The Swine Flu

©James Whittle. All rights reserved.


Note: The following article was written many years ago when the Swine flu was a potential threat. Now that the world has experienced a global pandemic with Covid, we can look back with a better understanding for how to handle a future pandemic should one arise. Some of the primary benefits of the Chinese medicine approach is that it focuses on prevention, treats the whole person, and attempts to inspire people to achieve lasting health. So with that said, enjoy these thoughts about the Swine that can now be taken with a grain of salt…


Note: At the Blue Ridge Acupuncture Clinic in Asheville, North Carolina, we treat many viral conditions. Typically if a patient comes in right at the beginning of a cold or flu, that is, at the moment they begin to feel symptoms, then acupuncture and herbal medicine can shorten the duration of the illness by half.

Helping you think outside the box on Swine flu.

While the swine flu is making headlines and is on our minds it is a good time to clarify some issues around immunity and what immunity means. The medical field of immunology is vast but we will touch on some common points. The typical general definition of immunity is:

1) The condition in which an organism can resist disease. Or:
2) A medical term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion.

The term immunity is also used specifically as in when someone has the mumps or measles and then becomes immune to getting them again. This happens because when the virus (the antigen) invades the body and replicates, the body has to create specific antibodies for it. Then later, if a person is exposed again and the virus begins to replicate, the antibodies mount a swift response and a person usually will not get sick. So being immune also means having specific antibodies for a specific antigen.

A flu shot or flu vaccine is designed to introduce a viral strain into the body (the virus is dead). Your immune system then creates specific antibodies for it so that if you are exposed to the living virus during the flu season, your body will quickly defeat it. This is the goal anyway.

It is important to understand that the majority of symptoms a person produces when fighting the flu, such as fever, cough, stuffy nose etc., are due to the body’s own immune response and reaction to the virus.

Some people report getting flu symptoms after receiving the flu shot. Even though the virus is dead, their bodies create a strong immune reaction against it and they get symptoms. After exposure to virus via the flu shot, their bodies will have created antibodies to that specific strain of influenza. So if later during flu season they are exposed to that specific virus, they will have the correct antibodies and ideally they will quickly eliminate the virus without the side affects of their own immune system: symptoms. When you do have antibodies to something and you get exposed, your body typically handles that exposure effectively and efficiently: antibodies are the reason that you only get the mumps or the measles once as we mentioned before.

Of course there are exceptions this situation, I have met people who have had the chicken pox more than once for instance.
As you might know, the problem with swine flu is that no one has antibodies to it (except some people exposed to live pigs), so there is no flu shot for it and no vaccine. This is the same situation that occurs in any possible pandemic. No one had antibodies for SARS, so there was lots of worry about it, but luckily it petered out. Much of this remaining fear does come from real experience with the flu of 1918 during which time millions of people did die.

The belief of most scientists is that since you do not have antibodies to the swine flu, you have a very strong chance the virus will replicate quickly inside you if you are exposed. In other words, some scientists say that the state of your immune system does not really matter, without antibodies, if you are exposed, the virus will replicate inside you and you will get sick.

But in many cases, people who are exposed, even if they do not have antibodies, do not get sick. In many of these cases it may be that the virus simply did not make it into their mucous membranes. Perhaps they washed their hands well after exposure. But there are also cases where the virus gets into the body but does not replicate, even when a person has not produced antibodies.

Most of us would say that the person who did not get sick in this case had a strong immune system. But much information out there would make you think that a strong immune system is detrimental in some flu outbreaks. They point to the fact that often a strong immune response is what kills a person when they get the flu.

To quote a health expert:

“The term that is used when the immune system over-reacts is called a Cytokine Storm. It is usually fatal. During this Storm over 150 inflammatory mediators are released. This would account for the high mortality rate from influenza in 1918-19.”

