never read because of it.

Title got me, but the answer to "How does the flu actually kill people" isn't going to start with "one sunday in november". I was interested, but not that interested.

Using a specific example of someone young quickly dying is interesting because it's different than our preconceived notions. Further, large numbers don't actually mean much to most people so again using details from a specific case is useful. Many years more people die from the flu than car accidents, but because the flu tends to take the young, old, or immunocompromised people tend to think of it as a non issue.

When the reality is you feel severely sick because your life is actually threatened.

I expect pyramid style for news stories about particular events, not for anything else. "How does the flu actually kill people?" isn't really an event, and I would be surprised if anyone could fit this story into the pyramid style and make it interesting to read.

You mean inverted pyramid? If so, then it may be a journalistic term, but it's universal and pretty much synonymous with how to deliver information effectively.

It is irksome at times, especially when I'm expecting concise journalism. And it's worse when you realize a given piece was deliberately written in this style to be more "appealing" (I wouldn't quite use the term "dumbed down," but it's in the same ballpark), and it ironically ends up being done poorly in that format, when it could easily have made a great "pyramid" style article.

And by "done poorly" I mean things like, the "story" they're trying to lead off with isn't particularly interesting, and/or has only the most superficial tie-in to the rest of the piece. That's a sign that they tried too hard to graft it on.

So I tied an onion to my belt. Which was the style at the time.

The 1918 Flu Pandemic generally killed the youngest and healthiest. The theory is that that strain caused a larger immune response than typical flus, making it much deadlier.

A few years ago I got interested in my ancestry. I discovered a great great uncle, born in 1892, who immigrated to the U.S. from Romania in 1904 (aboard the RMS Carpathia, which would later become famous for rescuing the survivors of the Titanic in 1912 and was itself torpedoed and sunk in 1918).

His family likely left Romania due to the persecution Jews were experiencing in eastern Europe. Sadly, he died from the Flu in Denver, CO in 1918. :(

The 1918 flu pandemic also came at the tail end of World War 1, when the youngest and healthiest were in incredibly close proximity and likely had compromised immune systems from a few years of warfare.

And people had had less food than normal Germany especially had major food shortages.

> The theory is that that strain caused a larger immune response than typical flus, making it much deadlier.

For bonus points, this is suspected to be due to it triggering a "cytokine storm": https://en.wikipedia.org/wiki/Cytokine_storm

2017's flu season in the southern hemisphere was pretty bad - it hit teenagers and young adults more than usual. If the same strains are going to be active in this year's northern hemisphere season, I'd strongly recommend getting the vaccine.

I JUST recovered from the flu (yesterday was my first day without fever). At it's worst, 102 degrees under a pile of warm blankets, with thermal underwear and sweatpants on. Was still cold.

I hesitated on taking medication to treat the symptoms because my understanding is that a fever is your body's way of fighting the virus. I let it run its course for a few days, before I started taking Ib Profin which was a SILVER BULLET for breaking the fever. Within 30 minutes of taking it (800) I was back to normal temp.

I wonder if I had taken Ib Profin from the start, would I have been stifling my bodies natural ability to defeat the virus? Would I have potentially increased my risk for developing secondary disorders as a result of the infection? I can't help but feel like letting your body run it's course (while being safe) is the best way to go... I am not a doctor, nor a virologist.

We don't really know if it affects ability to fight off germs, but I would assume it does. Fun fact, mix of ibuprofen and tylenol is one of the most effective anti-fever treatments known and by far out of OTC medicines.

I've taken ibuprofen in the past for other things, minor headaches, muscle aches, etc... Never really felt like it did much. Always kinda wondered why it was such a popular drug.

Well, I'm a believer now. When it comes to fevers ibuprofen appears to be incredibly effective. I took 800 at the peak of my 102 fever, and within the hour, my temperature was back to normal. Amazing stuff.

Huh I once had a fever of 103.6 in China and took some drug that was in a powder which worked similarly well. Maybe it was just ground up ibuprofen.

Could have been, injectables are frequently sold as reconstitutable powders where refrigeration isn't reliable. It's easy enough to just measure an oral dose from that in pinch

IMO OTC pain meds are much more effective for pain and fever than people give them credit for. On opiods you feel messed up and it's clear that you took the medicine.

