The Flu - Symptoms, Conventional Treatment and Alternative Approaches
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Sep 14, 2024
- 14 min read
Updated: Jun 28
It's summer. The flu is still here: It is still out there and always will be. As healthcare providers, many of us used the CDC's surveillance to track the spread of illness in various counties and states throughout the United States. Their service has been much appreciated because it has helped us diagnose and treat our patients.
At this time, it is difficult to determine the actual flu distribution in the United States because the CDC is undergoing changes. As of 2025, the current administration has requested that the CDC limit surveillance and publications regarding the spread of some of these diseases. Never assume the flu is not out there. There is still a CDC map available of estimated influenza cases in the United States (see the following link):
The Flu – Symptoms, Conventional Treatment, and Alternative Approaches
The flu hits hard and fast, often leaving people saying, “It feels like I’ve been hit by a truck." It is caused by a virus, so antibiotics do not work as a treatment. Symptoms can range from unpleasant to downright debilitating, often taking a person down for several days. It’s usually easy to recognize—but since the emergence of COVID and RSV, diagnosis can be more complicated.
, Flu symptoms tend to strike suddenly and may include
Symptoms
HIGH FEVER
HACKY OR WET COUGH
WEAKNESS
EXTREME FATIGUE
DECREASED APETITE
WATERY NASAL DRAINAGE
HEADACHE
HORRIBLE BODY ACHES AND CHILLS
FREQUENT SNIFFLES
Often, a person has - or has had - a sore throat, sneezing, maybe red or burning eyes, and sometimes stomach symptoms like nausea, vomiting, diarrhea, and stomach pain. Remember, however, that these symptoms can also indicate other illnesses, like COVID-19, RSV, or even plain old colds symptoms from rhinovirus or adenovirus. The only way to know for sure if it's the flu, COVID-19, or RSV is to get tested.
The best way to deal with the flu is not to get it in the first place. There are several conventional and alternative ways to prevent it (see below).
When Should I Go to the Doctor if I Think I Have the Flu?
Wondering when you should I go to your Doctor if you think you have the flu? We will never make that decision for you, but we can give you some good pointers. Consider the flu – symptoms, conventional treatment, and alternative approaches. There are several situations where it may be important to see a healthcare provider if you suspect the flu:
1) If you feel severely ill.
2) If you have underlying risk factors like heart disease, older age, diabetes, or an immune disorder (see below).
3) If you live with someone with any of the above risk factors, they can catch this from you.
4) If it has been 48 hours or less since you became ill, and, want antiviral treatment.
4) If you need a note for work.
Still trying to figure out what to do? Ask yourself the following questions:
1) How Sick Am I?
Plenty of people get through the flu without antiviral medications by "toughing" it out and dealing with their symptoms because they don't have time or energy to go to a healthcare provider, medicine is costly, or because of a belief that "the less medicine, is better." But there are exceptions: Some people experience debilitating flu symptoms, especially if they become dehydrated. I have seen some strong, grown men wallow and pass out - at the mercy of influenza. If this type of thing occurs, if the fever does not come down after treatment or persists after several days, you cannot keep liquids down; if you develop confusion, shortness of breath, chest pain or pressure, or palpitations, it is best to go to an urgent care clinic or ER.
2) Consider the cost of a flu test and treatment
Clinic visit: $60 -$130.00 (retail walk-in clinics are usually the least expensive)
Flu test: $20 -$70.00
Flu medicine: $22-$45 (with coupon), $70-$100 (without coupon) for Tamiflu
These are estimates, but the cost of testing and treating the flu in most places could easily exceed $180.00. If you do not have insurance or have not met your deductible and have a high deductible plan, this might be spendy (the cost for this family would have been $540.00). For a person with insurance, the price would depend on your PCP copay and medication coverage (I had "good" insurance and still paid $30.00). If you have any doubts, call your insurance company and, if they put you on hold, put them on the speaker phone and go about your business until they pick up (there are never enough people working to answer the phone). When you do speak to someone, ask them if and where your flu visit is covered and what pharmacy covers the Tamiflu.
You can read all the comparisons you want, but flu and COVID-19 symptoms can be very similar. Even if you have had COVID-19 and it doesn't feel as bad as your first case, we are dealing with different variants here, and symptoms may not be the same.
Think about getting a flu and COVID test (to rule out COVID) at a retail pharmacy like a grocery store pharmacy, or a pharmacy like Walgreens or CVS (you usually have to make an appointment online).
