Symptoms of both can include sore throat, runny nose, cough, fatigue, fever, and secondary ear infections. Thanks to widespread reporting about the shortage, we've learned some important basics about the flu season and viral strains, and that flu stands out symptomatically with a typically high fever, which can sometimes cause seizures, and its sudden onset of headache, extreme exhaustion, and muscle aches. Nausea is only common in children, making influenza a different beast from the misnamed "stomach flu," typically a bacterial assault with more volcanic digestive turmoil.

Not only do we know more about the bug itself—more accurately, the bugs themselves—the vaccine shortage is taking us where no flu season has taken us before, into conversations about politics (is it the Bush administration's fault or not?), ethics (child or elder first at undersupplied vaccination clinics?), biotechnological techniques (cell lines versus chicken eggs as viral incubators?), and the foundations of personal decision-making (e.g., trust in pharmaceuticals or in self-healing and naturopathic approaches?).

Then there is a whole slew of specific medical questions resurfacing, like whether it really is wise to advocate vaccination for people whose immune systems are already challenged or weakened, given that the vaccines were tested for safety in people with healthy immune systems, and include a host of foreign molecules, like thimerosal (a mercury-containing preservative), aluminum, and chicken egg albumin (in which vaccines are incubated). Should we worry that health agencies tell us to avoid mercury in food, water, soil, and air, but not to be concerned about the small but yearly dose we get in a flu vaccine? (See Chronogram's two-part series on vaccines, November and December 2002.)

If you were trying to decide whether or not to get vaccinated, ponder no more. The decision is out of your hands unless you're on the Centers for Disease Control's priority list. In early November New York State's Department of Health began distributing the state's existing vaccines to county health departments, with the mandate by State Health Commissioner Antonia C. Novello that they go only to people who meet the CDC criteria of being at highest risk of flu complications or of spreading the virus. Even if you qualify, a call to an area hospital, doctor's office, or county flu hotline may inform you there is none to be had.

So, many of us will be left on our own, as our ancestors were for millennia before vaccines were invented. Reminders that the flu pandemic of 1918-19 killed over 500,000 people in the US in a single year, and 20-40 million or more worldwide (more than the bubonic plague did from 1347-1351), isn't engendering much confidence about that, especially since we've grown up in a highly medically managed era. It's true that each year as many as half of kids get the flu, but only five to twenty percent of the overall population usually does. And while hundreds of thousands of people are hospitalized each year for influenza and its complications, that is saving lives. Fatalities persist: during the 1980s about 19,000 people died from flu complications in the U.S., rising to an average of 36,000 flu-related deaths in recent years because of an increasing proportion of elders and/or increasing virulence of the most predominant A strain (H3N2), possibly due to mutations in the viral structure that allow it to outmaneuver the immune system.

But consider this: the vaccine shortage and attendant CDC listing of high-priority recipients are a reminder that most people run a very high risk of being fine, and have clarified who most needs preventative and treatment measures. Ninety percent of flu-related deaths are among elders who succumb to complications like bacterial pneumonia and bronchitis and who live in group homes where exposure comes with the territory. Elders and others with chronic respiratory or cardiovascular illnesses also are at higher risk. Children are among the vaccination priority group because of the possibility of life-threatening dehydration due to high fever, vomiting, and/or diarrhea.

What can you do to ward off the bug and keep from spreading it? Plenty. Here are five simple behavioral tactics that will reduce your chances of giving or getting the flu.

1. Cover your mouth when you cough or sneeze (preferably with a disposable tissue that you throw away immediately).
2. Don’t share beverage containers.
3. Wash your hands with soap for at least fifteen seconds (or use a waterless cleaning gel) before eating and preparing foods, and after handling public doorknobs, phones, and other frequently-used items.
4. Clean items at home that many hands touch, like phones, refrigerator handles, and door knobs.
5. Share bodily fluids wisely.

Avoiding people is another, rarely practical, strategy. But at least try not to get trapped at a meeting or on the subway between people who are coughing and sniffling. Adults are infectious from the day before symptoms appear until about five to seven days after they are obviously ill, and children are viral incubators for more than ten days, including as many as six days before onset of symptoms. If you're sick, be kind to others and stay home. You could also stay away from work if anyone there is sick, or recently has been ("Hi, this is James, and I'm taking a preventative health day for the next two weeks"), though employers may find reason to send you packing rather than see it as creative and fair leverage for health care benefits.

Another prevention strategy: migrate with the seasons or transplant yourself to a dry, subtropical clime. Influenza season roughly spans November through April in the northern hemisphere and May through September in the southern hemisphere. In tropical and subtropical regions, influenza epidemics occur year round but seem more common after a region's wet season. Consider this additional motivation if you're perchance shopping for a new set of shores to call home.

There is a lot of talk about antiviral drugs (amantadine, rimantadine, oseltamivir, zanamivir), which are available by prescription. They are most often used to control flu outbreaks in hospitals and nursing homes, typically in combination with vaccination, and are considered by the medical community to be a useful preventative measure. They can also reduce the duration and severity of symptoms in people who already are sick if taken within two days of symptom onset. But antiviral drugs can have side effects and are untested in pregnant women. There isn't enough to go around, either: in October the CDC estimated there were 40 million doses nationwide. Getting vaccinated against pneumococcal bacteria, the pathogen leading to most flu-related deaths, is another preventative measure being suggested (the vaccine is effective for at least five years). New York City's Department of Health and Mental Hygiene (among others) recommends that everyone aged 65 and older do so.

