Flu Kills. Antiviral Treatments Exist. Why Don’t We Use Them?

In a moment I will ask you to step into my time machine and visit The People’s Pharmacy newspaper column 43 years ago on February 7, 1983. But first…

Antiviral medications have become standard medical practice. Most people have heard of drugs for HIV. Millions have taken effective antiviral drugs against herpes infections. We also have highly effective antiviral treatments for hepatitis C that can literally eliminate the virus in two to three months for most people. And in the COVID era, Paxlovid became a household word almost overnight.

But influenza? For some reason, the flu still lives in a strange medical twilight zone—where antiviral treatments exist, but too many people are never offered them, never ask for them, never fill prescriptions for them, or don’t get them in time to do much good.

The CDC (January 23, 2026) estimated that 19 million people have caught the flu so far this season, 250,000 have been hospitalized and 10,000 people have died.

This is not a new problem. It’s an old one. Older than most of the people reading this column.

An Antiviral Treatment–Amantadine–arrived in 1966. It was mostly ignored

The very first influenza antiviral, amantadine (Symmetrel), was approved by the Food and Drug Administration in 1966 for the prevention and treatment of the H2N2 influenza A virus. That flu bug caused a lot of misery. Doctors were offered something brand new…an antiviral treatment that could help against waves of pneumonia, hospitalizations and death due to influenza. Why not block it early, especially in patients at the highest risk?

But the medical culture never fully embraced the concept. Vaccines were viewed as the respectable solution. Flu treatment was largely reduced to a familiar list of home remedies and folk wisdom: rest, fluids, maybe aspirin. Yes, in those days, aspirin was often recommended for influenza treatment.

And then came the 1980–81 influenza epidemic. Tens of thousands of people died.

1983: A warning from the past

I remember what it felt like when influenza was surging in the early 1980s. The flu wasn’t abstract. It wasn’t theoretical. It wasn’t “something going around.” It was a big threat, especially for older people or those vulnerable to respiratory infections.

On Feb. 7, 1983, I wrote an editorial newspaper column warning readers that influenza was back and could become a deadly epidemic. Reading it now feels eerie—not because everything was correct, but because the central argument still holds: influenza can kill, and many doctors are reticent to prescribe antiviral treatments early enough to do much good.

My Column About Antiviral Treatments from The People’s Pharmacy Archive:

“The flu is back. If it follows the pattern of the last epidemic, thousands of people will die needlessly.”

And this wasn’t just dramatic language. Influenza is not the sniffles. It’s not “a bad cold.” It’s a virus that can leave even healthy people flat on their backs for days—and can push vulnerable patients over a cliff.

In 1983, I reminded readers:

“Anyone who has suffered knows that the flu is a lot worse than a bad cold. During the 1980–81 epidemic, influenza and its complications were responsible for over 60,000 deaths.”

And then I wrote something that, at the time, I believed should have been obvious:

“Though your doctor may tell you otherwise, this killer can be prevented or treated with a drug that’s readily available but rarely prescribed.”

Back then, that drug was amantadine (Symmetrel). It was the first antiviral treatment that could prevent or treat influenza A if taken promptly. The scientific tone of the era shows up in my words—but the emotion underneath is unmistakable. I wasn’t trying to sell a miracle. I was trying to shake medicine out of its complacency.

I called it “one of the biggest scandals of American medicine” that physicians were slow to recognize the antiviral benefits of this drug for influenza. I cited research showing high levels of effectiveness for prevention and made what felt, at the time, like a fairly simple argument: combine vaccination with antiviral treatment, and you could potentially prevent a large portion of needless suffering and death.

Even in 1983, there were debates over side effects. I acknowledged them:

“Experience has shown that only 7 to 10 percent of the people taking Symmetrel develop adverse reactions. The most common complaints include insomnia, jitteriness and difficulty concentrating.”

But I also quoted medical experts pushing back against exaggerated fears:

Dr. Arnold Monto was Professor of Epidemiology at the University of Michigan School of Public Health. He suggested doctors “are not yet accustomed to the idea of antiviral drugs,” and believed early reports of side effects were “overblown” (American Family Physician, Dec. 1983).

And I pressed the point that treatment mattered after a person became sick:

“Few physicians seem aware that Symmetrel can be helpful even after people have come down with influenza. If they take it soon enough, they can expect to be feeling better within a couple of days…”

I also quoted a little bit from an editorial in the New England Journal of Medicine (Sept 2, 1982) by Dr. R. Gordon Douglas, Jr. He described a study in that issue of the Journal:

“It is clear from the study of Dolin et al. and from the previous literature that amantadine is a highly effective prophylactic agent against several strains of influenza. This has been a consistent finding over 15 years of research with a number of different influenza A viruses belonging to the H₂N₂, H₃N₂, and H₁N₁ subtypes. Similar data are available on the therapeutic use of amantadine. Thus, it is clear that there is no pressing need for further studies to prove the efficacy of this drug in influenza A infections.

