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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
I’ll take masks over testing and tracing.
Until I read in detail the CDC explanation of how it determines the number of flu cases and deaths I hadn’t realized how potentially inaccurate it was and how little mortality is based upon actual diagnostic tests. It is more inaccurate, and more likely to be overstating deaths than with Covid-19 estimates. There are plenty of puts and takes with Covid, as they always are with such estimates, but still better than the flu.
It would certainly help to know the answer to that question. If it turns out that asymptomatic carriers do not spread it, this gets a lot easier to deal with.
Here is something else I think is becoming clear, but isn’t being discussed fully.
https://www.usatoday.com/story/news/nation/2020/05/05/patients-florida-had-symptoms-covid-19-early-january/3083949001/
The virus has been here longer than previously assumed, and it is far more widespread than previously assumed. We can theorize that these curve-like graphs are an incomplete part of the picture, and likely a product of testing. Deaths are more interesting, because we have no agreement as to what causes death. If we tested every death for the common cold, we would find a lot. Yet this virus actually does kill some people, obviously.
Point being, there is a lot of conflicting information. A lot that simply doesn’t add up. Those proposing massive state-imposed solutions are confident that their interpretations are correct, though they often contradict one another.
I’m with @daventers on the reason for the initial pushback on the comparison.
I agree with all of your 7 points regarding similarities between flu and Covid except #2. Specific biological mechanisms are still being determined but the clinical effects of Covid compared to flu are different, or in some other cases, amplified. The anticipated ventilator crisis arose because at the beginning docs thought treatment would parallel flu and pneumonia but because of the way Covid attacks the lungs and the reaction of lung cells it turns out ventilators often did more harm than good. It’s why x-rays of lung inflammation of Covid patients looks very different from flu/pneumonia and why many patients with Covid have low O2 levels yet are still functioning whereas normally those levels would leave patients incoherent, incapacitated, or even dead. The very unexpected levels of clotting in Covid patients, which has led to strokes and heart attacks, has caused some to ask whether it is more a cardiovascular than lung disease. Doctors are also seeing amounts of renal failure exceeding what they’ve observed in the past with the flu.
Thank you for your calm and intelligent bringing forth of a needed discussion. I for one very much appreciate it.
My thoughts
1 If any individual does not want to consider COVID 19 as being a flu, they need to ask themselves: why was the public told for months that it was a corona virus? We in the public herad the expression “Wuhan flu” or Chinese flu for weeks until the Lefties decided smearing the good people of Wuhan or China was the msot racist even to ever occur in the USA. (Even their own Talking Heads were using those terms, until the racist meme came out not to. No apologies from the likes of Rachel Maddow for being racist, though.)
2 Corona label indicates – now and for ever in the past – a cold, either minor or serious, or a flu.
If there are individuals that consider that this virus is not corona related, why the mislabeling from the same experts” who now indicate that they themselves have the intelligence and comprehension of this illness to keep all of us in Calif under lockdown for another 18 months.
3 If it is to be considered a SARS 2 affair, then these individuals are on the same page as Judy Mikivits, who they tend to denounce. So some explanation for that is needed.
In my view, whenever an issue’s “experts” attempt to belittle people for being human, it shows their desire for control. When a bunch of us in Lake County tried to sort thru the legalizing of marijuana issue, regardless of which side we were on, we were told that simply using the “m” word disqualified us from partaking of the discussion, as only the word “cannabis” should be used. That taught me overnight that those who wish to control language are about enforcing their desires and plans, to the exclusion of everyone else.
“Mandatory quarantine” = house arrest. That’s a very bold move.
Here is a wild thought, Gary. What if this really ends up being 100-200X more widespread than you think? Just as a hypothetical. A common cold with some unique characteristic that makes it potentially deadly for some certain group of people?
99% common cold, 1% very bad flu, depending on who you are.
Your proposal is “anyone could be a body snatcher. Trust nobody. Arrest everybody!”
My proposal is “hot damn! We need to figure out who this 1% are and what they all have in common. Then we need to protect them.”
In the meantime, where government is concerned, we err on the side of individual liberty, individual assessment of risk. I thought we learned long ago that nuclear bombs aren’t the best way to solve problems.
Fact is, if they do spread it, masks are pointless and we are probably quickly approaching herd immunity. If they do not spread it, tracing may be possible. The sheer number of cases very strongly suggest the former. Unfortunately, a lot of claims that we’re hypotheses in March have become common knowledge through mass repetition.
BTW, we “do not have a wewll established treatment” for COVID 19 because Big Pharma and one of its major patrons Bill Gates are hell bent on seeing to it that a vaccine, and only a vaccine, will be the only available treatment.
