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The news hit like a lightning bolt: Prince, the widely admired — beloved — singer, was found dead at his home in Chanhassen, Minn.

The only hint of an explanation — that he had recently been battling the flu — came from a report on TMZ.


Prince had cancelled two shows in early April because he was sick with the flu, a representative told the news website. And after a show in Atlanta a week later, his plane made an emergency landing in Illinois because he was unwell. Prince reportedly spent several hours in a hospital.

It’s not currently known what caused the singer’s death; an autopsy is expected to be conducted Friday. But if Prince had recently been infected with influenza, it could very well have been the cause of death, experts said.

People often dismiss the threat of the flu, likening it to the common cold. Most know it can kill elderly people with weakened immune systems, but they don’t generally see it as a danger for young adults or people in middle age people like Prince, who was 57.


Mostly, they are right. But sometimes they are wrong.

“It’s certainly true that otherwise healthy people can die of flu, although it’s rare,” said Dr. John Treanor, chief of the division of infectious diseases at the University of Rochester Medical Center.

“The bulk of the serious illnesses occur in young children and older adults. But that doesn’t mean that there are no deaths in otherwise healthy young adults.”

Three leading flu experts who spoke with STAT all stressed they didn’t know the particulars of the singer’s health problems. They were asked to comment on influenza’s potential to kill, not on whether it caused Prince’s death.

Dr. Danuta Skowronski, a Prince fan who was saddened by the news, cautioned against assuming the singer even had influenza. Many people misuse the term “flu,” she noted, believing it applies to anything that causes a respiratory condition. Some even believe it refers to gastrointestinal illnesses, though it does not.

“It’s sad — tragic — either way. But without more details we can’t say it’s influenza,” said Skowronski, an influenza epidemiologist at the British Columbia Center for Disease Control in Vancouver.

Still, flu can and does kill, somewhere between 3,400 and 49,000 people in the United States every year, said Dr. Tim Uyeki, of the influenza division at the Centers for Disease Control and Prevention in Atlanta. Those figures are estimates, devised by looking at the rise in deaths seen every year during and shortly after flu season.

The vaccine triggers the immune system to create antibodies, preparing the body for viral battle. Alex Hogan/STAT

Sometimes influenza kills directly, when people develop viral pneumonia. More often, though, the virus kills indirectly.

Think of dominoes. Flu is the first block to tumble, touching off a cascade.

People who contract the flu can go on to develop a bacterial pneumonia, which can also be fatal. As well, the inflammatory response triggered by influenza infection can lead to other health conditions, said Uyeki.

The inflammation caused by the immune response the body mounts to fight flu can damage the heart or brain tissues.  And some people who catch the flu are at an elevated risk of having a stroke afterwards, he said.

Generally, the serious side-effects of flu occur in people who already had health conditions prior to the infection.

But one strain of flu is known to cause severe, sometimes even fatal infections in young and middle-aged adults. That is the influenza A virus called H1N1, the strain that caused the 2009 flu pandemic.

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“I think the experience with the pandemic … certainly showed the potential for the influenza virus to kill young, healthy people, because the majority of people who died in 2009-2010 were young people who developed rapid and severe influenza,” Treanor said. The same was true during the 1918 Spanish flu, the worst pandemic in known history.

H1N1 is also the virus that predominated this flu season. For the most part, it has been a mild flu season. But even from the start, hospitals reported treating cases of young adults who were so sick they needed intensive care and breathing assistance.

In early February, the CDC issued an alert to health care providers to be on the lookout for severe flu cases. Uyeki said he received an email from a doctor treating such a case on Thursday.