“Perhaps the drug should also be used more widely for the treatment of influenza. Certainly, it is effective for the relief of symptoms and allows a more rapid return to school or employment. A specific diagnosis of influenza is not required for every patient before administering amantadine; epidemiologic diagnosis will suffice. Thus, in the winter months when the Centers for Disease Control or state or local health departments report influenza A activity in or near the region, a patient with acute onset of fever, chills, headache, and cough can be presumed to have influenza and treated accordingly.”

I also criticized the old standby advice:

“The conventional medical wisdom has always been to ‘rest in bed, drink plenty of fluids, and take aspirin.’ That recommendation just isn’t good enough anymore.”

Looking back now, there’s one critical update we need to make: amantadine is no longer recommended for influenza treatment today, because influenza A viruses became widely resistant. So this antiviral treatment may not be the solution in 2026. And it did have a number of side effects.

But here’s the part that still matters: the medical mindset hasn’t fully evolved. We replaced the medicine. We did not fully replace the inertia. Dr. Dolin suggested that if there was widespread flu in the country and patients developed classic influenza symptoms, they should be “presumed to have influenza and treated accordingly.” Today we actually have fast flu tests to determine if a patient does indeed have influenza. They are even available over the counter!

Fast forward to 2026: Antiviral Treatments Help If People Get Them

Now we fast-forward to Monday, Jan. 26, 2026, when the following People’s Pharmacy question-and-answer column begins appearing in newspapers around the country.

And yes—we want you to read it closely, because it demonstrates the modern reality of antiviral treatment when it’s actually used:

Antiviral Treatments Sped Recovery From Flu and COVID

Q. I’m immunocompromised and take medication for high blood pressure, irregular heartbeat and cholesterol. I tested positive for COVID and flu while traveling to California. Probably the plane trip was the culprit.

I’ve had all my shots, but due to my condition I don’t make antibodies easily. The urgent care physician prescribed Paxlovid and Tamiflu. She took me off all my medications to avoid drug interactions.

The medicines worked. Within three days, all symptoms except exhaustion were gone. The fatigue lasted a few more weeks and I tested positive for 20 days from start to finish.

A. Antiviral medications can make a difference for both COVID (Paxlovid) and influenza (Tamiflu, oseltamivir).
There are other prescription antivirals to treat flu. Xofluza (baloxavir) is a single dose treatment that can also be used for prevention. It’s expensive though, with the price running anywhere from $170 to $250.

Another option is Relenza (zanamivir). This inhaled medication may also shorten the duration of flu symptoms, possibly faster than Tamiflu (JAMA Network Open, Aug. 13, 2021).

That reader’s story contains something essential: not that antivirals are magical, but that antivirals can matter—especially when a person is medically vulnerable.

There’s another important point buried in the doctor’s decision: to avoid serious interactions, she temporarily stopped multiple medications. That’s the kind of careful, risk-balanced medicine we want to see more often. It’s not “throw pills at the problem.” It’s smart clinical judgment.

So if antivirals can help for COVID and influenza—why do so many people still treat flu like a suffer-through-it rite of passage?

A Modern Reality: Antiviral Treatments Are Still Underused

An article in The Atlantic (January 12, 2026) by Sarah Zhang explored the strange gap between what influenza antivirals can do and how rarely they’re used. The author made a point that’s hard to argue with: these medicines aren’t miracle cures, and they don’t transform you into a superhero by tomorrow morning. But in a severe flu season, they can reduce symptoms, reduce misery, and—most importantly for high-risk patients—may reduce serious complications.

And yet, only a small fraction of people who get influenza each year ever take an antiviral. In the Atlantic article, Dr. Janet Englund, a pediatric-infectious-disease specialist at the University of Washington was quoted:

“We are dramatically and drastically underutilizing influenza antivirals.” 

It’s one of the most baffling contradictions in American medicine. We have accepted, even celebrated, antivirals for other infections. We treat HIV with seriousness and sophistication. We suppress herpes outbreaks. We cure hepatitis C. We even have a cultural expectation that COVID infections may come with antiviral prescriptions.

But influenza? Too many clinicians and patients still behave as if it exists in a separate category: inconvenient, unpleasant, and basically untreatable. Here is what Sarah Zhang wrote in The Atlantic:

“Even the older, more commonly prescribed drug Tamiflu reaches only a tiny percentage of flu patients every year. Actual numbers are hard to come by, but compare the estimated 1.2 million prescriptions for Tamiflu and its generic form in 2023 with the some 40 million people who likely got the flu in the winter of 2023–24. Xofluza is even less popular, and exact prescription numbers even harder to find. But they are possibly somewhere from just 1 to 10 percent that of Tamiflu.”

Multiple Antiviral Treatments and Tamiflu may not be the best

Tamiflu (oseltamivir) has been around long enough that many people know the brand name. It’s often the default. It’s familiar. It’s widely stocked. It’s also generic, which matters because cost can determine whether someone gets treated.

