In the Flu Battle, Hydration and Elevation May Be Your Best Weapons
January 13, 2018 by admin
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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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To Get Medicaid in Kentucky, Many Will Have to Work. Advocates for the Poor Are Horrified.
January 13, 2018 by admin
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Roughly 500,000 adults have joined Kentucky’s Medicaid rolls since the state expanded the program under the Affordable Care Act in 2014. Mr. Bevin has consistently attacked the expansion as a waste of money, questioning why “able-bodied” adults should be given free government health care that used to be largely limited to children, the elderly and the disabled.
He filed for federal permission to impose work requirements in 2016 — notably, instead of seeking to end the state’s Medicaid expansion altogether. And since then, more than a dozen other states have also sought work requirements or said they plan to. Several sought Medicaid work requirements during the Obama administration but were rebuffed.
The approval came just a day after the Trump administration gave states the O.K. to impose work or other “community engagement” requirements as a condition of getting Medicaid. According to the nonpartisan Kaiser Family Foundation, 60 percent of working-age Medicaid recipients who aren’t disabled already have full- or part-time jobs.
Under its plan, Kentucky will also require many adults who aren’t elderly or disabled to pay premiums of $1 to $15 a month, depending on their income. And it will disenroll people from Medicaid for up to six months if they fail to report changes in income or work status. Those who qualified for Medicaid under the Obamacare expansion will also have to “earn” dental and vision benefits, which they have been able to access freely until now, through activities like taking a financial literacy course or getting a GED.
The Bevin administration has estimated that the plan will result in 100,000 fewer Medicaid recipients after five years and save $2.4 billion, mostly in federal Medicaid funds. But Mr. Bevin couched the policy change as a moral rather than a fiscal decision, saying he did not care about the savings and saw it as an opportunity for Kentucky’s poor “not to be put into a dead-end entitlement trap but rather to be given a path forward and upward so they can do for themselves.”
Advocates for Medicaid beneficiaries said they disagreed with the Trump administration’s assertion, in approving Kentucky’s plan, that work requirements were consistent with the goals of Medicaid because work could improve people’s health.
“Considering that it will seriously harm over 100,000 Kentuckians, in violation of numerous provisions of Medicaid law, we are very seriously considering taking legal action — and as we analyze the meager legal rationale in the approval itself, it seems inevitable,” said Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for the poor.
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Emily Beauregard, the executive director of Kentucky Voices for Health, an advocacy group, said the state had provided little information about how it would make sure people were complying with work requirements, how exemptions would be determined and other details.
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“We’re anticipating Kentuckians by and large are going to be extremely confused and worried about what they’re going to face and whether or not they’ll continue to have coverage,” Ms. Beauregard said. “They’ll be looking to advocates and enrollment assisters and their providers for answers, and at this point we don’t have any.”
She added, “The idea that we are encouraging work and independence, then taking away the health care that makes people more employable and better able to function — none of this adds up to something that’s going to be good for Kentuckians or our economy.”
But Hal Heiner, Kentucky’s Education and Workforce Development secretary, said during Mr. Bevin’s news conference that there was “an abundance of jobs” available to Medicaid recipients, as well as resources to prepare them.
“We have the jobs, we have the tuition resources, we have the job coaches in our career centers all across the state,” he said, “and now we’ll be able to connect the dots.”
Other state officials said the state was building an IT system to track people’s compliance with the work and premium requirements and participation in activities, like taking the financial literacy course, that would earn them points toward dental and vision care. They did not, however, provide a cost estimate for building and maintaining the administrative infrastructure necessary to monitor compliance with the new requirements.
Kentucky’s uninsured population has dropped more than almost any other state’s under the Affordable Care Act, and several studies have found significantly increased access to primary care, preventive screenings and care for chronic conditions there since the Medicaid expansion. But the state’s population remains unhealthy overall, which Mr. Bevin pointed to as proof that the Medicaid expansion was not working.
“The idea that we should keep doing what we’re doing is an insult to the people of Kentucky,” he said.
Sheila Schuster, a longtime health care advocate in the state, said she saw it differently.
“The administration has their chicken-and-egg story completely wrong — they say people need to work to get healthy,” she said. “We all know that health is the foundation from which people go to school, go to work and keep their employment. So I’m afraid the administration is not only going backward, but doing it for completely the wrong reasons.”
Such opposing views were evident in comments people posted on Mr. Bevin’s Facebook page during his news conference, which was livestreamed there. “ABOUT TIME to get others to pull their weight!” one viewer in favor of the new requirements wrote.
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“I feel this is wrong,” another said. “Wouldn’t they not be in Medicaid if they could get a job?”
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