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COVID-19 vs. The Flu: No Need to Pick Sides

While both viral illnesses, the impact of influenza and COVID-19 cannot be accurately compared. While it may seem to some that the coronavirus is no worse than a bad flu, one has to dig a little deeper into the data to get the full picture as to the extent of the impact.

This article was first published in The Montreal Gazette.

Whenever I try to press home the point that COVID-19 needs to be taken seriously, even as cases finally start to go down, one of the common responses I face is: “Why did we overreact to COVID-19 when we don’t do the same with influenza?” There is a commonly repeated refrain that this virus is no worse and no more dangerous than a bad flu.
In reality, the flu is pretty bad. Preliminary estimates from the CDC indicate that there were between 39 and 56 million cases of flu in the United States this year, which resulted in several hundred thousand hospitalizations and between 24,000 and 62,000 deaths. By contrast, in recent weeks the number of COVID-19 deaths in the United States has surpassed 100,000. So even with this type of simple comparison, we can easily see that COVID-19 has had a larger impact.

But comparing COVID-19 and the flu becomes even more complicated when you realize that COVID-19 deaths are counted, while influenza deaths are estimated. The distinction is subtle, but significant. As was pointed out in a recent letter in the journal JAMA Internal Medicine, counting the number of flu deaths would not yield an accurate picture of how bad the flu is. Not everyone who gets the flu goes to the doctor or gets tested. Sometimes tests come back as false negatives, especially if people are tested later in the disease course. Sometimes the flu leads to a complication like a pneumonia or heart failure that ultimately causes death. So influenza might not be listed on the death certificate as the cause of death. For all these reasons, the U.S. Centers for Disease Control uses mathematical modelling to try to get a more accurate estimate of the true burden influenza has on the population. In fact, the CDC estimates are generally six times higher than the actual counts.

But while the CDC estimates the number of flu deaths, it is directly counting the number of deaths from COVID-19. Unfortunately, delays in testing mean that many people with COVID-19 were never officially diagnosed with a positive test. Many people who got sick and died at home or in a long-term care facility may also not have been tested. In places like Italy or New York where the medical system was overwhelmed, many were likely never diagnosed or counted in the official numbers as they never made it to hospital. All this to say that the number of deaths attributable to COVID-19 may be much higher than the daily number you see on the news.

As we reopen our society, we have to continually walk a line between chaos and complacency. There is an understandable argument for wanting to restart the economy, as government financial support can obviously not last forever. But the pictures of hundreds of people flooding into parks in Toronto to enjoy the nice weather were very troubling and probably explain why Ontario is currently seeing a spike in cases. It would be wrong to assume that the virus is gone. Clearly it is not.

Some people believe that this disease is no big deal. Some people believe that the Chinese government and the WHO covered up how bad it was. Some people manage to believe both at the same time. Almost everyone has missed the point.

Even though most people do recover, both the flu and COVID-19 have killed thousands of people this year. Come fall, both are likely to return and kill thousands more. What happened in New York City showed us how bad it could have been. The point is we did not overreact to the COVID-19. We just under-react to the flu. Thousands of deaths per year is not something we should be accepting lightly.


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