This could lead one to believe that having a healthy immune system would be of no benefit in either fending off the flu, or in protecting one against it once it is contracted. Or you might think, based on this understanding, that a strong immune system would be a detriment after one contacted the flu, after all if it is a strong immune response killing someone, wouldn’t I want my immune response to be docile and weak?

But what is important in the quote above is that the immune system is over-reacting. Is an overactive immune reaction a strong or healthy immune reaction? Mostly no. Consider an autoimmune disease like multiple scleroses. In MS, the immune system is fighting tissue in the body. The immune system is malfunctioning. The way MS and other autoimmune diseases are often treated is by being given drugs to down-regulate or weaken the system. So we can see that the immune system is self-regulating when functioning well, and that a healthy or strong immune system is one that can get appropriately reactive and strong or appropriately slow down depending on the circumstances.

The fact that in Mexico many 25-40 year olds have died from swine flu should not indicate that a strong immune response is detrimental, it should point to the fact that the immune system can often over react. But again over reaction does not mean a smart or healthy immune response. Consider that many 25-40 year olds contract the illness but survive. And many are exposed but do not get sick at all.

Have you ever had a cold sore? If so, that means you have the herpes simplex virus living inside your body. When your immune system is weak, periodically, you get an outbreak. Normally the virus lies dormant. Some people however get one cold sore and they never appear again.

The take home point is that you want your immune system to function in a balanced way, in a smart way. Having a strong immune system is perhaps the wrong way to describe this. Perhaps having a balanced immune system is more appropriate.

Now back to the fact that some people without antibodies who are exposed do not get sick. If ten people are exposed to the same virus, not all of them will experience it in the same way. Chinese medicine has for thousands of years observed what creates health and wellness in the body. Chinese medicine focuses on creating balance within the system and studies why healthy people do not get sick. The Chinese view is that if someone gets ill, they must have been imbalanced to start with. People in a state of total wellness do not get sick. Of course this is a high ideal, many of us do get sick from time to time, but some people in a peak state of balance rarely if ever get ill. Again this does not mean their immune system is strong, as we know now over-reactive immune systems can often be just as hazardous as under-active ones.

To understand this holistic viewpoint we need to understand the immune system in a more comprehensive way. Chinese medicine offers a very elegant way of understanding the concept of immunity that is holistic and by integrating that understanding with what we know from western medicine we get a more inclusive perspective. Whereas western medicine focuses on the biology and biochemistry of immunity and is quantitative breaking things down into their parts, Chinese medicine focuses on the energetic and the qualitative and seeks to understand the totality of events and simultaneous functioning of a person in a most balanced state. Chinese medicine, for thousands of years has focused on radical wellness and keeping people healthy.

Both western medicine and Chinese medicine are extremely valuable ways for understanding human health. In my mind, neither one is necessarily better than the other, they are different and have their own sets of strengths and weaknesses.

In Chinese medicine we have the concept of Wei Qi or defensive energy. In this view the idea of immunity is more than just the biochemical components of the immune system such as T-cells or NK cells, it is the entire regulating protective event that keeps one disease free and in a balanced state. The idea is that the defensive energy of the body is composed of many things working synergistically to protect one against pathogens and to handle them smartly and efficiently if exposed. Wei qi is an energetic concept. The idea is that we literally have an energetic field that defends and regulates our bodies. When this energy field is weak we are more susceptible to infection. When it is strong, we are radiant and healthy. Though is has not been scientifically proven but only understood and perceived means we will have to wait until a more comprehensive theory of energy medicine emerges. Many intelligent scientists who discuss the energetic view of immunity include concepts like electromagnetic energy (the heart’s electromagnetic field is 1000 times stronger than the brains and can be measured 25 feet from the body), phonon energy (sounds waves and vibrations emitted from the body), or the energy of light waves (photons have been measured being emitted from the hands of healers).

So the concept of Wei Qi energy means that how you feel emotionally does play a role in your immune response. In fact the whole field of psycho-neuroimmunology has proven that the mind dramatically affects the body’s ability to heal. This means that thoughts (an energy form) radically affect the body ( a more dense energy form.) In an earlier newsletter I discussed the work of Norman Cousins who discovered that the body’s immune system could become 500% more efficient after 5 minutes of feeling genuinely joyful.

