Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
The Flu, or Not the Flu, That Is the Question
Whether ’tis nobler in the mind to suffer the slings and arrows of outrageous rhetoric, or to take arms against a sea of analogies, and by opposing end them.
I remain puzzled about the passions ignited by comparisons of COVID-19 to the flu. Full disclosure: I’m the sort of reckless miscreant who regularly compares COVID-19 to the flu. In fact, I called it the WuFlu in my initial posts on the subject, though I discontinued this practice on March 24, when I found a new data source demonstrating that reported cases in New York City had skyrocketed starting March 19.
Flu manchu. The Kung Flu Pandemic. One Flu Over the Cuckoo’s Nest. Me and you and a dog named Flu. I just can’t stop myself sometimes.
I find the flu to be an excellent, but not perfect, analogy to COVID-19. I’m less interested in arguing the case, than in exploring why the use of this particular analogy, and this particular word, seems to prompt anger in a number of generally thoughtful and sober-minded people.
I’m going to start by trying to “steel-man” the other side of the argument, by presenting ways that COVID-19 is not like the flu.
- SARS-COV-2 is technically a different virus than the flu, and part of an entirely different family of viruses.
- COVID-19 is significantly more deadly than the flu (at least more deadly than any flu we’ve seen in a century).
- COVID-19 may be substantially more contagious than the flu. (This remains unclear, but seems plausible based on what I know.)
- We have a vaccine for the flu, but no vaccine for COVID-19.
- We have established treatments for the flu, including several approved antiviral medications. We don’t have a well-established treatment for COVID-19.
- We have a good idea of the characteristics of the flu, from decades of experience, while our knowledge of COVID-19 is much more speculative and uncertain.
- We are confident that having the flu provides immunity that prevents re-infection or at least makes re-infection very unlikely. We are not confident about this with COVID-19.
Let me know if any other differences come to mind.
I’m going to elaborate on the issue of the deadlines of COVID-19. Per this CDC site, the number of annual flu fatalities has ranged from 23,000 to 61,000 over the past five years. These are generally spread over the entire year, with a spike during “flu season” in the winter months. COVID-19 has already caused over 72,000 reported deaths in the US, in a period of about eight weeks.
My calculations of the ultimate death toll from COVID-19 have been pretty pessimistic of late. I generally assume that 50-70% of the country will contract the disease, and 0.2%-0.5% of those will die, implying total deaths between 330,000 and 1,155,000.
It is possible that it will be lower, because some people may have immunity from COVID-19, which may be either a natural immunity or immunity acquired from a prior infection with a different coronavirus. (It turns out that about 20% of colds are caused by coronaviruses, and there are several types that infect humans other than COVID-19. But I do not think we know that such prior coronavirus infection would give any protection against COVID-19. It might, or might not.)
So my own calculations imply that COVID-19 will be about five to 20 times worse than even a bad flu year, and about nine to 30 times worse than a typical flu year. How, then, can I maintain that COVID-19 is “like the flu?” What in the world is wrong with me?
Here’s the other side of the argument:
- COVID-19 is a respiratory virus, like the flu.
- COVID-19 typically causes death by similar mechanisms to the flu, especially pulmonary edema (fluid in the lungs).
- COVID-19 is typically deadly only to the old and infirm, like the flu. (Per this CDC page, 83% of flu deaths in 2017-18 were people aged 65 and over. 80% of COVID-19 deaths are aged 65 and over, per this CDC page, though I had to do the math myself.)
- COVID-19 is spread just like the flu. (Though probably faster, and I suspect that this is because there is a lot of flu immunity, due to vaccines and prior infections.)
- COVID-19 came from China, like most flus.
- COVID-19 is definitely not Ebola or the Black Death, with death rates in the 50% range. It’s well under 1%, and much, much lower than this for most people.
- There’s not much that we can do about the flu, within reason. Get a flu shot if you want, then go about your business as usual. I think that this is true of COVID-19, too, though there’s no option for a vaccine in the near future.
