Influenza is widespread across the Carolinas, and there’s no way to predict whether we’ve seen the worst.

“We would like to think we’re going to have our peak soon, but you never know,” said Dr. Zack Moore, an epidemiologist with the N.C. Division of Public Health. “It ain’t over till it’s over.”

While we’re in the thick of it, some things to remember:

It’s not too late to get a flu shot.

Most people who get the flu just need to stay home and rest.

But flu can be deadly, especially for those at high risk for complications.

N.C. health officials have recorded 14 deaths this season, including of a previously healthy 16-year-old girl from Cary who died early this month.

Flu cases are not counted. North Carolina keeps track of a broad category of “influenza-like illness” by getting reports from hospital emergency departments and about 100 other “sentinel” sites, such as county health departments, college health centers and doctors’ offices.

Sentinel sites reported that 5.8 percent of patients had flulike illness during the week ending Feb. 5. As of Feb. 12, the number was 5.4 percent. that compares to about 6 percent in October 2009 at the peak of the swine flu pandemic.

“It’s been pretty intense since the middle of January,” said Dr. Jeffrey Cleveland of Charlotte Pediatric Clinic in Matthews. “It’s not the worst flu season I’ve ever had, but it’s definitely worse than your average year.”

Some parents have been surprised that children got the flu even after they had been vaccinated in the fall.

Unfortunately, this can happen. No vaccine is 100 percent effective. but experts say that doesn’t mean the vaccine isn’t worthwhile.

Federal health officials say the three flu strains in this year’s vaccine are well-matched to circulating viruses. They include H1N1, the once-pandemic swine flu virus, which is now a seasonal bug. In fact, H1N1 is the most common flu virus in North Carolina.

“People who got the vaccine are a lot less likely to get the flu than people who didn’t,” said Moore, the state epidemiologist. “We still consider vaccine to be the best way to protect yourself against influenza.”

Although the vaccine may take two weeks to become effective, Moore said it’s not too late to get a shot or nasal spray immunization.

“Even for kids who have already had flu or think they’ve had flu,” he said. “Just because you’ve had one influenza doesn’t mean they wouldn’t get another one.”

Rapid flu tests are available in the doctor’s office. but most people don’t really need to know whether they have influenza or another infection. Patients with new symptoms might benefit from the test because doctors could then prescribe antiviral drugs, such as Tamiflu, to reduce severity and duration of symptoms. (Remember: Antibiotics fight bacteria, not viruses.)

But not everyone needs Tamiflu.

Antiviral drugs work only if they’re taken within 48 hours of the onset of symptoms. In recent years, health officials have advised doctors to reserve these medicines for patients at high risk for flu complications, such as pregnant women, very young children and people with asthma and other chronic medical conditions.

So far this year, there are no restrictions. Still, Cleveland says he prescribes them only when appropriate.

“It may shave a day or two off of the symptoms,” he said. “It’s not a great treatment… and it’s pretty doggone expensive.”

With so many viruses circulating in winter, most people don’t distinguish between colds and flu. Sick is sick, and treating the symptoms is the best way to go.

Colds bring a runny or stuffy nose, cough and sore throat. Flu symptoms are generally more severe – fever, fatigue, body aches, headache, cough, stuffy nose and sore throat.

Influenza usually “runs a predictable course, over seven to 10 days,” said Dr. Evangeline Lausier, director of clinical services for Duke Integrative Medicine in Durham. “The hardest things are the cough and fever and the body aches. if you can get through those first few days, you’re going to be fine in most cases.”

To reduce a temperature or treat body aches, she suggested over-the-counter medicines, such as acetaminophen (Tylenol), ibuprofen (Motrin or Advil) or naproxen (Aleve). Cough syrups or menthol lozenges can relieve coughs and sore throat.

If mucus drainage is a problem, nasal irrigation or gargling helps, Lausier said. “Get as much salt water back there to sort of loosen up and move those big globs of mucus.”

Various herbal remedies are recommended to relieve symptoms or boost immunity. They include echinacea, astragalus, andrographis, slippery elm, elderberry extract and yin chiao. even chicken soup can relieve symptoms of colds and flu, Lausier said, especially if you add cayenne pepper or ginger.

Naturopath Michael Smith of Carolinas Natural Health Center in Matthews got flu symptoms himself last week and attacked them with a homeopathic remedy called Bryonia and a supplement called Super Bio-Vegetarian, which contains vitamins, minerals and botanicals, such as garlic, ginger, echinacea and mushrooms. He rested and used the “warm socks treatment” before going to bed. (See box on 1D.)

In recent weeks, Parade magazine included the warm socks remedy in a list headed “Don’t try these at home.” but Smith said he’s been using it and recommending it to patients for years with good results. less than 48 hours after his fever and body aches started, the symptoms were gone.

Smith also gives patients a recipe for what he calls “Kick-A-Bug Juice.” (See box on 1D.) The mixture of hot water, honey, garlic and vinegar could kick up a fever even if you don’t already have one.

“But that’s good,” he said. “When the body spikes a fever, that’s part of its normal response to kill off the virus.”

Finally, the best way to get better is to stay home.

“It’s ridiculous to think that you can go to work and take a bunch of over-the-counter medicines to suppress the symptoms,” Smith said. “People need to take time and rest.”

If you’ve successfully avoided the flu so far, you probably got the vaccine or have kept your immune system strong.

To keep it that way, Smith suggests taking probiotics (beneficial bacteria) and getting sufficient vitamin D. “We can’t mount a sufficient response (to a virus) unless we have sufficient vitamin D.”

And as always, follow these tips to prevent viral infections:

Wash your hands frequently.

Keep your fingers away from your eyes and mouth; cough into your sleeve, not your hands.

Get enough sleep, reduce stress and eat a healthy diet.

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