Laid Low by the Flu

By ANDREA DORFMAN

It comes in winter and is harder to dodge than a speeding snowball. This year the debilitating and sometimes deadly scourge of influenza is unusually virulent. So many people have taken to their bed with chills, aching muscles and fever that doctors are overwhelmed, offices are decimated, and some schools have temporarily shut their doors. Nearly 8,100 Americans, most of them elderly, are known to have died of flu and flu-related illnesses, and the figure is rising daily. The Centers for Disease Control has officially declared it an epidemic, the worst outbreak of flu in the U.S. in at least five years.

The first widespread cases of flu appeared in Montana, New Mexico and Utah in mid-December, slightly earlier than normal. Within weeks, the disease broke out in Texas, Mississippi and Georgia and then along the Eastern Seaboard. Says Dr. Margaret Tipple, an epidemiologist at the CDC: "At this point, it's virtually coast to coast."

In fact, it spans most of the northern hemisphere. From Britain to the Soviet Union, the flu has hit millions of Europeans, including Pope John Paul, Queen Elizabeth and Princess Diana. Britain was hit so badly that staff shortages and patient overloads forced hospitals to put off surgery that could wait. Several trials at London's Old Bailey had to be delayed.

The flu is hard to contain because it is highly contagious, comes in many varieties, and can originate almost anywhere. It has plagued humanity at least since 412 B.C., according to an account by the Greek physician Hippocrates. By far the most devastating flu season on record was in 1918-19, when some 20 million people worldwide -- including 500,000 in the U.S. -- died of the "Spanish flu."

Scientists first isolated a flu virus, named type A, in 1933 and subsequently found two other variants, now known as types B and C. Individual strains are named for the place where they are first identified. Most of this season's flu has been triggered by a nasty strain of influenza A, called A- Shanghai. A few cases of A-Taiwan and B-Yamagata (Japan) have also turned up.

The classic symptoms of flu, which begin to appear about 48 hours after exposure to the virus, include a sudden fever, chills, sore throat, headache, muscle pains, lethargy and a persistent dry cough. Although most of the symptoms subside after two to three days, victims remain contagious for an additional three or four days.

The virus spreads easily, traveling in droplets spewed into the air by sneezing and coughing or through contact with mucus on hands or objects. Transmission is faster in places with poor ventilation, such as rooms with closed windows, crowded classrooms, nursing homes and public transportation systems. On planes, where the air is continuously recirculated, just one flu- ridden passenger can infect all the rest.

) For most patients, a bout of flu means a few missed days of work or school. But for people 65 and over and for those who have chronic heart or respiratory problems, diabetes, asthma or weakened immune systems, the disease can easily be fatal. Less able to fend off infections, these individuals are more susceptible to bronchitis, pneumonia and, occasionally, kidney failure and heart attacks. In an average year, flu is a factor in about 20,000 deaths in the U.S. The majority of A-Shanghai victims have been elderly, and all 50 states have discovered outbreaks in nursing homes and other long-term-care facilities.

Flu shots are the best protection. Though a vaccine does not necessarily prevent the disease, it can lessen the severity. But designing the right vaccine is difficult because the viruses mutate, changing their chemical profile from year to year. Today's A-Shanghai may soon be supplanted by one that is substantially different. What is more, entirely new types of flu viruses appear every few years. Months before each flu season, scientists must guess which strains will be most active and then tailor a vaccine to combat them. Sometimes their forecast is wrong, and the vaccine is virtually useless. In 1976, for example, the anticipated swine-flu epidemic never materialized.

This year the vaccine seems to work, but not enough people have received it. Ordinarily, the CDC recommends the shots for senior citizens, nursing-home residents, people with AIDS, anyone who is susceptible to lung and heart ailments, and for health workers and others who deal with flu patients. This A-Shanghai strain is so virulent, however, that anyone who wants to avoid it should probably be inoculated.

With reporting by Don Winbush/Atlanta