I think that it’s this last point that seems to get the “not the flu” folks angry. When I say flu, I seem to be minimizing the risk, and I think that this is an understandable criticism. I don’t think that I’m actually minimizing the risk, as my flu analogy makes a different point. I think that the extreme efforts taken, by individuals and governments, to stop the spread of COVID-19 are doing much more harm than good.
About 80% of COVID-19 fatalities have been people aged 65 and over. Using the same calculations that I set forth above, this implies that the risk of a person under 65 dying from COVID-19 is around 0.02%-0.08%. (This is not the IFR for this group — it includes both the risk of getting the disease, 50%-70%, and the risk of dying from the infection.)
I find this to be a negligible risk. Not zero, of course, and I wouldn’t play Russian Roulette even if there was only a one in 1,000 chance of having a bullet in the chamber. But living my life is not like a pointless game of Russian Roulette, with no upside benefit to the gamble but a nihilistic thrill. I need to actually live my life, take care of my family, see and teach my friends at church, and earn a living. I’m willing to accept this low risk of COVID-19, with little or no change to my behavior.
This is why I find it helpful to consider COVID-19 to be like the flu, or like a number of other risks that we regularly accept as we go about our daily lives. It is a greater risk than most of the others, but still small, and it is temporary.
Reckless and heartless demagogues like me, who compare COVID-19 to the flu, do not seem to get angry about the issue. I think that we find it to be a persuasive analogy. Not perfect, but useful. I don’t think that the analogy drives our policy determination. I think that we reach our policy determination based on the judgment that this is an acceptable risk, and that the catastrophic harm being caused by the alleged cure of the lockdown — governmental or individual — is quite a bit worse than the disease, figuratively and literally.
If you’re one of the “not the flu” folks — why take up arms against this analogy? Why does this comparison make you angry?
Published in Humor
Early on the flu comparison was used to downplay the seriousness of the virus, sometimes with an eyerolling dismissiveness. I know because I did that to people I thought were unduly alarmed. I think it was that attitude that got under people’s skin a little bit. It had nothing to do with whatever similarities might exist between the two viruses. The point of the comparison was all about how many people would be killed by it.
My major concern is that we are acting on bad information. We have problems with both the numerator and the denominator. We have no idea how many are infected and show no symptoms and we have a death count that is poisoned. The state of NY threw 179 deaths onto the tabulation in one day last week. They were not tested but assumed to be dead from Corvid19. We can’t work with “assumed.” We need proven numbers to see what’s going on.
As for the name game, at The Ace of Spades HQ site they are calling it Sino Lung Rot. That’s my favorite so far.
What he (she?) said. Your analysis of the similarities above is, typically, well done. But the flu analogies were mostly designed to downplay the prospect of illnesses/deaths–even here. We’re not discussing your points 1-7, which are well taken. We’re considering the appropriateness of assessments as to real world consequences.
One reason for the flu/not flu issue is that a lot of folks don’t accept this number as legitimate.
I am with you 100%, Jerry.
Maybe true, but considering the alternatives are fairly draconian government overreach to little or no good, I think it would be preferable for most people to think of their individual risk as being roughly the same as the flu. There are way too many people who prefer to think of this as a death sentence (see the insane adoption of masks and reaction to those who disagree and choose not to climb on board). Because of the groupthink element, the media “horror sells” fear mongering, the state overreach, and the fact that there is nothing we can really do except work toward herd immunity – it is probably far more accurate to think of this as pretty darned close to the flu.
The Fru. (h/t @miffedwhitemale)
Whatever we decide after things calm down, there is always going to be one flu that is worse than all the other flus, so on those grounds that one is not the flu.
Well, I think back to someone’s post the other day, “what’s your death number?” The goalposts seem to have changed so much on this one, how can we justify any sporting events or gatherings or churches or schools ever again? Why wouldn’t we have to socially distance and wear masks always? Why shouldn’t we be just as vigilant about avoiding the flu as well? How is anyone going to accept any death at all? We’ve decided that “public health” trumps individual liberty. No, it’s not a slippery-slope fallacy, it is a changing of our standards. Require masks, ban sugary drinks, save lives.