The fact that using the proper amounts of hydroxychloroquine has brought about excellent results even for critically ill COVID patients is being suppressed. When I discuss a new study of this medicine on FB, I spell the term backwards as otherwise, the Zuckerberg’s see to it that the post is deleted.
The couple came out a few weeks ago to say they were partnering with Bill Gates, who is a friend and even better than that, the savior of humankind. The only thing they have to contribute is “pihsrosnec.” So that is the path they are taking.
As someone else brought forward, there is also a Vit D protocol that is being used with good success.
Many of the people who have died due to COVID would have died within weeks of being infected with the virus. The one person I know of who has died is the parent to a fellow member on a FB group. Had he not been affected by COVID, he was not expected to live out the summer. In fact, the doctors had stated this patient would not live to see July 4th. It might not have been possible to save this patient regardless of what remedy and treatments had been chosen.
However as Bill Gates sees to it that there are hydroxychloroquine studies underway, I rather suspect he will fill up the studies with exactly that sort of COVID patient. available
Quarantines of those who are actually ill have a long history and are justified.
Quarantines of the entire population because some are ill, no so much.
I would expect that if asymptomatic carriers do spread it, they could very possibly spread it at a lower rate than symptomatic persons. And even symptomatic persons start out as asymptomatic for the first several days. It’s complicated.
What that tells me is that the number of deaths is more severely “overcounted” than the bad definitions are causing. Not that people haven’t died, but that they were preventable deaths. As our mode of treatment is better understood, covid becomes less and less deadly.
Track criminals, not citizens.
and, here’s where we descend into conspiracy ville again.
Super important for people to pick up on several things that have happened:
Oct 2019: Cal State legislature passed AB262, which removed the past constraints on County Public Health Officials, making it possible for these petty bureaucrats to now have dictatrial powers. (With only Gavin Newsom being able to impede them, and he has no intention of doing that.)
Oct 2019: The 201 event occurs in which Mike Bloomberg, Bill Gates, and Johns Hopkins people simulated a pandemic event. You can read up on it here:
https://www.centerforhealthsecurity.org/event201/
January 2020: according to at least one Congressional staffer, the CARES/Stimulus package was already being worked on by certain members of Congress. (I have not vetted that one.)
Also start noticing the language that is being used. When I post things on FB, the crowd that comes aboard to slam my comments are not people saying they are doctors or nurses, but “bio tech.” Look into event 201, and see how the various aspects of “any proper handling of a pandemic event” are labelled.
I do not find the notion of “health security” very reassuring. The very expression indicates we are turning our health care system, already very broken, into a National Security system. It means that I am no longer considered an individual with rights, who may at some point be a COVID patient needing a treatment available now, rather than six to 18 months in the future. Rather due to my thinking independently, those involved into turning our health care system into a “health security” system could label me a terrorist for not sheltering at home, for not wearing a mask, for asking grocery store clerks to not sanitize the counter, or even for writing a letter to the editor supporting hydroxychloroquijne.
If the seasonal flu deaths were counted like COVID-19 deaths are being counted, where you have a confirmed diagnosis, an actual body with a medical chart saying what it was and so on, then there would only be about 4000 seasonal flu deaths a year.
Someone did a survey and found that most internal medicine doctors have never seen anyone die of the flu. The numbers of seasonal flu deaths like you cited are estimates, and they might be way off, which the CDC admits. Apparently, most people who die with the flu are not diagnosed with that because something more immediate killed them.
So the scenario where someone gets the flu and then dies of it is very rare.
It’s like in New York City right now, according to one survey, 14% of people have antibodies to the COVID-19 virus. If you survey all the people who die you’ll probably find that same percentage. Does it mean that COVID-19 contributed to the death of someone who had a heart attack? I don’t know how they’d determine that.
Right now in the US ~2000 people a day are people who got COVID-19, had to go to the hospital with it, and then died. That’s a lot worse than the seasonal flu.
Can I just say that is such a great observation. Comparisons only work if listener understand the context/subject of the comparison.
I would slightly disagree with that. From what I have read. Previously unknown strains would go into an unknown category. Now the unknown defaults to COVID-19. Yes most of the unknown would most likely end up being COVID-19 if tested.. However this could be overstating COVID-19 death rate by lumping other unknown strains in its rate.
However if the unknowns make up a small % say no more than 10% to 20% of total COVID-19 deaths. It will not mater on public policy or decision making (will within there margin of error). So it does not mater so it does not change the story.
However if untested deaths start going into the majority of reported COVID deaths. Then yay we have a data collection issue related to this specific strain.
Unless what you are saying is there is much more testing going on now than normally with P&I deaths in a given season. So there is actually fewer untested P&I deaths. Then you might be right. However, I have not seen anything to otherwise indicate that.
