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This initial phase takes one to four days. “The more you inhale, the shorter the incubation period,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville. “In the beginning, you don’t feel sick. You don’t even know it’s there.”
As the virus colonizes your respiratory tract, your body starts to figure out something is amiss and rallies its immunologic troops in an inflammatory response, releasing proteins called interferons — because they interfere with alien invaders. Interferons flood your bloodstream and set up camp in your mucous, prompting more proteins called cytokines to join the battle. These protein soldiers circulate throughout your body, ready to rumble.
“Paradoxically, our own soldiers created for the fight are what cause us to have symptoms,” said Dr. Schaffner.
“War creates damage and so you get fever and a headache and muscular aches and pains,” which you experience as the abrupt and intense opening salvos of the flu. These early symptoms are usually what distinguishes the flu from just a normal cold.
The achiness and fever also signal that you need to start drinking a lot of fluids. The battle royal being waged inside you will dehydrate you more than you think. You may notice that your urine will get darker and you’ll have to go less often. Experts say to make sure you drink a cup or so of water or other liquid every hour, avoiding alcoholic and caffeinated beverages.
Drinking fluids will diminish your headache and also bolster your immune response because your protein soldiers are conveyed via bodily fluids. Dehydration hampers their movement. It’s one reason people tend to want soup when they’re sick and may crave watery fruits like citrus and melon.
While you may feel rotten all over, the real battle is going on in your respiratory tract where the virus is localized. When the war is winding down, you stop feeling achy and feverish but you have residual inflammation in your throat, sinuses and bronchial tubes. All those cells lining your mucous membranes have been damaged and are like weeping sores, Dr. Schaffner said. That’s why your nose is runny and you start to sneeze and cough to clear out the detritus.
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Given this, over-the-counter medications that suppress your cough and dry your sinuses may not be the best idea.
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“Certainly there is the thought that you don’t want to suppress a cough too much or dry out your nasal passages because you want to get rid of the infection,” said Dr. Tara Vijayan, an assistant clinical professor in the division of infectious diseases at the University of California, Los Angeles, David Geffen School of Medicine. “There’s a balance for sure. I don’t think you should suffer unnecessarily, but you need to weigh the true benefit.”
Although you want to rest, lying flat all the time can be problematic because it collapses your lungs so you can’t cough as efficiently, trapping bacteria in your respiratory tract. If the virus destroys enough cells in your bronchial tubes it creates openings for bacteria to get into your lungs, which can lead to pneumonia, a potentially life-threatening complication of the flu.
When your lungs are vertical rather than horizontal, “you’re able to breathe deeply and freely and you’re able to cough out any inadvertent material, even microscopic bacteria, that get down into bronchial tubes,” Dr. Schaffner said.
The C.D.C. recommends people who are hospitalized or at high risk for complications of the flu, such as older patients, pregnant women and those who are otherwise immunocompromised, take the antiviral drug oseltamivir, sold under the brand name Tamiflu, because observational data indicate it might reduce the likelihood of death.
Other researchers, including those at the Cochrane Collaboration, disagree, saying that there’s not enough evidence to support taking oseltamivir or its chemical cousin zanamivir (brand name Relenza). They question the wisdom of spending billions stockpiling them as many countries, including the United States, began doing during the swine flu scare in the mid 2000s. Indeed, the World Health Organization last year downgraded oseltamivir from its list of essential medicines. It may or may not help, depending on which study you look at.
For healthy people who get the flu, most researchers agree the data indicates oseltamivir taken within 48 hours of onset can reduce the duration by about two-thirds of a day. But at around $154 for a course of the medication, that may not be worth it, given that the side effects include nausea and vomiting.
“We wish we had better drugs that could wipe out flu,” said Angela Campbell, a medical officer with the C.D.C.’s Influenza Division. But she said oseltamivir is “what we have right now” and in outpatient situations “it’s really the clinician’s decision with the patient based on a number of factors,” including cost and effectiveness, whether it should be prescribed or not.
The C.D.C. also still recommends getting this season’s flu shot, despite its questionable prophylactic value, because it might reduce the severity of the flu should you contract it. In previous years, against strains other than H3N2, flu shots have had reported effectiveness of about 40 percent to 60 percent.