Tylenol and ibuprofen are very transparent. There's no obvious effects to remind you that you're on it. Yet multiple scientific studies have shown that the two in combination are just as effective for relieving some kinds of pain as Vicodin.

I can't count the number of times I took Tylenol and 800 of ibuprofen then told everyone at work I was feeling 'better', only to train wreck at the end of the day and feel just as bad as I did that morning

Ibuprofen does a great job reducing inflammation for me. Not sure about just “aches” in general.

For example, I caught the Coxsackie A virus (“hand, foot, and mouth disease”) from my toddler a few months back, and it got in my gums and made them swell up very uncomfortably for a week. Ibuprofen significantly reduced the inflammation.

Different "pain medicines" do different things. NSAIDs like ibu are literally only effective for for fever/inflammation. Always check what a pain med does before trying to take it without doctor's advice.

http://rspb.royalsocietypublishing.org/content/281/1778/2013...

Some evidence seems to indicate you did the right thing. Anecdote: I do the same thing now (embrace the fever); I let my body overheat; I’m convinced it shortens the total suffering

Did you mean to link to an articulate that leads with the benefit to the individual is disputed and then focuses on the benefits to the herd?

I guess so? I believe the comment I was responding to claimed the positive/negative effect of antipyretic medications was nebulous; I at least found something that showed that was not the case

Ibuprofen has been shown to inhibit antibody production, and I believe similar research showed something similar for paracetamol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693360/

That said, the discomfort of a 10+ day flu vs slightly reduced immune response, I'd take the medicine any day.

I'm not sure if this is correct but the Flu is more of respiratory illness. There is a Fever associated with it but most Fevers people experience are probably some sort of viral infection and not necessarily the Flu.

Advil and Tylenol can be used when the body can't effectively lower its temperature on its own. My understanding is your temperature rises to kill the virus and sometimes your system loses control and that is when folks get into serious trouble. The medication will help lower your temperature.

I think the most important thing to consider is Starve a Fever and Feed a cold. Do not eat anything sweet ever during any kind of fever. It will fuel it like gasoline on a fire.

My Grandmother lost both her parents when she was 2 years old in 1918 to what they said was Pneumonia. I suspect it was the flu.

The flu is 100% viral by definition.

If the problem is with the immune system reacting too strongly, could suppressing the immune system potentially help? Of course, you'd probably want to combine that with antibiotics, to fight any secondary infections that could develop.

Modern biologic immunomodulators have shown no benefit in survival in systemic inflammatory response syndrome. Steroids have not been assessed in SIRS specifically, though hey have been in sepsis and septic shock, where high dose steroids have been harmful and low dose steroids have been beneficial.

It’s tough lobbing immunosuppressants at people with a rampant infection.

One thing you may find interesting is the video from Sci Show about body temperature. The video and subject somewhat relates to fever it's about why the human body temperature is what it is (spoiler: it's to fight off fungus).

TL;DR:

Based on autopsy studies about one third of people who die from flu-related causes expire because the virus overwhelms the immune system; another third die from the immune response to secondary bacterial infections, usually in the lungs; and the remaining third perish due to the failure of one or more other organs.

Thanks for the TL;DR.

I always wondered about this phenomena - People dying from flu.

> and the remaining third perish due to the failure of one or more other organs.

One of these organs is the heart-- the seasonal variation in influenza actually overlaps with an increase in acute myocardial infarction (AMI, or a 'heart attack'). Recent meta analysis has shown an odds ratio of ~2 for AMI in the setting of influenza.

Mechanistically, there is a suspected link between the virus and inflammatory changes in the blood vessels supplying the heart that destabilizes existing atherosclerotic plaques.

More here: http://heart.bmj.com/content/101/21/1738 http://www.sciencedirect.com/science/article/pii/S1473309909...

Edit: The article mentions (viral) myocarditis as a sequelao f the flu-- this can also happen, but is separate from AMI

I've often wondered this. Interesting article.