But it’s not the only option.

Xofluza (baloxavir) was approved in 2018. It is a different kind of influenza antiviral. It’s often taken as a single dose, which makes it more practical when someone is nauseated, exhausted, or caring for a sick child.

That convenience difference sounds minor until you’ve watched someone trying to take medication while shivering under blankets, barely able to sit upright.

Xofluza also appears to reduce the amount of virus more rapidly, which may matter for household spread. Many families have seen this pattern: one person gets influenza, then three days later everyone else gets it too. Anything that reduces contagiousness faster isn’t just about comfort—it’s about limiting collateral damage.

There is also growing interest in whether Xofluza may help reduce certain serious post-flu complications, particularly among high-risk patients. If those findings hold up across diverse populations, it would strengthen the argument that influenza antivirals should be treated less like optional “symptom reducers” and more like targeted tools to reduce medical harm.

One detail that deserves attention: Xofluza tends to perform better against influenza B than Tamiflu does. Not every season is dominated by influenza B, but when it is, that difference may matter. You can read about Xofluza side effects at this link and what happens when you overdose at this link.

Still, the best medicine on paper isn’t always the best medicine in real life. For many people, the best drug is the one they can get quickly, affordably, and reliably.

The Problem Isn’t Antiviral Treatments. It’s the system.

In an ideal world, a person with sudden fever, body aches, sore throat, headache, and crushing fatigue would test quickly, talk to a clinician quickly, and, if appropriate, start antiviral treatment immediately.

But our real-world pipeline is slow when it comes to antiviral treatments:

• You wake up sick.
• You assume it’s “just a cold.”
• You wait a day.
• You try to get an appointment.
• You find out your doctor can’t see you.
• You go to urgent care.
• You wait.
• You get tested.
• You leave with a prescription.
• You drive to a pharmacy.
• You stand in line.
• You learn it isn’t in stock.
• You go to another pharmacy.

At that point, the window where antivirals work best may already have closed.

This is one reason flu antivirals are chronically underused: by the time many people get diagnosed, they’re told they’re “too late.”

Another barrier is the way we talk about influenza. Public health messaging is strongly vaccine-focused—and that’s kind of appropriate. But vaccines don’t work as well as most people believe. You can read more about vaccine effectiveness at this link. Too many people hear the message that: the vaccine is the only tool.

It’s not.

Flu prevention can include vaccination, masking in crowded spaces during outbreaks, and better ventilation.

But flu treatment can include prompt antiviral medication—especially for high-risk patients and those who are severely ill.

Why Has Modern Medicine Dragged Its Feet on Antiviral Treatments?

What’s the matter with modern medicine? Why do we accept antivirals for some viruses but not others?

Part of the answer may be emotional. Influenza is familiar. People have been getting flu for centuries. It feels “normal.” Even when it’s dangerous, it doesn’t feel exotic. It doesn’t inspire the same clinical urgency as hepatitis C or COVID.

Another part of the answer is marketing and culture. The COVID era trained patients, pharmacists, and health systems to act quickly with antiviral treatment. But influenza never got the same attention.

And part of the answer is medical habit. Some clinicians remain unconvinced that antivirals are “worth it” if the benefit is only a day less of symptoms in otherwise healthy adults. That argument can sound reasonable, until you remember what influenza does to the elderly, the immunocompromised, infants, and patients with asthma, COPD, heart disease, kidney disease, or diabetes.

For them, it’s not merely about comfort. It’s about avoiding complications that can turn deadly. A one-day reduction in symptoms may not be the real headline. The headline is: how do we prevent influenza from turning into pneumonia, heart strain, hospitalization, or death?

A practical takeaway: don’t wait, and don’t downplay it

If you are at high risk, talk to your clinician now about a plan. Ask:

• If I develop flu symptoms, should I start antivirals right away?
• Should I be tested immediately?
• Which antiviral makes the most sense for my health situation?
• If a family member has influenza, should I use preventive treatment?
• How can I avoid dangerous drug interactions?

If you get sick during a flu surge, don’t assume you’re supposed to suffer in silence. That old advice—“rest, drink fluids, and ride it out”—wasn’t adequate in 1983. It’s definitely not adequate now.

The flu is back. The lesson still stands.

In 1983, I ended with a warning:

“The flu is back. If we’re not careful it may turn into a tragedy.”

It’s 2026 now. We have better antivirals. Better testing. Better data. Better public health knowledge.

And yet, every flu season, we watch the same story unfold: huge waves of illness, overwhelmed clinics, missed treatment windows, preventable hospitalizations, and deaths that should not have happened.

Flu kills. Treatment exists.

Final Words:

I have been writing The People’s Pharmacy newspaper column with Dr. Terry Graedon for 48 years. We hope you have found this update helpful. If so, please share it with friends and family. If you appreciate our free newsletter, please encourage them to sign up at this link. If you can make a contribution or go ad free at this link, we would also be grateful.