There may be too few flu shots, but there is no shortage of natural products for immune support in general, and flu/cold support specifically (the Chinese herbal tablets, Yin Chiao, are my favorite miracle-in-a-bottle taken at first sign of symptoms). Some are preventatives, while others help to alleviate symptoms once they've appeared by promoting healing, rather than masking them, as do standard over-the-counter pharmaceutical concoctions (and the latter include a variety of additives like artificial sweeteners and colors). Consult an herbalist, naturopathic healer, or peruse the shelves of natural food stores to find the appropriate supplements, herbs, tinctures, and homeopathic remedies.

Dr. Thomas Francescott, a Rhinebeck-based naturopathic doctor also known as "Dr. Tom," highly recommends elderberry as a "very strong antiviral and antibacterial that you can find as a syrup or extract, often in combination with other things." He agrees with other natural health experts that echinacea and golden seal are great, and possibly licorice. Many people and clinical trials (at least of echinacea) likewise attest to their value. (Note that echinacea is more effective if taken daily for a few weeks at the most, rather than continually.) He also recommends digestive system-enhancing probiotics and fish oil, with its "omega-three oils that are great for the immune system and have the good fat and the nutrition that people need." Zinc and vitamin C are also helpful.

Dr. Tom emphasizes the importance of nutrition and digestive system health over vaccination. "The vaccine is not a benign thing. It has a lot of chemicals and foreign compounds. If people are eating okay and there is nutritional balance they are going to be fine if they get the flu. Most of the cells of the immune system are in the first two layers of the intestinal tract, so I pay a lot of attention to the health of that. I look at food allergies and usually take people off of sugars and inappropriate types of dairy that are congesting and mucus-forming. A lot of stuff starts with digestion, especially respiratory problems. People are not going to get fully well without paying attention to that."

Then there are tasty, nutritionally nurturing, very absorbable mineral broths you can make at home. Local herbalist Jennifer Costa of Monarda Herbal Apothecary in Phoenicia created Deep Immune Broth, to enhance natural protection against pathogens. It's a "food for the immune system, so it can be energized to do the best job it's supposed to." Costa has posted its recipe on her Web page (www.monarda.net). It's full of ingredients to stimulate repair processes, like shitake mushroom, garlic, burdock, astragalus, and ginger. It can be eaten during wellness as a soup or with rice, or as medicine during illness. She also offers an immune support tea blend, and recommends sage tea with lemon and honey. Ginger also makes a good tea; our household often keeps a pot of ginger pieces steeping in water on the woodstove during winter.

Eat right, exercise regularly, and get plenty of rest. That familiar suggestion of how to care for yourself during flu season may be the toughest prescription to follow. No doubt that trinity is the best all-around health suggestion—and a sort of holy grail that cannot be won without first slaying the Wicked Demon of Workaholism and the Monster of Making Ends Meet, not to mention the ever-demanding Beast of the Undeserving Self. Indeed, it is sadly true that getting sick is one of the few chances for work-a-day folks to get a proper rest.

"We've forgotten how to take care of ourselves when we're sick," says Costa. "You can take the painkiller and go to work, but you're infecting people around you and you get sicker by not redirecting the immune system to the appropriate place. You need to know how to convalesce. Nature conserves its energy. We should bring that message home: when you come home with a scratchy throat, what's your body saying to you? Lay down, and rest, because the body's trying to heal itself." And you'll get better sooner.

You can look at a bout with the flu as a chance for a "fall cleaning" to get some residues out of the body. "That healing sweat is killing all kinds of things," Costa says, "and you're almost doing a liquid fast, not eating much, and going inward to heal." Give into it, she urges. Curl up, snuggle down, get quiet, and stay out of the sun until you're on the mend. And enjoy some eucalyptus oil to help clear stagnant airways and as an antibacterial. Add it to bathwater or to steaming water and inhale the vapor.

So believe in your body's own healing wisdom, take some wise precautions, and enjoy a little Internet entertainment this flu season by tracking it around the state and across the country, in lively colors and simple graphs. The state's Department of Health web page (www.health.state.ny.us/nysdoh/flu/flumap.htm) posts confirmed cases in New York counties, updated weekly, and the CDC offers weekly reports with colorful graphics (www.cdc.gov/flu/weekly) summarizing which strains and how many cases are showing up nationally. Last year's data at the CDC site has some people worried, because the typical sinusoidal curve that shows the seasonal ebb and flow of influenza/pneumonia fatalities over the last several years has an ugly high spike at the height of last year's flu season, and a graph of numbers of people seeking medical attention looked like Mount Everest compared to earlier years' Catskill Mountains.

On the positive side, experts say a previous year's flu season is not a reliable predictor about the severity of the next one. And anyone who got sick last year (and survived) has a natural immunity protecting them this year, as long as the viral strains are similar enough to last year's. So far (as of late October), they are—though only an immune system will know for sure.