In 2015 I did my longest fast ever. I went 12 days without food -- just water. I felt surprisingly normal for the first 7 days. After that I felt weaker and weaker. The weakness very much reminded me of the experience of having the flu. By the final day it felt as if I really did have the flu, though those symptoms would come and go, and disappeared quickly after I finally had some food.

The conclusion I draw from this is that some of the symptoms that we associate with viruses actually comes from the under-production of our normal enzymes. If you go 12 days without food, then your body starts to run out of the protein needed to make normal, everyday enzymes. And when a virus hijacks the machinery of your cells, and forces those cells to make virus proteins, the cells under produce the normal, everyday enzymes that are needed to live. And the symptoms of both experiences are very similar. So this aspect of a virus needs more study -- what is the result of not producing normal, everyday enzymes?

Out of curiosity, beyond the weakness, how painful / unpleasant was the experience ?

I've read in an account collated from a hunger strike participant that starving is a bit unpleasant the first few days and then pretty much OK (which I was pretty skeptical of); albeit apparently the more overweight you are initially the more unpleasant and painful it is, at first at least. Although of course 12 days is comparatively short. I'm still curious if you have anything to comment on this description though ?

I believe the source where I've read this account was here: https://books.google.fr/books?id=ipQDHj1aAe4C&pg=PA111&lpg=P... . It's a fascinating, if a bit morbid, read. The guy stopped eating for 68 days, and ended up weighting 44kg.

As an example, on the 11th day, I decided to go to the Verizon store and get a new iPhone, because my old iPhone was having problems. So I walked to the iPhone store. I felt very weak, and I was sweating. The experience was surprising because I'd gone for a long walk on the 7th day and I'd felt fine. But by the 11th day, on a long walk, I felt like I was walking up a steep hill, even though I was walking on flat terrain. At the Verizon store I appeared normal and I had a good conversation with the sales clerk. Then I walked towards home. I felt much weaker on the way home. I stopped to buy water at a connivence store. The sales clerk asked if I was okay. I explained that I was sick. She said I looked sick.

I walked a total of 8 kilometers, which isn't much, but it felt like a serious hike. I felt very sick that night, and I fell asleep early and I slept for 12 hours.

But when I woke up in the morning, I felt good. I had energy and mental focus. And then that faded away over the course of the day. Which is the other thing about a long fast -- you still have good stretches, even after 12 days, but they become increasingly rare.

I think those people who go 2 weeks without food and then claim they feel great are simply taking for granted the fact that they are resting a great deal, and they expect you to take it for granted as well. Nobody goes 2 weeks without food and continues to have the same energy level, sustained over an entire day, as someone healthy who is eating normally.

Thank you for your response. I imagine in the case of a hunger strike in prison - which the above testimony was about - the fact that you're basically not moving all day must help with the weakness (not to mention slow down the actual starving due to lack of calories burning).

I have read that once your body starts burning muscle tissue it gets really painful. Thank God I have not experienced this. 10 days fasting is not bad. Towards the end I felt losing strength but otherwise was fine. I would not recommend doing this in a normal workday setting though.

Yeah, I've read that too and it seems logical; but again, the account I linked above says it isn't (which is what I found weird) - it says mostly you experience weakness but not pain, at least not after a few days.

Due to medical issues I fasted for 10 weeks. After around 1.5 months, I was getting nutrients via IV, though. I lost an average of a pound per day in weight.

I felt great for most of it.

Due to medical issues I fasted for 10 weeks. After around 1.5 months, I was getting nutrients via IV, though. I lost an average of a pound per day in weight.

I was active and felt great for most of it. ~

Why did you decide to fast for 12+ days?

Health benefits. There is a whole world of study regarding the health benefits of long fasts. It gives your immune system a chance to generate a greater variety of responses to different pathogens. Also, it might have some benefit in staving off cancer, as it has been shown to offer aid with chemotherapy. See here:

https://www.scientificamerican.com/article/fasting-might-boo...

Why 12 days though? Did you quit after seeing the downturn, or were you planning on 12 to begin with?

