Build Muscle, Stay Healthy Blog: WTF - What The Flu?!

I was born in Upstate New York but I was raised in a small Canadian town in Southwestern Ontario called Sarnia. Having been raised in Canada, I know about many things. I know that Maple Syrup and Poutine are two entirely different food groups. I know how to cut a bag of milk with pinpoint accuracy, optimizing the flowrate of the milk when pouring it from a milk pitcher. I know what a “Robertson Screwdriver” is and of course, I know how to use one. I also know about the flu. Sadly, I know about the flu all too well…

This is NOT the Flu:

When reports about COVID-19 cases in Wuhan and Northern Italy began to emerge in early 2020, many political leaders dismissed COVID-19 as “something just like the flu.” As it has become very clear, COVID-19 is NOT like the flu! In an editorial in the New England Journal of Medicine, Dr. Anthony Fauci, Director of NIAID/NIH estimated that the overall case-fatality rate (CFR) of COVID-19 is ~1% or less while the CFR of the seasonal flu is 0.1% [1]. COVID-19 is not something to be taken lightly; it is ten times as lethal as the flu! I bring this up not to scare you but to remind you to truly take social distancing and handwashing very seriously as today on April 1, 2020, we prepare for an entire month of social distancing.

The 1918 Influenza Pandemic and A Tale of Two Cities: Philadelphia and St. Louis

If you are reading this blog, the statistical odds are pretty good that you are younger than 102 years old. If that is the case, you probably don’t remember The 1918 Influenza Pandemic. It is estimated that ~500 million people or one third of the world’s population was infected by the flu in 1918 [2]. Some estimate that ~50 million people died [3] during the Mother Of All Pandemics [2,3] while other estimates have placed total mortality at ~100 million people [4]. In the United States, St. Louis moved rapidly to implement social distancing while Philadelphia was slow to act [5]. As it is apparent from Figure 1 [5], these measures helped St. Louis significantly flatten the curve. When healthcare systems are given time to catch up and increase their capacity, they are much better positioned to respond effectively and save lives.

The 2018-2019 Influenza Burden in the United States:

Thanks to advances in vaccination research and the hard work of Scientists and Engineers at companies such as Sanofi Pasteur, GlaxoSmithKline and Seqirus, the flu does not devastate our communities the way that it did in the United States in 1918. Nevertheless, it is estimated according to the C.D.C. that the seasonal flu led to 490,561 hospitalizations and 34,157 deaths in the United States. Think about that number for a moment: 34,157 deaths. I grew up in a Canadian city, Sarnia in Southwestern Ontario that is capital of Canada’s petrochemical industry. Sarnia has a population of <72,000 people. Think about how the death of 34,157 people would devastate a place like my hometown. 3 out of 4 of these people are adults over the age of 65 years old; some of these people are younger than my parents (and my favorite Uncle in Mississippi, a Physician that taught me curse words in Hindi when I was a kid). Sadly, there are many people that die every year from the flu. Although there is a vaccine for the flu, many people (including myself some years) don’t bother to take time out of our busy schedules to get a quick jab in the arm. What will ultimately make COVID-19 an event that will be discussed in the History books in 2120 is vaccine research. Companies such as Moderna, Inc. (Cambridge, MA), CureVac AG (Tübingen, Germany) and BioNTech SE (Mainz, Germany) are making exciting strides in terms of developing a vaccine for COVID-19 using messenger RNA (mRA) technology. Their technologies involve vaccinating people with mRNA, the instructions that code for a specific protein. The cells in your body manufacture a specific protein according to the instructions provided by the mRNA blueprint and the target protein elicits a response from your immune system. This response comes in the form of antibodies that are specific to SARS CoV-2, the virus that causes COVID-19. Cambridge-based Moderna, Inc. initiated clinical trials on mRNA-1273, their vaccine candidate for COVID-19 on March 16, 2020 [7].

The Flu and Muscle Health:

According to C.D.C. data, 3 out of 4 U.S. flu related-deaths involved adults that were 65 years of age or older. Age related muscle loss (or ‘sarcopenia’) primarily impacts adults in this age demographic. Research published by Scientists at the Karolinska Institute, Sweden, University of South Carolina and University of North Texas [8] has reported that sarcopenia increases the rate of mortality when considering all causes. The best way to avoid the flu is to get vaccinated but the work of Ruiz et al. suggests that people with more muscle mass may be able to “weather the storm” of the flu better than people with low muscle mass.

During the 2018-2019 U.S. Flu Season, there were 490,561 hospitalizations that resulted; 57% of these hospitalizations involved adults 65 years of age and older. Research at the University of Connecticut [9] has shown aging significantly enhances the muscle damage that is caused by the flu. During the flu, the body responds with a massive inflammatory response to fight the flu. Turning on these inflammatory signals (atrogin1, MuRF1, ubiquitin B, ubiquitin C) to fight the flu inadvertently fights muscle as well. Rebuilding this muscle is vital due to the importance muscle plays in energy metabolism, balance, bone health and movement.

Learn more about how the advanced nutrition product, Fortetropin® in combination with protein and resistance training can help you build muscle mass at In the meanwhile, build muscle, stay healthy.


1. Fauci, Anthony S., H. Clifford Lane, and Robert R. Redfield. "Covid-19—navigating the uncharted." (2020).

2. Taubenberger, Jeffery K., and David M. Morens. "1918 Influenza: the mother of all pandemics." Emerging infectious diseases 12.1 (2006): 15.

3. Patterson, K. David, and Gerald F. Pyle. "The geography and mortality of the 1918 influenza pandemic." Bulletin of the History of Medicine 65.1 (1991): 4-21.

4. Johnson, Niall PAS, and Juergen Mueller. "Updating the accounts: global mortality of the 1918-1920" Spanish" influenza pandemic." Bulletin of the History of Medicine (2002): 105-115.

5. Hatchett, Richard J., Carter E. Mecher, and Marc Lipsitch. "Public health interventions and epidemic intensity during the 1918 influenza pandemic." Proceedings of the National Academy of Sciences 104.18 (2007): 7582-7587.

6. Centers for Disease Control and Prevention. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season. Accessed data on April 1, 2020.

7. U.S. National Institutes of Health. “NIH clinical trial of investigational vaccine for COVID-19 begins.” March 16, 2020.

8. Ruiz, Jonatan R., et al. “Association between muscular strength and mortality in men: prospective cohort study.” Bmj 337 (2008): a439.

9. Bartley JM, Pan SJ, Keilich SR, Hopkins JW, Al-Naggar IM, Kuchel GA, Haynes L. Aging augments the impact of influenza respiratory tract infection on mobility impairments, muscle-localized inflammation, and muscle atrophy. Aging (Albany NY). 2016 Apr;8(4):620.

Figure 1: Social Distancing and A Tale of Two Cities: St. Louis and Philadelphia

Reproduced from [5].

Table 1: Estimated influenza disease burden, by age group — United States, 2018-2019 influenza season according to U.S. Centers for Disease Control and Prevention

Reproduced from [6].

Figure 2: Age Distribution of the 2018-2019 Flu-Related Burden according to U.S. Centers for Disease Control and Prevention

Reproduced from [6].


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