The Flu-Treating Symptoms
Multi-symptom over-the-counter medicines for the flu
Whether you try Tamiflu or one of the other options, you will still, initially, need to treat your symptoms to make the flu bearable. While using a multi-symptom medication may be easiest, it is not always the wisest: You usually don't need all the components of these, and it can be counterproductive. Often, the smartest thing to do is to treat each symptom as it comes. The Case Against Multi-symptom Medications:
1. Risk of "overdose"- Many people take cold and flu medications AND, at the same time, acetaminophen (common: Tylenol) or ibuprofen (Common: Motrin, Advil) on the side. They do not realize that the multi-symptom medication almost always contains one of these as well, and they end up taking far more than the recommended or safe dose. While not typically fatal, this can be harmful to your kidneys (ibuprofen) or liver (acetaminophen). If you take a multi-symptom cold and flu medicine, READ YOUR LABELS before taking anything else! Be sure you are not duplicating medications.
2. Side effects of some medications - There are some ingredients in multi-symptom over-the-counter medications that you may not need. They can be counterproductive or cause side effects. For example, if you have a runny nose, the cold and flu medicine may help dry it up and make it more tolerable. But that cold and flu medicine can also make your mucus drier and thicker, and, if you are "lucky" enough, you might even end up with a sinus infection!
3. Symptoms change - Flu symptoms change over time. What may start as a dry, hacky cough and runny nose can become a productive cough, thicker sinus drainage, and ear pain. The medicine you use to treat symptoms at the beginning of your illness may not be what you need later because your symptoms change.
If you take a multi-symptom over-the-counter medicine, match it with your symptoms. I'd recommend Nyquil at bedtime (this is not an advertisement: It is one of the only multi-symptom medications I recommend because so many patients say it helps them sleep through their symptoms. Nighttime cold and flu products usually contain dextromethorphan (cough medicine), acetaminophen (fever and pain reducer), an antihistamine (to help with congestion and runny nose), and sometimes alcohol. Because of the drying agents in this medicine, you must stay well hydrated otherwise, your mucus can get very dry and tends to fester.
During the day, you can also take a multi-symptom daytime medication, like Dayquil, to match your symptoms. These contain similar medications to night-time preparations but are non-drowsy (decongestants instead of antihistamines).
If you decide to treat your symptoms individually
In general, use as directed over-the-counter
Acetaminophen (common: Tylenol) or ibuprofen (common: Motrin, Advil, Naproxen) for a fever and body aches
A decongestant to stop a drippy nose during the day
An antihistamine for the runny nose at night
A cough suppressant like plain dextromethorphan (common: Delsym, Robitussin)
and - as directed - but again, stay well hydrated. Use guaifenesin (Mucinex) if your mucus gets too thick (will almost always be like this in the morning). Note: links in blue (above) will provide further information about treating these symptoms.
According to the Mayo Clinic, people also NEED to get enough sleep to optimize recovery.
Hydration is also essential.
Natural and Herbal Remedies for Flu
Herbs have an advantage over conventional medicines in their preventive abilities and antiviral properties. In fact, Tamiflu comes from an old Chinese medicinal herb called star anise (not the American version often sold in grocery stores).
Some of these are available over the counter, some online. You may want to have some stashed in your cupboard to prepare for winter or just anytime. Various teas hold up well.
According to reviews, several good antiviral herbal products are on the market today (see below). If you begin to get a cold or have flu symptoms, taking something as
soon as possible is important: the sooner you start a supplement, the better it seems to work. The following are some recommendations (many are the same herbs and plants that may prevent and support flu symptoms). Many of these same herbs also help with colds (which are also due to viruses).
If you decide to take an herbal supplement, be sure to check for any medical
contraindications or interactions (check Drugs.com). Reminder: Pregnant people should check with their ob-gyn before taking herbal medicines.
Echinacea is one of the most studied herbs, especially in comparison to Tamiflu. It stimulates the immune system and has antiviral properties. Like Tamiflu, it can decrease the length and severity of flu symptoms as long as you start it within 5 days of onset. According to the NIH, the results may be comparable to Tamiflu's.
Pelargonium Sidoides - or Umckaloabo. This herb helps improve symptoms of the common cold and flu, among other upper respiratory disorders. It has antiviral and antimicrobial effects and is sold over the counter as UMKA.