Social obligations. Which is what always ends my fasts. I had scheduled to do some traveling and meet some friends. I ate vegetarian food for the first week after the fast. It was two days till I got my strength back, and several more days before I felt 100%. I've read there is a unique kind of diabetes that comes up when you do a long fast. When we say "diabetes" we tend to think of Type II, which comes from over-eating, but I've read that "diabetes" actually refers to any disregulation of the insulin response. And it makes sense that we wouldn't have much of an insulin response after 12 days without food. Because the purpose of insulin is to sweep excess nutrition out of our blood stream and into our cells, especially our fat cells, but if you've just gone 12 days without food, then there is no excess -- the cells are desperate for whatever nutrition they can get.

> I've read that "diabetes" actually refers to any disregulation of the insulin response

I am assuming you know the difference between type 1 and 2 diabetes, but for the benefit of other people reading this, please be aware that in type 1 diabetes, the body's response to insulin is irrelevant - the body (pancreas) does not produce insulin at all, and thus it is necessary to inject insulin. It is a wholly different condition from type 2 diabetes.

Diabetes, technically, refers to the production of excessive urine. Hence the two major diseases called diabetes, diabetes mellitus (sugary diabetes) and diabetes insipidus (tasteless diabetes, an unrelated disease). Generally, people are only talking about diabetes mellitus, of which there are several etiologies. While some conditions are on the spectrum of insulin resistance (metabolic syndrome, polycystic ovarian syndrome), you wouldn't call it diabetes unless the urine contains glucose.

For anyone interested, there is a video on Amazon Prime called The Science of Fasting 2016.

Just watched it and was really unimpressed. For a documentary titled "the science of fasting" they really went out of their way to find the least credible sources and seemed to try appeal as much as possible to consumers of alternative and holistic medicine. Secret, untranslated texts by open-minded Soviet researchers, Western science rejecting studies out of a bias against unprofitable treatments, genetic memories of starving on the savannah, body resets and cleansing...I know a lot of people who are into fasting would really like that stuff, but I was hoping to find a description of fasting that avoided those sources.

After about a week of no carbohydrates your body would enter ketosis, which uses a parallel set of metabolic processes that burn ketones rather than carbs. The onset of ketosis is marked by really clear flu-like symptoms. After ~48 hours those disappear and everything is ok again. Do you think that could have been what you were experiencing? Your body will fall out of ketosis very quickly as soon as you have some carbs.

>The onset of ketosis is marked by really clear flu-like symptoms

I tried a ketogenic diet once out of curiosity (confirmed ketosis with urine testing) and I did not experience this. I have read many other anecdotes of people who also did not experience it.

The flu like symptoms are mostly electrolyte imbalance in my experience. You lose a lot of water weight and salt.

Although I had not heard that reasoning before, I was told to increase water and salt consumption, which I did. Possibly this could have prevented any flu-like symptoms.

When you deplete glycogen (you can store about 500 grams of it), you also lose 3 grams of water per gram of glycogen. So in total, you lose about 1.5 liters of water once you're fully glycogen depleted.

Ok. I did experience it. It would be unsurprising if there is biological variability in this. But from the parent's description if they did experience symptoms like it, it seems like ketone flu is a highly likely explanation.

I've experienced what's commonly called the "keto flu". Whenever I get back on a keto diet, I drink a lot of electrolytes, get plenty of vitamins, and that seems to mitigate most of the symptoms. It definitely feels like a cold or the flu when it happens, though without a fever.

I'm about a week into a ketogenic diet and I am having flu-like symptoms. I woke to my sinuses being very inflamed but no amount of sudafed or benadryl seemed to make any difference. Then suddenly this afternoon I started sweating profusely and my nasal passages opened right up. It's been a real trip!

> The conclusion I draw from this is that some of the symptoms that we associate with viruses actually comes from the under-production of our normal enzymes.

The conclusion I would have drawn is that different assaults on the metabolism can create similar symptoms.

I don't think 12 days is nearly enough time to deplete your protein, especially if you have weight to lose.

Fasting/ketosis is protein sparing in and of itself, and if you have extra weight to lose, you have extra skin surrounding that fat which can be recycled.

its long enough to become potassium deficient which is not a fun trip, but it should be a trip - to the ER for an IV drip.

Yep, a lot of people who are in to fasting will add lite salt to their water to prevent that.

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