A comprehensive concept of immunity includes not only things like antibodies or the specific biology of immune reactions nor eating well and drinking lots of water, it also includes eliminating negative thoughts and feeling joyful. So in addition to the sage advice you will read below on the swine flu, please consider the Chinese view as well and stay stress free, happy and joyful, by doing so your Wei Qi will be strong and vigorous and you wont get sick in the first place.

So what do I recommend to prevent the swine flu? In addition to all the public health recommendations of experts that you will see below, I recommend acupuncture. Acupuncture regulates and balances the immune system and helps the body to act in a most efficient way. Acupuncture strengthens your Wei Qi or defensive energy and puts you in a state of optimal wellness, a state most resistant to disease. I also recommend being prepared with specific anti viral Chinese herbal medicines and recommend herbs that balance and optimize your general immunity.

More things to consider about swine flu:

Many people are panicking about Swine flu, but let’s keep it in perspective. As of late Thursday, there are 236 cases of swine flu and eight confirmed deaths worldwide. By comparison an estimated 600 people die of tuberculosis yearly, about 1,400 people die from strep and 2,704 people die from a common asbestos-related lung cancer in the United States every year.

Last year the seasonal flu took the lives of 83 children and an estimated 36,000 adults in the United States, according to the CDC.

Of course, pandemics can be deadly and need public health measures. The 1918-1919 influenza pandemic killed more people than the entire First World War. Estimates range from 30-50 million lives lost, according to the U.S. Department of Health and Human Services.
But in every flu pandemic since, the numbers have luckily dwindled. The 1957-1958 pandemic flu took 70,000 deaths above the normal flu season, and the 1968-1967 pandemic flu caused 33,000 more deaths than the average flu season. The virulence of the virus does matter, but public health measures can clearly make a huge difference.

When SARS was first encountered in 2003, there was a global panic, but the disease was quickly controlled.

The following information is reprinted from some of the best that I have found on the internet. The perspective is western medical and the notes accompanying some of the answers are my own.

Health Experts Answer Swine Flu Questions?

With more outbreaks of the new strain of swine flu come outbreaks of misinformation and rumor. Below are 20 questions answered by infectious disease expert Charles Ericsson, M.D., professor of internal medicine and director of Travel Medicine at The University of Texas Medical School at Houston.

Also, Robert Emery, vice president for Safety, Health, Environment & Risk Management at UT Health Science Center and associate professor in the UT School of Public Health explain common sense preparedness and prevention of illness.

1. How do symptoms of swine flu differ from other types of flu?
None, really, although this flu might include gastrointestinal symptoms (diarrhea and vomiting), as well as the usual respiratory symptoms. The basic symptoms for swine flu are similar to the seasonal flu which may include:
*Fever (greater than 100°F or 37.8°C)
*Sore throat
*Stuffy nose
*Headache and body aches

2. If I felt flu-like, how would I know if I had swine flu?
You wouldn’t really, nor would your physician know for sure without a respiratory specimen taken within the first 4-5 days. The specimen would then be sent to the US Centers for Disease Control and Prevention (CDC).
The cases so far in the US have been relatively mild compared to the illness described in patients in Mexico. We do not yet know why the US cases have been milder.
The important point is to call your doctor if you think you have the flu. Prescription anti-viral drugs such as TamiFlu or Relenza can be called in by your doctor. Unless you are:
*exceptionally ill with flu-like symptoms
*are chronically ill
*quite elderly
*or have a very young child, under age 2
It is best not to report to the hospital, clinic or doctor’s office, where you could risk spreading the disease. Again, call your doctor first to get instructions as to what you need to do next.

3. How long are people contagious?
Adults are potentially contagious for the length of time one has symptoms, up to 7 days following the beginning of illness. The shedding stage of the virus is during the first 4-5 days of illness. Children can be considered contagious longer, up to 10 days. The initial incubation period is 24-48 hours.