But beyond that, rest, fluids, not staying horizontal all day and perhaps also letting in fresh air and sunlight are the best things you can do for yourself. To prevent friends, family members and colleagues from getting sick, keep to yourself until 48 hours after your fever has subsided and you’re feeling better.
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While you may continue to cough for weeks, Dr. Schaffner said you probably aren’t infectious. Just annoying.
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WASHINGTON — President Donald Trump has delivered an ultimatum to America’s European allies to fix the “terrible flaws” in the Iran nuclear deal, or he’ll pull the U.S. out in a few months’ time.
Trump made the threat Friday as he extended waivers of key economic sanctions on Iran, keeping the accord alive at least for now. But his explicit warning to Europe that the deal must be fixed by the time the next sanctions waivers are due in the spring creates a high-stakes diplomatic deadline that will be difficult to meet.
“This is a last chance,” Trump warned in a statement that outlined several tough new rules on Iran. “In the absence of such an agreement, the United States will not again waive sanctions in order to stay in the Iran nuclear deal.”
Trump’s declaration puts great pressure on Britain, France and Germany, the European signatories to nuclear pact with Iran. Trump wants them to help the U.S. devise a new agreement designed to prevent Iran from escalating nuclear activity again next decade, as permitted under the 2015 arrangement reached by President Barack Obama.
Iran has said it’s not interested in any renegotiation and would almost certainly view a side agreement between the U.S. and Europe as a violation of the deal. The Europeans, meanwhile, have said they are willing to discuss the matter with the U.S. but have shown little enthusiasm with Trump’s hard line.
Iranian Foreign Minister Mohamed Javad Zarif accused Trump of “maliciously violating” the nuclear deal.
“Trump’s policy (and) today’s announcement amount to desperate attempts to undermine a solid multilateral agreement,” Zarif tweeted shortly after Trump’s statement. “Rather than repeating tired rhetoric, US must bring itself into full compliance — just like Iran.”
The sanctions Trump had to waive Friday dealt with Iran’s central bank. These penalties largely cut Iran out of the international financial system, until they were suspended by Obama under the nuclear deal. Trump is also waiving other U.S. penalties covered by the agreement, including on Iran’s oil and gas sectors, which were up for renewal next week.
Trump will next have to deal with these decisions in mid-May.
He paired Friday’s concession with other, targeted sanctions on Iran for human rights abuses and ballistic missile development. The Treasury Department’s action hits 14 Iranian officials and companies and businessmen from Iran, China and Malaysia, freezing any assets they have in the U.S. and banning Americans from doing business with them.
Those hit by the sanctions include: Iranian judiciary chief Sadegh Amoli Larijani; the Rajaee Shahr Prison and its director, Gholamreza Ziaei; the Islamic Revolutionary Guard Corps Electronic Warfare and Cyber Defense Organization; Iran’s Supreme Council of Cyberspace and National Cyberspace Center; Malaysia-based Green Wave Telecommunication and its Iranian director Morteza Razavi; and the Iran Helicopter Support and Renewal Company and Iran Aircraft Industries.
In his lengthy statement, Trump said the U.S. would work with European partners to remove the nuclear deal’s so-called “sunset clauses,” which allow Iran to gradually resume advanced atomic activity.
“Today, I am waiving the application of certain nuclear sanctions, but only in order to secure our European allies’ agreement to fix the terrible flaws of the Iran nuclear deal,” Trump said.
“If at any time I judge that such an agreement is not within reach, I will withdraw from the deal immediately,” he added. “No one should doubt my word.”
The decision had been expected since earlier this week. Officials, congressional aides and outside administration advisers said had the president would likely extend the sanctions waivers, citing progress in amending U.S. legislation that governs Washington’s participation in the deal. One aspect of the law that Trump has particularly bristled at is having to give Iran a “thumbs up” every few months by acknowledging that it is meeting its nuclear requirements.
In his statement Friday, Trump said he remained open to revising the Iran Nuclear Agreement Review Act, or INARA. He said he would only sign it if an Iranian refusal to allow U.N. inspectors to visit sites triggered an automatic re-imposition of U.S. sanctions. He said Iran’s restraint on long-range ballistic missile programs also must be linked to sanctions relief.
Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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