Elderberry - (the shelf brand is Sambucol) - Reports and studies of the flu-fighting properties of elderberry are extensive because of its age-old antiviral effects. Reportedly, a case of the flu can sometimes be shortened by a couple of days if using elderberry. Because of its reported efficacy, Sambucol sells well in stores. It comes in many forms: Teas, syrups, extracts, lozenges. Elderberry also has some anti-influenza properties.
Andrographis paniculata is an anti-inflammatory, immunostimulant, antimicrobial, antiallergic, and antiviral. It comes in several forms: capsule and tincture, and it is reportedly helpful with flu symptoms.
Oscillococcinim - (Anas Barbariae Hepatis et Cordis Extractum or extract of Muscovy duck liver and heart). This has been a popular homeopathic remedy, easily found over the counter for flu treatment. It is one of those supplements with a fascinating history: It has been around for many years and gets some excellent user reviews. However, there is little evidence-based research in support (except that research was done by the company itself). It sells well during flu season. But...Duck liver?
Garlic - has been shown to help shorten the course of a cold or flu by enhancing immune function.
Goldenseal has antimicrobial, antiviral, and antifungal properties. Studies show that Goldenseal helps with flu and is quite popular for flu and cold symptoms. Combining some of these would have optimal efficacy. Examples of these combinations include Echinacea, Andrographis paniculata, and elderberry.
Ginseng stimulates the immune system. It is thought to have antiviral and antibiotic properties. It is used to prevent the flu and help treat symptoms. It comes in teas, elixirs, and capsules and can easily be found in many stores.
Astragulus - According to several sources, Astragalus boosts the immune system; it is an excellent antiviral, antimicrobial, and antifungal. It comes in capsule form, elixir, and tea.
Tulsi Tea (Holy Basil) originated as an Indian Ayurvedic medicine, which has been around for more than 3000 years. It has antimicrobial, antiviral, and antifungal properties. It has a widely acclaimed efficacy in prevention and potential treatment. It is widely available in stores as tea, capsules, and extracts. It is not the same as the basil you buy on the spice rack in the store or the Italian herb grown in your garden. The plant usually has the term "holy basil" included in it. Widely acclaimed for its many properties.
Prescriptive Treatment for Influenza
If you seek conventional flu treatment from a healthcare provider, it is essential to determine how long you have had symptoms. For the medicine to work well, you must be treated within 24-48 hours of developing symptoms. The sooner you get treated, the better off you will be.
The big benefit of taking oseltamivir (generic Tamiflu-antiviral medication) or Boloxavir (name brand Xofluza - a new $$$ flu medicine last year) is that it will reduce the length of your symptoms by a day or two. So, if you think you may have had the flu for more than 48 hours and you are not severely ill, your best treatment will be symptomatic. You may explore alternative remedies here or visit your friendly pharmacy if you do not see your doctor. In that case, pharmacists are typically VERY knowledgeable and helpful and can recommend the best over-the-counter medications to take while you have the flu. Sometimes, actual pharmacies will also do relatively inexpensive testing.
Anyone diagnosed with the flu with an underlying chronic illness (below) should consider getting treated with Tamiflu. If you have the flu and live with a person who has an underlying chronic disease, both of you should consider getting treated with Tamiflu. Tamiflu can also be prescribed preventively to those exposed to the flu. What makes a person "at risk"? The CDC cites the following conditions that put people at risk for developing complications of the flu:
Asthma
Neurological and neurodevelopmental conditions
Blood disorders (such as sickle cell disease)
Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
Those with endocrine disorders are at risk. In fact, those with diabetes have three times the risk of being hospitalized with the flu as nondiabetics.
Heart disease (such as congenital heart disease, congestive heart failure, and coronary artery disease)
Kidney disorders
Liver disorders
Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
People who are obese with a body mass index [BMI] of 40 or higher
People younger than 19 years of age on long-term aspirin therapy
People with a weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids or immunosuppressants)
Other People at High Risk From Complications of Flu Symptoms:
Adults 65 years and older
Children younger than five years old, but especially children younger than two years old
Pregnant women and women up to two weeks after the end of pregnancy
American Indians and Alaska Natives
People who live in nursing homes and other long-term care facilities
If in doubt, speak to a healthcare provider.
