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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
Here’s a market based solution. I read that the instant tests are a loss leader at $50 a test, but are cost-effective at $100 a test.
How about letting anybody and everybody test to their heart’s content at $100 a test?
If it was antibody tests and those numbers were reported, that would go a long way toward making people feel better. I see no other way that testing does anybody any good at all.
But it enables the media to start off each broadcast with “Another grim milestone today . . . “
It was recently determined that a patient in Paris caught COVID-19 in December. He is currently the earliest one in France. Still alive, though, which is good. [Edit to fix the quote block]
I believe you have it backwards here. People (often) get pneumonia because they have the flu. Not vice versa. It is usually the pneumonia that kills. Hence, pneumonia’s (sardonic) “nickname:” The Old Person’s Friend. [Edit to fix the quote block]
I don’t doubt that there were cases here before the first official one was found, and that it is more widespread than known. I don’t think the article, and the records they discuss, however, show that with any certainty. The article mentions patients having symptoms as early as Jan. 1st, and then not actually testing positive until much later. But as we all know, the Covid-19 symptoms are similar to symptoms of all kinds of things. Even right now, the overwhelming majority of tests are being done on people with symptoms, and the tests are still coming back negative about 84% of the time. After 2 months of spread, 84% of people with symptoms of the virus don’t have it. They have something else. So, of course a large number of people who contracted the virus in Feb or March had similar symptoms weeks earlier. Like all those people testing negative now, they probably just had something else at that time.
This is a point also touched on by @gumbymark in this thread. One reason not to compare COVID-19 deaths with seasonal flu deaths is that the seasonal flu deaths are not a “count” in any meaningful sense. Here’s a good explanation of this issue.
Another point is: New York City. Yes, the mayor and the governor each made things worse, but there has not been anything like that in the US in my lifetime. The real death toll, not to mention bodies being stacked in trucks because the morgues were full, is way above anything from the seasonal flu. Maybe we’ll get through this with only double the current national death toll, if we’re lucky.
Agreed. And if they tested positive later, it is likely they didn’t have it before. Perhaps I misread and was thinking that they either went back and tested blood samples, or that they presently tested positive for antibodies.
Sure, I have no problem comparing C19 to the flu, but then I also see the flu as a killer. World War I killed off a substantial portion of the young men in Europe, and then the flu took a lot of civilians.
My grandmothers were both born in 1901, my wife’s in 1895; at one time or another in our childhoods they all got around to telling us about the flu epidemic of 1918 (As we know today, that’s an oversimplification, since there were many genetic strains, but an understandable shorthand term given the science of the time).