It really doesn’t matter how you look at COVID. When you compare it to all the other risks in life, it’s a wonder people don’t stay home 24/7 just to be safe.
Then again, staying at home is risky too. The bottom line is we take steps to reduce the risks in life. We fasten seat belts, we install smoke detectors, we lock our cell phones so our wives won’t find out about Trixie. Here is a link to a couple of charts (food for thought):
https://www.iii.org/fact-statistic/facts-statistics-mortality-risk
Most people don’t change their routine during flu season, shot or no shot. It would have been better if all COVID decisions were made at the local level – cities, towns, and counties. Even within states, one size doesn’t fit all, but what governor and state legislature can resist the lure of power in a crisis?
Nor do we have any vaccine for any coronavirus, ever. Another name for other coronaviruses: “common cold”, as in “that for which we have no cure”.
That’s an interesting chart. I do think it helps explain the reaction to the coronavirus in this way: You have to get all the way down to number 8, influenza, on the chart to get to a cause of death that is a contagious disease. We are not accustomed to dealing with something this deadly that can be passed from person to person. (It won’t keep up the current rate, of course, of approx. 60,000 per month, but if it did, covid-19 would be the top of this chart after 12 months. Even if it doesn’t keep that rate up, it would surely end up in the top 5. And this is with extraordinary social distancing in practice world-wide.)
For the other top causes listed, there are ways to reduce your risk without having much of an impact on the economy. That’s not the case with Covid-19. The fact is, until there is widely available effective treatment or a vaccine, this is a legitimate disease to fear, and it is going to cause economic problems because people are going to try to avoid spreading it. I don’t say that as an argument for continuing severe lock-downs, but I do say it as an argument for cutting governors and public health administrators some slack when being cautious in opening up, and for refraining from hyperbolic rhetoric about tyranny, etc…
The only thing I think you are critically ignoring data on is previous COVID strains. I think in comparisons where its not like the Flu we should compare to other COVID strains, which we have less experience with. But a decent amount of data. Also I agree this COVID can get you in more ways than the Flu.
However its still falls pneumonia & influenza. And although technicaly everything is not the flu that falls under that broad category. From a language standpoint its easier to say Flu than be technical about a broad category of disease. So if there’s a word. That kind of is short and easy to use. That broadly describes this General category. I say we all start using that other than Flu. But I don’t know what that term would be.
I can see cutting governors some slack, but I’m not in favor of refraining from hyperbole, not even if the governors start refraining from hyperbole.
I think we absolutely have to switch from this belief that it is primarily spread by healthy people, to assuming it is spread by sick people. First, I don’t think the first notion is actually proven, but second, we simply can’t operate as a society with 100% of people having to assume they are the invisible zombie carriers and act accordingly. We need to switch back to a “cover your cough” mitigation strategy, just as we do with the flu.
I don’t the talk of tyranny is hyperbolic. Forcing healthy (or even sick) people to wear masks is outright tyrannical, as are many of the other measures. As I said, the best we can do right now is adopt mitigation techniques used wth the flu.
Exactly. We need a vigorous testing/tracking program like the one in South Korea.
“Sino Lung Rot” is great, except that it does not properly note the prominent role of the CCP in stopping the efforts to stop and control COVID-19.
Many of the same problems with COVID-19 mortality statistics are also there for flu. Docs make interesting assumptions. Years ago a friend told me about a patient of hers, a child with classic whooping cough symptoms. The child had been immunized against pertussis, so the pediatrician had promptly diagnosed it, with no further investigation, as “parapertussis.”
There is such an illness, it is not prevented by pertussis vaccine, but the assumption that led to the diagnosis (“pertussis vaccine prevents pertussis) is not entirely valid.
With appropriate variations, rinse, repeat for other vaccinations.
My own belief is that before the vaccination era, immunity acquired by recovery from an illness was also not 100%, or that it could degrade over time in individuals… and that repeated exposure to new cases provided a natural “booster,” possibly updating the immunity to reflect mutations in the organisms.
I like the Epoch Times’ CCP virus.
There will probably be no vaccine.
We will probably all get it.
It just has to run its course like every other virus.