Deciding how to treat your flu is yet another "life in the fast lane" situation. A normally healthy person should be able and "allowed" to fight off symptoms, but obligations—like work, family, or school—do not allow that. Since Tamiflu decreases the symptoms and length of time, folks with the flu will choose the medicine route—the "quick fix" to get back to normal functioning as soon as possible if that is what is important to you. But no matter what, TAKE CARE OF YOURSELF!
Prevention
Should you get a flu shot?
Many people who come to our clinic ask me if they should get a flu vaccination. Here's what I recommend:
1) People who have a good chance of being exposed to the flu in the future, like teachers, travelers, healthcare providers, people who work with the public, and students
2) People who don't have time to be sick.
3) People who cannot afford to be sick
4) People with underlying medical problems or risk factors: Those who do not have a sound immune system and those with underlying medical conditions (for example, diabetes, lung conditions, heart conditions) who could become extremely ill if they get the flu.
Did the Flu Shot Really Make You Sick?
Some people do not want to get vaccinations because they do not believe or trust them. Some feel the flu shot made them sick. Those folks have had various side effects or feel that the vaccination actually gave them the flu (or they know someone who this has happened to). Most of the time, the flu shot does not make people sick. Consider these points: You may have been exposed to the flu before you got your flu shot. You may have been waiting at a pharmacy or your doctor's office for a flu shot, and there are a lot of sick people coming in and out of the area, sniffling and sneezing. The flu shot does not work for two weeks, so you catch the flu within that two-week period right after you get the vaccination! Occasionally, the creators of the vaccine have mismatched it to one of the strains of flu that's going around. Occasionally, it has been improperly stored, o it loses its efficacy, and sometimes a person's immune system just does not respond adequately, unable to make antibodies against the virus.
Occasionally, a person feels a little under the weather the day after a flu vaccination, but the question they need to ask themselves is, are those side effects as harmful as getting a full-blown flu? The flu can, and often does, make you a person pretty darned sick: People say "I feel like I have been hit by a bus. It can lay a person up for a week and easily spread from one person to another. The cough alone can last for weeks. If you did not have any problems with your flu shot and are not allergic, consider getting one. This concept is called "risk versus benefit," whereby the benefits outweigh the risks.
From a personal and clinician's point of view (having worked with people with active flu symptoms every day during flu season for 20 years, showered with coughing and sneezing every winter, during a time when we never wore masks, the flu vaccination has helped me immensely. I have never had the flu. I recommend it unless you suffer from true, potentially serious flu vaccine side effects, allergies, or other contraindications. Over time, I imagine that I have also developed some immunity from exposure in the clinic. Still, from what I have seen, the flu vaccination can reduce flu illnesses, needless doctor visits, missed work and school, and flu-related hospitalizations. And, if you get the flu shot and get the flu, it does not always work for everyone, but often, it will.
Other Ways You Can Try to Prevent the Flu
Handwashing—Wash your hands with soap and warm water for at least 20 seconds, especially after touching a potentially "germy" surface or shaking someone's hand. Use hand sanitizer if there is no visible or known soil.
Get plenty of rest. Lack of rest can weaken your immune system. This is huge, and people forget about it—life in the fast lane.
Hydrate. Hydration helps boost your immune system in many ways.
Try to avoid crowds if possible (airports, planes, and large events are huge vectors) at the height of the flu season - We see this a lot in the clinics.
Here is a brief aside on a family of travelers to illustrate my point: A couple of years ago, I saw a whole family of positive flu members going to Disney at my clinic. They had
already paid, so they could not get out of their trip—you have to wonder how many
people got infected and then took it home to their respective states and countries! Don't
get me wrong, I love Disney, but there are lots of kids there.
Keep your distance from sick people if you can - germs can travel up to six feet from sneezing or coughing. If you are sick, please stay home.
Do not share anything that comes in contact with someone's mouth, especially when they may be sick (and remind your kids and little athletes to do the same!).
Eat a healthy diet.
Avoid stress - Really, in our world? But yes, stress is one of the worst things for the immune system. Viruses love to break out in a stressed body. Shingles and cold sores are great examples of what happens to the body under stress. Transcend it.
Use a humidifier (proper use of humidifiers is a MUST). Research shows that the flu virus is less likely to survive and less likely to be transmitted in environments with higher humidity.
Avoid touching your face, nose, or eyes with unclean hands.
Try preventive herbal supplements that claim to boost immunity (many of which are backed up by studies).
Mask up - Using a mask can help prevent flu transmission - giving it and getting it.