4. Is there medication for this?
Yes, Tamiflu or Relenza have shown to be effective against these recently reported strains of swine flu. Altogether, there are four anti-viral drugs that we commonly use to treat various strains of flu.
(Note: Chinese medicine can also be used in conjunction with these antivirals to make them work more efficiently. Acupuncture is also very helpful for balancing an over reactive immune system or stimulating a weak one)

5. Can I start taking medicine for it now, just in case I get it later?
That is not presently advised. Preventative medication might be advised for very special circumstances where a person had to expose themselves to potentially ill people during an epidemic (which we do not yet have here). Such people might include ER workers. An outbreak in a nursing home, for instance, might lead to protecting all the other residents with a drug like TamiFlu.
For the general public, the current answer is no to prophylactic (preventative) use with anti-viral medications. Its coverage time is limited.
Do not confuse over-the-counter cold and flu preparations for anti-flu medications that require a prescription.
(Note: But what you can do now is focus on prevention. Again most docs believe that if you don’t have the antibodies you will get the disease if exposed, this leads them not to mention being balanced or having a balanced immune system. However prevention can also mean being stress free and joyful, getting exercise and eating well, hydrating well, taking specific herbs and getting acupuncture)

6. Are the symptoms in children different from adult symptoms?
Though the basic symptoms are similar, the signs of potentially life-threatening complications differ.
The CDC advises those with these symptoms to seek emergency care immediately:
Emergency warning signs in children are:
*Fast breathing or trouble breathing
*Bluish skin color
*Not drinking enough fluids
*Not waking up or interacting
*Being very irritable
*Fever with a rash
Emergency warning signs in adults are:
*Difficulty breathing or shortness of breath
*Pain or pressure in the chest or abdomen
*Sudden dizziness
*Severe or persistent vomiting

7. Is there a vaccine?
Not yet, but the CDC has this current strain of virus and will consider whether to add it to next year’s flu vaccine as time goes on.

8. If I took the swine flu vaccine in the swine flu scare during the 70s, would that cover me? What about this year’s flu shot I just took?
We don’t know yet. Previous vaccines could be expected to afford only partial, incomplete protection at best.
This new strain of the swine flu virus (H1N1) actually has a mixture of swine and avian components (not to be confused with the deadly avian flu of Southeast Asia).

9. Can I catch it from pigs?
No. This strain is one that is communicable through human-to-human contact. It is a mutated form of a swine virus.

10. Can I catch it from eating pork?
Absolutely not! Swine flu is not transmitted by food. It is not a so-called foodborne illness. Bacon, ham and other pork products are safe to eat, assuming they are prepared properly. An internal temperature of 160 degrees for cooked meat will kill any bacteria or virus.
Swine flu is transmitted by airborne droplets from an infected persons sneeze or cough; or from germs on hands, or germ-laden surfaces. Eating pork will not give you swine flu any more than eating chicken will give you bird flu.

11. How does it cross from a pig to a human?
The swine virus mutates so that it can infect humans and be spread by humans.

12. Can it kill me?
Deaths have been reported from the Mexico City outbreak. So far the cases in the US have been mild and there have been no deaths as of this writing (Monday, April 27) We do not know all the factors geographically and demographically that may contribute to the mildness or severity of this flu.
But, like seasonal flu, there is the potential for serious outcomes.

13. Why the big concern if the regular flu kills 35,000 people a year, which is why we are all encouraged to get a flu shot?
This is a new flu strain that our bodies have not been exposed to before. The flu strains that the CDC creates a vaccine for each year all have the potential to cause great harm, especially in elderly, pediatric and chronically ill patients. This particular flu strain has struck seemingly healthy, young adults, with some resulting in death in Mexico. It also appears to be quite contagious. We will know more about this strain in the coming days.

