This year’s flu season began early, with five children dying from complications of the disease and hospitalizations on the rise. Family doctors are warning that influenza is not a mild winter illness, outlining its symptoms, identifying who is truly at risk and explaining how it should, and should not, be treated.
“Influenza is a viral disease characterized by complications of the respiratory system,” says Dr. Zehava Alon, a family medicine specialist with Clalit Health Services’ Central District. She describes it as a severe illness that typically lasts about a week and is marked by very high fever and serious respiratory symptoms, including cough, pneumonia, sinus infections, shortness of breath and bouts of bronchitis, along with body aches and profound weakness. Unlike common cold viruses, which usually cause mild symptoms and resolve within days, influenza can worsen significantly. “Patients die from the complications, when the underlying cause is influenza,” she says, noting the deaths of five children this year and severe outcomes among older adults.
Dr. Adam Reiter, a family medicine specialist with Maccabi Healthcare Services, echoed her remarks. “Generally speaking, influenza is a viral disease of the respiratory tract. In most cases it begins and remains in the upper respiratory tract, meaning the nose and throat, but it can, God forbid, worsen and spread to the lower respiratory tract — the lungs. That is why it has the potential, like any viral illness and perhaps more so than other viruses, to cause significant respiratory disease with lung involvement.”
Dr. Zehava AlonA virus, not a bacterium
One of the most common misconceptions about influenza and other winter illnesses is whether they are caused by a virus or a bacterium — a distinction that is critical for treatment.
“Not everyone understands the difference between a virus and a bacterium,” says Dr. Reiter. “Both can make us sick, but the key difference is practical: what medicine can do.” Bacterial infections can be treated with antibiotics, he explains, while viral illnesses cannot. “There are no drugs that kill viruses, so treatment for viral diseases is supportive and aimed at relieving symptoms. That is why people with fever or worsening symptoms should be examined, so we can determine whether the illness is viral or bacterial.”
Dr. Adam ReiterPhoto: Ofer HajayovThe confusion often leads patients to expect antibiotics even when they have influenza. “Influenza does not respond to antibiotics. It is a viral disease,” says Dr. Alon. “Antibiotics are sometimes given only for complications, such as pneumonia — not to treat the flu itself, but to treat a secondary infection that develops when the immune system is weakened.
Who is at risk?
Influenza does not affect everyone the same way. While many recover within days, others can deteriorate quickly and develop serious complications, including pneumonia, severe respiratory failure requiring ventilation and even death.
“When someone has a viral illness, the immune system is already weakened, which allows bacterial infections to develop on top of it,” says Dr. Reiter. “If there is no improvement, it is important to seek medical evaluation.”
These warnings are especially relevant for high-risk groups — people whose immune systems may struggle to fight a viral infection. They include the very old and the very young, people with underlying medical conditions and those taking medications that suppress the immune system, for whom vaccination is particularly important. Dr. Alon adds that nearly everyone carries some level of risk, particularly people in close, ongoing contact with children, such as teachers and preschool staff.
What's the treatment?
Treatment for influenza is not the same for everyone and depends largely on the severity of symptoms, a person’s overall health and whether the illness is mild and self-limiting or requires medical evaluation.
“It very much depends on the individual, their medical background, whether they are in a high-risk group, and how the illness presents,” says Dr. Reiter.
“There is a big difference between a bit of coughing and a sore throat and a significant illness with high fever and breathing difficulty. The individual situation determines whether testing is needed. If symptoms are mild and within a day, two or three there is improvement, there is no need to seek medical care. But if the illness is severe, with high fever and significant symptoms, a medical evaluation is necessary. We have to rule out worsening, a secondary bacterial infection or lung involvement from influenza.”
In recent years, home test kits sold at pharmacies have also become available, allowing for rapid diagnosis of influenza and in some cases combined testing for influenza and COVID-19. These kits can help in cases of mild symptoms and guide initial management at home.
What about children?
“In general, we always recommend looking first at the child’s overall condition,” says Dr. Efrat Wechsler, head of primary care and a pediatrician at Meuhedet Health Services. “The first step is to bring the fever down. When the fever drops, the child usually recovers somewhat — plays, eats and drinks. If there is no shortness of breath, you can wait through the first 48 hours and see how things develop.”
If the fever lasts more than two days, especially if it is very high, as is typical of the current wave, or if other concerning signs appear, including decreased alertness, reduced eating or drinking, breathing difficulties, a troubling cough or unusual rashes — the child should be examined, she says. “These can be signs of a secondary infection or another condition that requires treatment. Of course, this is not treatment of the illness itself, but of possible complications. Some complications are rare but can be very dangerous, such as inflammation of the heart muscle.”
Dr. Alon adds that with any illness, preventing further spread is essential. “It’s important not to go to work for two days while sick and then collapse, after having already infected everyone. People who are ill should stay home, wear a mask, drink plenty of fluids, eat appropriately and rest. Grandma used to say chicken soup — but above all, hydration, light food and rest are key.”
Fever reducers can be used, she adds. “There is also a medication given in severe cases, called Tamiflu, but it is prescribed only in serious cases and only in hospitals.”
Dr. Reiter stresses the importance of basic hygiene. “Wash hands, cough into your elbow and keep distance from people in high-risk groups, such as infants, older adults and those with weakened immune systems.”
Vaccination: The most effective tool
Alongside treating the illness itself, one of the main ways to reduce infection and complications is prevention — foremost through the influenza vaccine.
“There are two types of flu vaccines,” says Dr. Reiter. “There is a live attenuated vaccine given as a nasal spray, and the familiar injected vaccine, which is inactivated. The live vaccine may cause very mild illness, but not significant disease, while the inactivated vaccine should not cause illness at all. Both are very similar in terms of effectiveness and the protection they provide.”
The vaccine, he says, is safe and recommended for all residents of Israel starting at 6 months of age and should be taken once a year ahead of the winter flu season. “This is especially important for people in high-risk groups. For them, vaccination can truly mean the difference between severe illness and hospitalization and a mild illness that passes easily.”
“This year alone, more than 800,000 people have already been vaccinated through Clalit, and that is not enough,” adds Dr. Alon. “At most, the inactivated vaccine can cause muscle aches for a day. Beyond that, there are no side effects. It does not cause the flu or complications. People remember the COVID-19 vaccines, which were developed quickly due to an emergency, but this is not the same. This is a vaccine that has existed for decades — safe and without side effects. Personally, I have been getting vaccinated for more than 25 years. As soon as vaccines are available, I am first in line.”
She notes that the vaccine is available as a nasal spray for children and as an injection for the rest of the population, with a formulation for older adults and nursing home residents that contains additional virus strains.