I am not suggesting that we not remain alert, nor am I suggesting that we cast caution to the winds, but this present coronavirus will probably be nowhere near as deadly as many Chicken Littles are predicting.

Why?

Because, quite often, it is not the virus itself, but the secondary infections that are so deadly.

The majority of deaths during the influenza pandemic of 1918–1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Instead, most victims succumbed to bacterial pneumonia following influenza virus infection. The pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.

Did you catch that? It was bacteria, piggybacking on top of viral damage, that caused the fatalities.

However, unlike 1918, today, medicine has an arsenal of antibiotics available to fight such bacteria — antibiotics that were not available in 1918. And yes, some bacteria have developed resistance, but not all. In plain terms, medicine has a better fighting chance.

In many cases, a course of antibiotics and acetaminophen (Tylenol) to control the fever might prove sufficient. However, there will be worse cases.

The 1918 flu also caused a cytokine storm, where the body's immune system over-reacted.

[T]he 1918 strain seems to trigger a particularly intense response from the immune system, including a 'cytokine storm' — the rapid release of immune cells and inflammatory molecules. Although a robust immune response should help us fight infection, an over-reaction of this kind can overload the body, leading to severe inflammation and a build-up of fluid in the lungs that could increase the chance of secondary infections.

In essence, the body's immune system overreacted to the point that it became the body's worst enemy. A large part of the problem stems from the inflammation caused by such infections. The bronchial tubes inflame and plug up. Mucus and fluid is over-produced. Patients choke on their own phlegm.

So what can be done in the these cases?

Such bodily overreactions are common in people with severe allergies, where the body overreacts — and medicine, today, is much better at handling it.

Can you say...steroids? Prednisolone was discovered in the 1950s. Variations such as prednisone, Solu-Medrol, etc. are quite common today.

Such steroids are quite powerful and work fast. They can bring down inflammation at miraculous speeds. Anyone who has had shock, an auto-immune disease, a severe arthritis flare-up, or severe asthma knows that an injection of steroids (Solu-Medrol) can often clear up the situation in a matter of minutes. Anyone who has had a transplant knows how steroids can prevent the body from rejecting a new organ.

[Solu-Medrol] is usually given by slow injection into a vein or directly into a muscle, as directed by your doctor. The dosage is based on your medical condition and response to treatment.

Today, doctors might give a patient dosages of steroids during the worst of the flu to control inflammation, swollen bronchial tubes, etc. After the initial intravenous delivery of steroids, the doctors will slowly reduce the patient down to oral prednisone, and then ideally off the steroids for good.

However, the astute will caution that steroids have side-effects.

Boy! Do steroids have side-effects!

Weight gain is almost immediate. Water retention will be common. Hunger will also increase to unbelievable levels. Desire for a fourth or fifth serving of dinner will be common. As the steroids will be given during the worst of the flu, when the patient is too weak to eat, this may be ameliorated. However, when the patient comes home, the refrigerator may need to be on lockdown for a while, until the side-effects wear off.

A lowered immune system response is another side-effect of steroids — which may be a good thing during a cytokine storm, when one wants to rein in an over-reactive immune system. But even after coming off the steroids, one's immune system might be temporarily weakened, and one might be more prone to regular colds for a while.

Side effects of corticosteroids [such as Solu-Medrol or prednisone] can persist long after you stop taking them so continue seeing your doctor regularly.

Then there may be higher blood sugar for the duration of the steroid treatment. This does not happen to everyone, but diabetics will have to be watched. Those who do not have diabetes will have to be cautioned not to panic over a temporary spike in blood sugar — you probably have not developed diabetes. However, temporarily cutting back on sweets, for the duration of the treatment, might be recommended.

Fortunately, in many cases, the effect is temporary, though in some cases, there can be consequences.

Generally, blood sugar levels should return to their previous levels 1–2 days after finishing steroid treatment. However, some people may develop type 2 diabetes as a result and will need appropriate follow-up treatment with oral medication or insulin therapy.

And, of course, with steroids come the psychological effects. These can be major, and patients are not often warned about them. Roid rage is real.

Sometimes I fill with rage, other times it's anxiety, and sometimes it's brain fog or something else. It's very unnatural. … More recently I've pretty much discovered that these things have happened to me simply because it's a side effect of the medication that is helping me so dearly.

Patients on the highest dosages of steroids (for the flu) will probably be too weak to murder anyone, though one should be aware that the effects can linger after the steroids are withdrawn, depending on how long one had to take them.

If this all sounds scary, remember that it can save lives. The antibiotics will stop the deadly secondary infections, while the steroids will help to control the dangerous symptoms of fluid buildup, inflammation, and even high temperatures as you ride out the worst of the

It is a one-two punch, and quite an effective one at that. In the vast majority of cases, any side-effects should be temporary at worst. Had they had these treatments in 1918, the Spanish Flu would have been a whimper.

Controlling the side-effects

Digestive upset from the antibiotics can be controlled by eating probiotic live culture yogurt, which doctors now regularly recommend whenever they hand out antibiotics. Take the yogurt halfway between dosages of the antibiotics. It is astounding how well yogurt works in this area. If you can't stand yogurt, then take probiotics. If you are in a hospital, just write yogurt on your menu. The kitchen will always have it, and the doctor will applaud your good judgment for requesting it.

The weight gain from steroids should be temporary, though it will take longer to lose than it was to put on. In the meantime, just tell your wife she is still pretty, and she might not maul you.

The blood sugar problems will often resolve themselves after you come off the steroids. They might not even be a big issue, but one should be aware of them — just in case someone misdiagnoses you as having high blood sugar. Thankfully, most medical help know that the high blood sugar may be temporary and will ignore it. You might not even be put on a special diet while in the hospital, and you can order that fourth piece of cake you crave from the steroid hunger.

As for any psychological issues, being aware of them is half the battle. If not, ask the doctor for some temporary medication to control it. Fortunately, with a very short dose of steroids, this may not be necessary.

Between antibiotics and steroids, the fatalities that come with flu should drastically decrease. The fatalities that come with murder — a wife who kills her husband in a fit of roid rage, after he asks why she put on so much weight — might see a temporary spike.

The point is that whatever this coronavirus is, it will probably not be anywhere near as deadly as former plagues were. Hospitals in the West come stocked with antibiotics and steroids. While some of the newer antibiotics are in short supply, they might not even be needed, as older antibiotics may prove sufficient.

Do not panic, not matter how much the media hypes this.

Mike Konrad is not a doctor, but during his life, he has been in the hospital on Solu-Medrol and antibiotics more times than he cares to admit, and the medical staff got used to him ordering two or three servings for dinner. He started ordering from the Kosher menu to get the special bagels and lox for breakfast, until somebody in the kitchen noticed that he was not Jewish and told him to stop — but his Jewish doctors were impressed at the maneuver.