Right, but if you’re dealing with something widespread where 99% of cases are like the common cold, quarantining “the sick” is not so straight forward.
I don’t disagree entirely, but I also don’t think that’s quite accurate. Many people are hospitalized and die, and virtually every death is being tested for covid. Unless I’m mistaken, positive tests are counted covid deaths. Some of those are caused by covid, some are not. As an example, what do you think would happen if we tested every death for the cold? There would be roughly the same number of positives as exist in the population at large.
You are miss understanding the data. Most people don’t die from pneumonia. They die from influenza caused by the pneumonia. That is why the CDC lumps the to together. We are talking almost totally about influenza deaths, with the 28k to 68k number.
What you can’t argue with is the overall mortality rate is up while accident deaths are down in hotspots. Are you claiming the increase in local mortality rates (which is normally fairly steady week to week) above the norm for the flu season is not from COVID-19?
We need to look at COVID-19 Death rates verses the delta above the norm on mortality rates. If COVID-19 reported deaths are say double the increase in Mortality Gap numbers. Then you have good evidence its being overstated. I am not seeing that with the limited morality rates I have seen so far.
Gosh, I don’t know. Well, before we go headlong into South Korean mandatory quarantines, let’s first start with quick testing and tracking.
I think that I may have been too expansive.
Mark, you may be right, but the evidence is quite limited right now. I’ve seen the reports of odd behavior similar to people with oxygen deprivation, but these seem anecdotal at present, and I don’t necessarily believe everyone who is a doctor (or claims to be a doctor). There’s a lot of misinformation out there. I’m not even saying that it’s wrong, just that it is unclear. I’d be interested in seeing more, if you know of any authoritative references for these claims (meaning something other than, say, a YouTube video by someone claiming to be a nurse).
Most of the mechanism, and symptoms, seem similar to bad cases of the flu.
Gary, I’ve been skeptical of these claims about the effectiveness of contact tracing, or that we know precisely why South Korea avoided this plague. They appear to have done so. I’ve heard experts claim that contact tracing a respiratory virus is essentially impossible; others claim that it works. It seems quite implausible to me that it would work well, given the extremely large number of contacts that people typically have. This plays into a political argument, in which people point to South Korea in order to indict the leaders of every other country that has had a worse result.
I don’t know why South Korea has had such an easy time of it. It may have been as simple as putting on masks — something that we have not yet been ordered to do, or even advised to do with any urgency. This may have been a major error on the part of our public health officials, and those in many other countries.
Germany had a contact tracing program, I think — I’ve mostly heard about it from Mendel. Per Worldometer (here), this hasn’t prevented a major outbreak, as Germany has 2,000 reported cases per million, while South Korea has 211 per million. Germany is a bit better off than most other Western countries, but not much — the others generally range around 2,000 to 5,000 per million. All of these are reported, confirmed cases, probably much lower than the actual number of infections that have occurred (many of which are reportedly asymptomatic).
Germany has been strangely fortunate in having a low number of deaths, currently 86 per million, compared to 222 per million for the US and around 400-550 for the other major Western European nations. Again, I don’t think that anyone knows why this is so.
I don’t think that I’m particularly politically motivated in my assessment of these things. I actually wouldn’t expect either Donald Trump or Andrew Cuomo to know what to do in response to a pandemic. I’d expect this to be brought to their attention by their public health experts — which it was — and I’d expect those experts to give good advice. Unfortunately, my impression is that the President and governors — and the rest of us — got very bad advice in the early days, followed by an overreaction that sent us into lockdown mode.
It may also be that exposure to sars1 caused a sort of immunity. It may also be that they count differently. It may be genetic. The post hoc ergo propter hoc fallacy has come to define what many people are believing to be true about covid.
Three felonies a day. We’re all criminals now.
I agree with this and it is a good point. However, I’d also mention that in some years the deaths to flu cause local mortality rates above the norm for the flu season, too. Those are not as far above the norm as we’re seeing this year, though (as far as I know).
I will look for the article I’ve read from doctors as well as watching the emergency medicine livestreams from doctors in places like NY and LA who are treating Covid patients (they are not claiming to be doctors, they are doctors). It’s also reflected in changes in the treatment guidance EM and ICU doctors are getting (including my daughter who is an ER doc) regarding ventilation and more use of anti-coagulents. Some of the difficulty in getting precise data is that we are in the midst of this and the docs are reporting what they are seeing on a day to day basis but they don’t have the time to do analytical studies.
I would also recommend following Dr. Roger Seheult’s MedCram videos on YouTube. He’s working directly with Covid ICU patients, and also paying an extraordinary level of attention to what is happening elsewhere. I think this is an ICU week for him and he doesn’t have time to do as many videos on those weeks. But he has done some.