14. How is it different from avian (bird) flu?
Avian flu so far has had difficulty infecting humans unless they are exposed intensely to birds, because the virus has not mutated in a way that makes it transmissible by humans to other humans. This virus has origins genetically from both pigs and birds, and the big difference from the avian flu is that this swine virus can be transmitted readily from human to human.

15. Is this just another scare that will go away like bird flu?
Bird flu is a theoretical threat and will need a mutation to be able to be transmitted among humans to become a serious threat. The present “swine/avian” virus clearly has already caused a major outbreak in Mexico City and San Luis Potosi, Mexico and has spread to places in the US (California, New York, Texas, Kansas and Ohio). What is not clear yet is whether this virus will result in a so-called pandemic worldwide spread with major outbreaks–or whether it will fizzle out. But, even if it fizzles out, there is logical concern that it might re-emerge next flu season.

16. Should I cancel my vacation to Mexico?
At this writing, the situation is very fluid, changeable. I suggest checking frequently with the CDC Web site for possible Travel Alerts. I probably would not travel to Mexico City for a vacation that could easily be rescheduled, if for no other reason than the city has tried to limit access to crowded or public places where transmission might be facilitated. That does not sound like a very pleasant vacation to me!
Having said that, there are more than 4,000 flights to Mexico from the US and none have been cancelled as of this writing. However, some international airports in Europe and Asia are stepping up precautions and issuing alerts. Again, check the CDCs Travel Alerts page.

17. What if I’m on a plane? Should I wear a mask?
Not necessary. The air on a plane is filtered. Transmission might occur if someone sitting close to you coughs or sneezes on you. The newer designs of aircraft airflow keep the air in a top-down flow, not forced air from front to back. However, if you do have a respiratory illness, it might be best not to travel.

18. How long does the germ live on surfaces, like on my desk if someone sneezes in my office?
Influenza virus survives only minutes on inanimate objects or hands, so these are very inefficient ways to spread the illness. Influenza is most easily spread by droplets that come into contact with our mucus membranes such as when someone coughs or sneezes in our faces. If we shake hands with an infected person who has just wiped their nose and then we rather quickly rub our nose or eyes with our own hand, then we could get the flu. So, good hand washing does play a role in diminishing the spread of the disease.

19. Other than hand washing and covering my mouth if I sneeze or cough, what can I do to take care of myself and others?
If you are ill, stay home. Control your sneezes and coughs. If you cough into your hand, remember the virus could be live on your hand at least for a few minutes, so wash your hands before touching anyone else. If you get symptoms suggesting the flu, call your doctor, who can call in a prescription for medication to treat the flu. Resist going to the doctors office or a hospital ER for influenza symptoms unless you are seriously ill. You do not want to spread the disease to others.

20. What else can I do?
Keep in touch with the most recent CDC messages through the following links:

Go to the sources of verifiable information such as WHO (World Health Organization) or the CDC.

Most important, be alert, not panicked.

There is a huge difference between preparedness and paranoia, says Dr. Robert Emery, occupational health expert at the UT School of Public Health at Houston. Although we’re dealing with a new strain of flu, a set of universally applicable preventive measures exist that can be employed right away by everyone to help stop the spread of this disease
Proper hand hygiene:

How to wash your hands:

There’s a right way and useless way to wash hands and wash away micro-organisms. The object is to break down the protective membranes of germs, dislodge them from your hands and let them go down the drain. Plain soap in the right hands is strong stuff.
*Lather well with a bar of soap or squirt a coin size of liquid soap in the palm of your hand.

*Vigorously rub your hands together, soap up between your fingers, AND your wrists, front and back for 15 seconds. Sing the first chorus of any song you know and that will take you through the 15 seconds.

*Rinse under warm, RUNNING water. Remember, the object is to dislodge germs. The force of water is key.

*Dry thoroughly your hands with a disposable towel or under the blower, again, rubbing your hands together.

*Discard the towel.

