I see it over and over: assertions that COVID-19 is just “a bad flu,” and accusations that those who say that are wrong, wrong, wrong.
Both statements annoy me – but then, maybe I’m just getting testy from being cooped up.
Or maybe I’m not just being testy, because what annoys me is that the phrases “the flu” or even “a bad flu” are rarely defined. They seem to have become protean terms that people use as they see fit.
So first I’d like to give some definitions. For “flu”:
There are two main types of influenza (flu) virus: Types A and B. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year.
Influenza viruses can and do change quite regularly, and the people who make vaccines try (and sometimes fail) to keep up with those changes. But the viruses remain one of those two types.
Note also that word “seasonal.” There is a flu season, and although it drifts around somewhat and varies somewhat in length, it tends to be from later in the fall to sometime in the spring.
This is part of life and happens every year. But some of these seasonal flu seasons are worse than others, so there’s a lot of variation in how many people get sick, how sick they get, how many die, and the age distribution of all of the above.
COVID-19 is a different type of virus, a coronavirus rather than a flu virus. However, just to complicate matters, this particular coronavirus causes symptoms that are very very much like the flu. But we don’t know how seasonal it is. And still another important difference is that we already have vaccines for the flu, and so it’s not so very hard and doesn’t take so very long to transform those vaccines into one for a new flu strain.
That’s not true of coronaviruses. We started to develop a vaccine for the previous one known as SARS (although COVID-19’s official name is “SARS-CoV-2,” just to complicate matters). But the process was never finished because the disease ended up being far more localized than originally thought and therefore the money was never spent to fully develop a vaccine that was considered to be unnecessary. That SARS vaccine work might be helpful in developing a vaccine against COVID, but it’s nothing like the head start we ordinarily have in developing vaccines for new types of flu.
But sometimes a flu becomes a far greater killer than it usually is even in a “bad” year. Sometimes the flu becomes a far more vicious killer around the world. These flu pandemics also vary in deadliness, although they all are nasty. In the 20th century we had three: 1918, 1957, and 1968.
You probably know that 1918 was the worst of all. I’ve written about it before:
How many people died worldwide? Estimates vary, but the most conservative state that the death toll was 25 million. Oher estimates go much higher, up to 70 million or even 100 million.
That’s worldwide, in a time when the population was much smaller than today. The US was by no means the hardest hit, but it’s estimated that we lost about 675,000 Americans back when the US population was somewhat less than a third what is today – so today’s equivalent US death toll would be approximately two million.
That was devastating, and it also was “the flu.” What’s more, that illness tended to work in a way that was somewhat strange for flu: it killed the young and old, which is typical, but it also killed a far greater proportion of young adults in the prime of life.
So there’s no “just” to “just the flu,” unless you specify something like “regular seasonal flu rather than pandemics” – which is a mouthful.
But even regular seasonal flu can be very very bad. We accept it for various reasons, though. One is that we’re used to it. Another is that the media reports on it at times but doesn’t often highlight or spotlight it. Another is that it tends to kill the very old (although COVID does the same in that regard, and yet is very much in the new). What’s more, flu deaths are mostly estimated. It’s a little-known fact (at least, I didn’t know it till recently), but patients – even those who die – are not tested for flu that often.
So all these things have combined to make the terms “flu” and even “seasonal flu” take on an aspect far more benign than they sometimes deserve.
Let’s take an example from the “bad” flu year of 2017-2018. That wasn’t so very long ago, right? So we all should remember, correct? But we don’t; I certainly didn’t, until COVID came along and I started looking this sort of thing up (the article is from early February 2018):
The amount of influenza ravaging the U.S. this year rivals levels normally seen when an altogether new virus emerges, decimating a vulnerable population that hasn’t had a chance to develop any defenses.
It’s an unexpected phenomenon that public health experts are still trying to decode.
And yet it flew under the radar for most of us, although I assume that the CDC, doctors, and hospitals were paying close attention:
The primary type of influenza this year hasn’t changed enough from previous seasons to be considered a novel strain, Schuchat said. The agency’s virologists are studying it to determine if there are any other explanations for why it’s been so hard-hitting…
Deaths from influenza and pneumonia, which are closely tied to each other in the winter months, were responsible for 1 of every 10 deaths last week, and that’s likely to rise, Schuchat said in a conference call Friday. There were 40,414 deaths in the U.S. during the third week of 2018, the most recent data available, and 4,064 were from pneumonia or influenza, according to the CDC data. The number for that week is expected to rise more reports are sent to the agency.
It gets worse. The death toll in future weeks is expected to grow even higher because flu activity is still rising…
That was written on February 10. I don’t have weekly figures for later in the season, but I’m going to assume they went up, although I doubt they ever came to rival what we’ve seen lately with COVID-19. Of course, none of these are exact figures. The flu deaths in 2017-2018 were estimates. And the deaths attributed to COVID-19 may be over- or under-reported as well (are all people with COVID who die being labeled COVID deaths no matter what they may be dying from, and/or are home deaths from COVID not being properly listed as caused by the disease?). But the figures are all we have to go on.
Here’s the CDC report on that 2017-2018 season. You can see the death rate estimates that year per 100,000 people were as follows: for ages 0-4 it was .4 (or 115 total), for ages 5-17 it was 1 (or 528 total), for ages 18-49 it was 2 (or 2803 total), for ages 50-64 it was 10.6 (or 6751 total), for ages over 65 it was 100 (or 50,903 total).
Of course, we didn’t have social distancing edicts back then. And I’m not saying that social distancing is a bad idea now, because I do think that without them, COVID would be killing a lot more people. It’s already killing plenty, and it certainly seems that it’s at least going to be equal to a “bad” flu year even with all these draconian rules in place. But the big (and so far unanswerable) questions are: at what cost? How many more deaths would there have been without the rules that are crippling the economy and causing resultant hardship?
[NOTE: This is Part I of a projected two-or-more-part series on the topic of COVID and flu. My plan is to cover the following: the 1957-1958 “Asian” flu pandemic, the 1968-1969 “Hong Kong” flu pandemic, and the “swine” flu H1N1 pandemic of 2009-2010.]
