Can we compare COVID-19 to the flu? Experts and survivors explain

Michael Moentmann, Leon Wheeler

In this Friday, April 24, 2020 photo, Wayne State University medical school student Michael Moentmann swabs Leon Wheeler’s nostril at a COVID-19 testing center in Detroit. Moentmann, 23, had planned to observe surgeries this spring but then a highly contagious virus disrupted everything. So he’s volunteering in one of America’s hardest-hit cities, testing police officers, firefighters, bus drivers and other essential workers who keep Detroit running. (AP Photo/Carlos Osorio)

EL PASO, Texas (KTSM) — Texas is re-opening under Governor Abbott’s order as El Paso grapples with ever-increasing cases of COVID-19. El Paso is expected to reach its peak cases in a few weeks.

On Friday, El Paso’s “Stay Home, Work Safe” order was lifted, relaxing restrictions on social distancing and allowing certain businesses to operate at 25 percent. Restaurants with 16 tables will be permitted to operate with four tables in the dining area available to patrons.

Misinformation and panic have spread as people try to understand the reality that life as we knew it six weeks ago (and before) will never be the same.

One source of confusion is how little medical experts and scientists know about COVID-19. The novel coronavirus is being compared to the flu, but CDC data, emerging scientific research and anecdotal testimony by COVID-19 survivors are demonstrating the vast distinctions.

If the devil is in the details, let us pray we understand the data and exercise good judgement.

By the numbers

According to Scientific American, a revised virus forecasting model released in April suggested American deaths from COVID-19 was projected to fall under 60,000, which prompted some to compare the pandemic in America to the annual flu season.

By the end of April, the COVID-19 forecasting model was again revised to predict at least 67,641 American deaths.

It is dangerous to compare flu death figures to COVID-19 forecast models because both are estimates based on limited data.

No one knows how many people die from the flu each year — not even the CDC. Reasons range from states not being required to report rates of flu illnesses and deaths of people older than 18, death certificates often fail to list the flu as cause of death, and many flu-related deaths result from secondary infections weeks after the initial flu infection.

The CDC uses a mathematical model to estimate the number of flu cases, medical visits, rates of hospitalization, and death. Moreover, the CDC bases its estimates by factoring in the impact of the flu vaccine. The CDC’s model employs a ratio of deaths-to-hospitalizations to predict the total flu-related deaths that will take place based on the predicted number of flu-related hospitalizations.

The CDC also considers the number of flu-related deaths where the person was not hospitalized. The CDC’s website reports:

“There may be several reasons for underreporting, including that patients aren’t always tested for seasonal influenza virus infection, particularly older adults who are at greatest risk of seasonal influenza complications and death. Even if a patient is tested for influenza, influenza virus infection may not be identified because the influenza virus is only detectable for a limited number of days  after infection and many people don’t seek medical care in this interval.”

The CDC acknowledged the limitations of its flu burden estimates, and explains it is important to be mindful of making direct comparisons to flu burden data from decades ago. These sorts of comparisons are often unhelpful, and the CDC says are complicated by shifting national demographics.

It is unhelpful to compare the rates of two viruses based on data that are mere estimates.

Interpreting the data is also leading to the spread of misinformation.

For instance, many in New York state have been confused by some report that claim the death rate is 7.4 percent, while others say .75 percent — an obviously massive disparity.

It’s paramount to understand the differences in what the figures represent. The 7.4 percentage reflects the case fatality rate, which is the number of deaths from confirmed cases. The .75 percent represent the infection fatality rate, which is determined from antibody research (the infection fatality rate of the flu is .05 percent)

By the antibodies

According to The Washington Post, COVID-19 antibody testing is revealing the complexities of the virus. Disease experts agree COVID-19 is more lethal than the seasonal flu.

Cecile Viboud, an epidemiologist at the National Institute of Health’s Fogarty International Center told The Post COVID-19 is the most severe pandemic in a century.

Provisional serological data, which analyzes the immune system’s response to pathogens like viruses through blood serums, suggest COVID-19 infections are far greater than the number of confirmed cases. Researchers say that number may be as great as a factor of 10 or more.

As many of 30 percent of COVID-19 tests produce a false negative, and many cases present with mild symptoms or none at all that are never tested.

Testing continues to be limited, which challenges attempts to obtain accurate data that legislators and health experts can make informed decisions upon.

Texas, for example, is ranked 49th in testing access and availability in the U.S.

In New York City, antibody tests have revealed about 25 percent of the city’s population is infected or has been. At the same time, more than 12,000 COVID-19-related deaths have been confirmed while several thousand more are suspected. These figures suggest the infection fatality rate to be somewhere between .5 and .8 percent, which is deceivingly benign number.

More than 60,000 lives have been lost to COVID-19 in the U.S. That means 60,000 families are mourning and wondering how to go forward.

According to Viboud, that percentage has scientific validity and is alarming to infectious disease experts. The suggested case fatality rate of .5 percent is larger than a typical flu season, which is about .1 percent.

A study conducted by epidemiologists at Columbia University developed a COVID-19 model that predicts 1 in 12 cases in the U.S. have been documented. That figure yields an infection fatality rate of .6 percent, which closely matches the rates seen in New York City.

By experience

Researchers working to develop antivirals and vaccines are finding support from people who have recovered from COVID-19 both serologically by studying antibodies and anecdotally.

Tim Herrera, an editor at The New York Times, contracted COVID-19 in March and shared his experience.

Herrera tells KTSM that his experience was similar to a medium-grade flu that also included coughing and slight chest pain.

“For me, the worst symptom was the fatigue, there was like a day and a half where it was a struggle to get out of bed, so I mostly just didn’t,” he says.

“Frankly, the extreme quarantine was the worst part. I was happy to do it, but literally not setting foot outside of your apartment for two weeks or more really weighs on you.”

KTSM has been keeping up with native El Pasoan, Doris Hagans Schwartz, on her road to recovery from COVID-19.

Schwartz cautions people to beware of the second phase of COVID-19.

“It usually comes in two waves,” she tells KTSM. “The first is the flu wave, then there’s the second part that’s hits the respiratory system. You can be extremely healthy but it just kills your lungs.”

Both Herrera and Schwartz tell KTSM they were in very good health when they contracted COVID-19.

“The range of symptoms go from flu symptoms to heavy respiratory, to ventilator,” says Schwartz.

“It’s not until it hits home or someone you know because you want to believe the best.”

Copyright 2021 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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