If you’re using alcohol-based gels as hand cleansers:
Put a dime-sized amount in one hand:

*Vigorously rub your hands together and in between your fingers until the GEL IS DRY, about 30 seconds.

*DO NOT touch your face!

Once your hands are clean, do not touch your face, nose, eyes or lips.

Rubbing your eyes and nose provides a freeway for micro-organisms and good breeding ground once they’ve arrived.

Cover your cough

If you must cough or sneeze, cover your mouth with a tissue, your sleeve or your hand.
Throw the tissue away in a waste basket. Do not leave discarded tissues on your desk or other surfaces.

Then, wash you hands thoroughly.

The throw-it-away part is essential.

Micro-organisms live a life span from a few seconds to days on inanimate surfaces such as desks, table tops, faucets, tissues. If your tissues are scattered on your coffee table, they then are in contact with community surfaces. Both the tissues and the surface it sits on can spread germs to the person who touches the coffee table.

If you begin to feel ill: feverish, achy, have a dry, painful cough, sore throat, go home from school or work and call your health care provider for further instructions.
If you feel sick with flu-like symptoms and you care for the very young or the very elderly or the chronically ill, inform your health care provider when you call their office.
If you have recently traveled to Mexico or to one of the areas worldwide that has reported a swine flu outbreak, inform your health care provider. He or she may prefer to treat you with prescription anti-viral medications from home, or may request that you come in for a visit. Follow instructions from your health care providers.

The Flu of 1918:

In large U.S cities, more than 10,000 deaths per week were attributed to the virus. It is estimated that as many as 50% of the population was infected, and ~1% died. To compare, in “normal” (interpandemic) years, it is estimated that between 10-20% of the population is infected, with a .008% mortality.

The fact the current ‘swine flu’ has shown to be contagious is alarming. So far the virus has shown to have a 6% to 6.3% mortality rate. It may not seem like much, but please consider the following: The deadly influenza panic in 1918 had a mortality rate of under 1%.

This virus went on to kill tens of thousands of healthy people a day in large cities and up to 100 million people world wide.

Viruses, like this strain of swine flu, kill their host by over-stimulating active immune systems that are robust and healthy. That is why the victims in Mexico were between the ages of 20 and 45.

Some have said that no one in the United States have died from the virus, so we need not worry. Experts say it is only a matter of time. The virus is not prevalent enough to reach statistical significance in the United States, with only a handful of confirmed cases. 93.7% of all Mexicans with the virus recovered.

More cause for worry: The 1918 virus started off ‘mild’ before it mutated into a raging storm. It also does not mean we will see millions of deaths. It is too early to draw sweeping conclusions. Nevertheless, there is potential for a disastrous pandemic. If 50% of Americans catch this flu in the next two years, and the mortality rate stays at 6.3%, we would witness 20+ million deaths.

This strain of virus is more potent and more deadly than the virus that hammered the world in 1918 and 1919. Viruses come in waves. There are striking similarities to this virus and the virus that killed up to 100 million people in 1918. The first wave is historically more mild than the later waves.

In addition to this virus becoming more severe, it is mutating faster than previous virus that we have seen. In addition, this virus is nothing like we have ever seen before because it combines features from viruses natural in different parts of the globe. We are in uncharted territory.

If it follows the same path as the 1918 flu, we will see very damaging results. However, we must remember we are a global society now and the virus can spread quicker than we have ever witnessed in history. This is very concerning especially since the drugs we have now seem resistant.

While there have been no deaths in America, it is shadowed by the fact the common variable among the deaths seem to be age. While most American cases have involved the very young and very old (under 10 and over 50) the Mexican cases that ended fatally involved the robust and healthy (over 20 and under 45).

This virus kills the host by over-stimulating the immune system. The term that is used when the immune system over reacts is called a Cytokine Storm. It is usually fatal. During this Storm over 150 inflammatory mediators are released. This would account for the high mortality rate in 1918-19.

Reach James Whittle M.S. L.Ac. Acupuncture in Asheville

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