This story appeared on page 14 of the Comments and Features section of The Guardian on 21 July 2009. Reporter: Emine Saner.
Rushing back to work after swine flu could be dangerous. Taking your time to recover is the best way to avoid complications.
Last week a friend of mine, Emma, a 31-year-old publisher, developed what she thought must be swine flu. She decided it wasn't any worse than a bout of flu she'd had before, and followed the NHS guidelines and stayed at home, waiting for it to pass.
"I took Monday, Tuesday and Wednesday off, and went back to work on Thursday," she says. "My boss took one look at me and said I looked as if I should be in hospital. I must have looked really ill, because I noticed other colleagues giving me looks of horror. I thought I was getting better – I thought I had shaken it off and was over the worst of it. I didn't feel completely well, but I thought it was nothing a couple of nights' sleep couldn't fix."
She was sent home, but decided to go back into work the following Monday – only to be sent home again. "The problem for me is it seems to come in waves. You think you're over it, then I start to feel like I have a fever again. The office environment can make symptoms feel worse as well – the lighting made my headaches worse, and the dry, air-conditioned air made me cough. I suppose we live in a culture where work is all-important – I've never taken two weeks off for sickness before, and I feel slightly aghast at it. It feels like a bad thing to do."
When Emma finally went to see her GP, she was told it was too late to start taking Tamiflu, but was "prescribed" rest. "That's what I've been doing, but rest seems to be very underrated as a medicine," she says. "We are so used to being able to fix things with drugs."
Whether it is because the outbreak of swine flu has coincided with economic meltdown and fear for our jobs, or whether it's because we live in a society where our lives are so relentless that we're just not used to taking time off, anecdotal evidence suggests many of us are forcing ourselves back to work too soon. It is now estimated that up to half of the UK's workforce could need to take time off work at some stage because of swine flu, and the government is considering plans to allow anyone infected with swine flu to stay off work for 14 days without the need for a doctor's note (a week more than the current seven days they are allowed without a note). "We don't want people to feel obliged to leave the home or return to work when they are still unwell or put an unnecessary burden on GPs in a pandemic," said a department of health spokesman.
"The primary danger of going back to work too soon is infecting other people, particularly people who may be susceptible to swine flu," says Ann Robinson, a GP. According to the Health Protection Agency, people are most infectious to others soon after their symptoms appear, and continue to be for around five days as the symptoms subside.
"After a week, you'd be unlikely to be contagious. But if you push yourself with any viral infection, there is the possibility of developing something nastier such as pneumonia. It's the same reason you shouldn't go for a six-mile run while you're ill – your body has enough to cope with."
Physical over-exertion seems to be one of the main factors in prolonging illness, says Robinson, so it largely depends what your job is. "Going back to work in an office and sitting at a desk won't affect you as much as if you're a gardener and you spend all day digging and lifting heavy loads, for instance. The vast majority of people get over the vast majority of viruses in about a week, though there are some, such as glandular fever, which linger longer. It also depends on your immune system. Listen to your body – if you're still running a fever, coughing up green muck and feel nauseous at the thought of getting on the train or bus, don't go into work." You should rest, she says, but not lie in bed for days, particularly if you are obese or smoke as even two or three days in bed can put you at risk of developing a thrombosis – take it easy at home, she says, but get up and about.
There isn't any evidence, so far, that swine flu hits people harder than any other form of flu, despite news of a study published in the science journal Nature last week. Experiments on the effects of swine flu on animals at the University of Wisconsin showed that the virus was able to penetrate the lungs to a deeper level and caused greater respiratory damage than other forms of flu, and could be more likely to cause pneumonia. Professor Ian Jones, an expert in virology at the University of Reading, says it doesn't automatically follow that swine flu is any harder to get over than current seasonal flu – he points out that these experiments were performed on animals that were given a far higher dosage of flu than a human would usually catch from another person.
"If we say this flu is three or five times worse than current seasonal flu, what does that mean? Current seasonal flu tends to be quite wimpy, but Spanish flu [the outbreak in 1918 which killed an estimated 50 million people] was considered to be 1,000 times worse, so compared with that, swine flu doesn't look too bad. The evidence so far is that it tends to be mild and over fairly quickly."
However, as with any viral infection, there could be longer-lasting health problems. It is thought that chronic fatigue syndrome, also known as myalgic encephalopathy (ME), can be triggered by viruses, including flu. The symptoms of ME can range from tiredness and recurrent mild illnesses to debilitating conditions that can affect every area of a person's life.
"The causes of chronic fatigue syndrome and ME are unknown but it is accepted that a common triggering factor is acute viral illnesses and or stress," says Professor Leslie Findley, a consultant neurologist who specialises in chronic fatigue syndrome. "It is possible that swine flu could trigger chronic fatigue syndrome in people who are vulnerable to it, and exacerbate symptoms in people who already have chronic fatigue syndrome." But Findley stresses that any viral illness can trigger it, "and we have no evidence that swine flu will be any worse, so you have to keep it in context".
Dr Charles Shepherd, medical adviser at the ME Association, says: "I am comparing swine flu to ‘ordinary' flu here, and some people do report that flu was their trigger, but I should say that it doesn't tend to be a major trigger. Most fit adults get over flu and are perfectly healthy. But if there is going to be a major outbreak, some people are going to have post-viral symptoms and may go on to develop ME. So listen to your body. Anyone who still feels under the weather two weeks on should consult their doctor to see if they have got post-viral syndrome coming on. It is important to get appropriate management early on."
There is no drug treatment, but people should take adequate time to rest and recuperate. "We do know that people who force themselves back to work too early seem to be the ones who go on to develop long-term problems."
How to get better quicker
A GP's top tips for recuperating well
• Once you are feeling over the worst, go for a gentle walk to get some fresh air. But don't over-exercise, and go back to it gradually.
• Don't panic if you don't feel like eating. Try to eat small meals, often. This is better than going from no food to bingeing. It sounds obvious, but eat healthy food (below)
• There's really no evidence that supplements boost the immune system, so don't waste your money. Also, don't listen to the scaremongers – the odds are you will be back to normal within a week or so.
• Get enough sleep – between eight and 10 hours a day, if possible.
• Try to avoid crowds – you don't want to pick up another bug on the rebound, which is what can happen.
• Moderate your alcohol intake. It's not so much the alcohol itself – although drinking too much does put your body under strain – it's the behaviour that goes with it, such as staying out late, not eating properly and being in crowds.
Dr Ann Robinson