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Got the flu? Here are four good reasons for staying out of the ER

We are right in the middle of the "flu" season, an annual rite of passage for Canadians during the winter months. As an emergency physician working in a busy urban emergency department, this can be an extremely overwhelming time of year. Volumes increase because patients flood emergency departments, worried about flu symptoms such as fever. They fear it may be a dire situation, when in reality they should be at home in bed resting, drinking fluids, taking antipyretics such as ibuprofen or acetaminophen and giving it some time.

Influenza, or the flu, is an acute respiratory illness. It is caused by various strains of influenza A or B. Outbreaks occur worldwide on an annual basis, often in the winter months. The Public Health Agency of Canada states that the current level of influenza activity is in the higher range of expected levels for this time of year. The vast majority of cases in Canada are due to the H3N2 subtype strain of influenza A. This strain tends to cause more severe illness, particularly among the elderly and young children. Concurrently, influenza B is also more prevalent than usual this season.

This makes it even more vital that we recognize flu symptoms, understand how to best manage them at home and also know when to seek medical attention.

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Flu symptoms often have upper-respiratory symptoms such as coughing, sore throat, watery eyes, "runny nose" (rhinitis) and systemically also include fevers (greater than 38 C), headaches, chills, aching in the joints and muscles, and overall fatigue. The severity of symptoms can vary among individuals. Fever and cough with aches/chills are by far the most common symptoms.

It is vital to remind everyone that serious complications occur in only a very small fraction of patients and rarely in those outside of the higher-risk groups such as those who are immunocompromised (active cancer or HIV), long-term-care residents, pregnant women, people with underlying respiratory ailments such as asthma, the very young (under two years old) and adults older than 65. Thus, if you do not have any of these co-morbid health conditions, you should get better in a few short days and need not worry. If your physical condition deteriorates such that, for example, you are having difficulties breathing, experience a severe headache or are still having high fevers for several days in a row, then it might be time to seek medical attention.

Large amounts of the flu virus are shed through respiratory secretions such as coughing and sneezing. This is how it can quickly spread to others in close contact with an infected individual. It is critical to maintain hand hygiene by washing your hands regularly when you have symptoms. Coughing and sneezing into a tissue or your own clothing is best.

The average incubation period after exposure to an infected individual is two to five days, before a person manifests flu symptoms. One can shed the virus (and thus pass it on) for up to seven days.

In the vast majority of cases, influenza is self-limiting and one improves within three to seven days. Minor symptoms such as a cough can linger on a while longer.

Keeping all of this in mind, here are four good reasons to stay away from the emergency department when you have the signs and symptoms of the common flu:

1. You can manage it at home. All that you need to do to control the fever and chills is rest, hydrate yourself and take an antipyretic such as acetaminophen or ibuprofen as directed. The flu in the vast majority of cases is benign and self-limited and you will get through it in due time.

2. You do not want to be around other sick people in the emergency department and thereby exchanging viruses unless you really have to be (i.e., you are in one of the risk-factor groups, fever is lasting for more than five days or you are in respiratory distress).

3. You can get those whom are immunompromised (such as cancer patients) seriously ill by exposing them to your viruses needlessly.

4. You will add to the burden of already overextended emergency departments dealing with the most acutely ill in society.

Dr. Ahmed Mian is an emergency physician and coroner in Toronto. He is also a faculty member at both Queen's University and the University of Toronto's Department of Family Medicine.

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