My main concern about the hyperbole is the loss of credibility. It’s crying wolf, and makes it more difficult to get people to hear the alarm if real tyranny shows up. It makes it more difficult for people to discern real vs. imagined tyranny. The majority of people seem to believe these actions have been reasonable and justified because there is a real threat. Trying to convince them, especially at the moment most places are easing restrictions, that they are actually the victims of sinister tyrants will sound like fringe radicalism, and will fall on deaf ears and turn them off from further discussions of that topic.
Maybe some governors are being too cautious, overzealous, but in general most governors are taking reasonable steps to open up, which has been their stated intent all along, even if they didn’t have a solid time-frame to give out. If that reopening occurs without a major spike in hospitalizations and fatalities, the overzealous governors will be under massive pressure just from ordinary politics and economics – without hyperbolic rhetoric – to do the same.
What strikes me about people who are upset by the comparison is the degree to which they underestimate the effects of the flu.
I think tyranny is all in the context. Forcing people to wear masks, especially in our culture which is traditionally suspicious of mask-wearing, is definitely an imposition on our liberty. If it is imposed by elected officials (or people serving under elected officials), who are regularly held accountable and must stand for election with some frequency, where there is a free press, where there is free speech, where there is access to the courts, where there a representative legislature, and when there is a clear danger, even if it ultimately proves to be an unnecessary move, then it is not tyrannical.
When the British crown shut down Boston harbor, that was rightfully seen as an act of tyranny. Not just because the harbor was shut down and the people were burdened and liberty restricted, but because it was done to basically punish the colonists for behaving as if they were more than just colonists. It was done by a distant, unrepresentative government, which imposed laws on the colonies in order to help the crown win a game of global politics – it treated individual colonists as pawns in the crown’s game.
If the Crown had closed the harbor for a few months to prevent the importation of a deadly disease, which had already occurred elsewhere in the world and had killed thousands, the colonists would have seen that as a legitimate use of authority. There would still have been smuggling, disobedience, complaints about the economic impact, but no armed revolt.
I’m glad there are people who make a fuss about it to remind us of the coercive nature of government, but wearing masks is pretty low on the list of coercive measures I’m concerned about. Governments have often forced people to wear clothes in public, ostensibly for health reasons in some cases, so this is more of the same. We are also forced to wear seat belts for our own good, so while that may have been a step in the wrong direction, I don’t think that’s the slipperiest spot on the slope.
More worrisome are the bailouts, which are going to result in increased control of our property and economic life. The increased control over health care and the increased monitoring of individuals are also danger points. The easy use of emergency powers by governors, with willful brushing aside of legislatures even when there is time for them to act, is also a bad precedent.
That’s not the end of it. We should probably be making lists.
I urge you to read about how South Korea was successful in stopping COVID-19. https://www.theatlantic.com/ideas/archive/2020/05/whats-south-koreas-secret/611215/
Again, pick one. Masks or testing and tracing. The comparisons to SK are foolish. If one is necessary, the other is completely ineffective. But that’s what people want to do, throw in the kitchen sink.
Right now, the mood I detect is “1944”–it’s now clear we’re going to win. Most of us are going to make it. The costs have been high, but they could have been higher. They credit Trump for that. People are reasonably satisfied that the president handled a tough, unprecedented situation well, about as well as he could have. Even in Santa Monica, where I live, they don’t blame Trump for what we’ve been through. They blame the Chinese government; they blame bad luck and a nasty virus.
But here’s where real life differs from Ricochet: they don’t blame Gavin Newsom either. Like Trump, he’s seen as somebody who is stuck with doing a job. They don’t see him, and I don’t see him, as a demented tyrant. It would be politically useful for conservatives not to sleepwalk into this election thinking that the whole country thinks like Scott Adams. If we do, we will lose. That loss would hurt. Bigly.
For a while. People get tired of living in fear. It’s clear we’ve reached the “eff it – I’m going out” point. It’s one thing if an individual cowers under a rock. It’s another if the stone is placed on someone to hold them down . . .
I would choose testing and tracking with mandatory quarantines. Masks can be voluntary, as can be closures.