8 ms·

How Does the Flu Kill People?

154 points by digital55 9y ago

gadders 9y ago
I've often wondered this. Interesting article.
simonswords82 9y ago
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.
- justboxing 9y ago
  Thanks for the TL;DR. I always wondered about this phenomena - People dying from flu.
- nkrumm 9y ago
  > 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://heart.bmj.com/content/101/21/1738 http://www.sciencedirect.com/science/article/pii/S1473309909702336 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
lkrubner 9y ago
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?
- duozerk 9y ago
  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=PA111 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.
  - lkrubner 9y ago
    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.
    - duozerk 9y ago
FreeFull 9y ago
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.
- arkades 9y ago
  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.
- dghughes 9y ago
  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).
tomohawk 9y ago
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.
- js2 9y ago
  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. :(
- mindlar 9y ago
  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.
  - walshemj 9y ago
    And people had had less food than normal Germany especially had major food shortages.
- taneq 9y ago
  > 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 https://en.wikipedia.org/wiki/Cytokine_storm
toomanybeersies 9y ago
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.
- jcadam 9y ago
  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
- baddox 9y ago
  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.
  - caf 9y ago
    Opiates are cough suppressants.. which is also why in large enough doses, they're breathing suppressants.
EngineerBetter 9y ago
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.
- adventured 9y ago
  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).
- toomanybeersies 9y ago
  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.
  - nitwit005 9y ago
    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.
- cgag 9y ago
  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.
rubicon33 9y ago
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.
- forgotpassagan 9y ago
  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.
  - rubicon33 9y ago
    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.
    - dmoy 9y ago
      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.
      - forgotpassagan 9y ago
caf 9y ago
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.
deleted 9y ago
[deleted]

154 points by digital55 9y ago

I've often wondered this. Interesting article.

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.

justboxing 9y ago
Thanks for the TL;DR. I always wondered about this phenomena - People dying from flu.
nkrumm 9y ago
> 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://heart.bmj.com/content/101/21/1738 http://www.sciencedirect.com/science/article/pii/S1473309909702336 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

lkrubner 9y ago

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?

duozerk 9y ago
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=PA111 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.
- lkrubner 9y ago
  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.
  - duozerk 9y ago

FreeFull 9y ago

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.

arkades 9y ago
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.
dghughes 9y ago
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).

tomohawk 9y ago

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.

js2 9y ago
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. :(
mindlar 9y ago
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.
- walshemj 9y ago
  And people had had less food than normal Germany especially had major food shortages.
taneq 9y ago
> 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 https://en.wikipedia.org/wiki/Cytokine_storm

toomanybeersies 9y ago

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.

jcadam 9y ago
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
baddox 9y ago
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.
- caf 9y ago
  Opiates are cough suppressants.. which is also why in large enough doses, they're breathing suppressants.

EngineerBetter 9y ago

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.

adventured 9y ago
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).
toomanybeersies 9y ago
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.
- nitwit005 9y ago
  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.
cgag 9y ago
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.

rubicon33 9y ago

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.

forgotpassagan 9y ago
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.
- rubicon33 9y ago
  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.
  - dmoy 9y ago
    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.
    - forgotpassagan 9y ago

caf 9y ago

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.

deleted 9y ago

[deleted]