COVID-19 vs. Seasonal Influenza
Dear Family, Friends, and Colleagues,
Over the last several weeks I have been dismayed by some of the inaccurate and purposely misleading information I have encountered on social media and elsewhere with respect to the ongoing COVID-19 pandemic. More frequently, I have been contacted through various outlets by individuals requesting my thoughts on myriad issues regarding COVID-19. To be sure, Christie and our family discuss daily the medical facts about what is transpiring. With that in mind I am going to write a series of factual summaries that will attempt to provide some unbiased education about this international crisis. As physicians and scientists, we must do a better job of communicating with the general public, as this pandemic evolves and we learn more. I would add that we cannot leave this solely up to the national experts such as Dr. Anthony Fauci or Dr. Michael Osterholm. These true experts and leaders are guiding the response and setting the tone for all scientists and medical professionals, but they clearly cannot convince the populace alone to adhere to recommendations. This takes all of us and I would argue that it is our duty to reach out to our social circles to provide ongoing education and information.
First let me provide a general disclaimer. I am not an infectious disease expert or an epidemiologist. My expertise resides in pediatric oncology, basic laboratory science, and patient advocacy. However, this expertise does position me to carefully assess the literature and communicate its meaning broadly to the lay public — something I do frequently within the pediatric cancer advocacy community.
With that out of the way, I wanted to start today by discussing two phrases commonly used to describe SARS-CoV-2 (the virus that causes COVID-19).
1. It is just a virus.
2. It is less severe than the seasonal flu, so why are we making such a big deal about it.
While viruses may seem like simple, mostly harmless entities for which we have the basic medical knowledge about how to combat them, this is far from the truth. There are numerous viruses that widely inflict disease and long-term health complications in the human population. New and novel viruses continue to arise and present additional challenges. As a group, viruses cause untold suffering worldwide in the human population; they cause heart failure, liver failure, renal failure, severe infection of the brain, and can completely wipe out the body’s ability to make blood cells and destroy the immune system. They have a significant role in the incidence of autoimmune diseases and cancer. Right now, we are dealing almost exclusively with the acute effects of SARS-CoV-2 and the long-term health burden is completely unknown. That should cause all of us to stop and think about our individual behaviors. Finally, as a general rule, viruses are extremely difficult to treat with small molecules or drugs — unlike some bacterial infections for which antibiotics work reasonably well. In the case of viruses, we do have some therapeutics, but often they are not greatly effective and many carry additional health risks. So while it may seem like “just a virus” is a reasonable assertion, I would argue exactly the opposite. Therefore, the use of the word “just” as a modifier should be removed from any discussion of SARS-CoV-2
A comparison of mortality caused by COVID-19 and seasonal flu is telling. In Figure 1, I have compared annual mortality from seasonal influenza to deaths related to COVID-19 to date. First, it is important to understand some of the specifics about how these numbers and plots are derived. Unlike COVID-19, seasonal flu numbers are not a reportable disease, so these are estimates generated through scientifically sound statistical algorithms. More information can be found at: https://www.cdc.gov/flu/about/burden/index.html. Second, I made this comparison because it clearly shows the significantly higher U.S. mortality caused by COVID-19 compared to each of the past 10 annual flu seasons. For the purposes of this comparison I used the actual numbers of COVID-19 deaths reported to date and then applied a 20% variance to generate an upper and lower limit. While this is not necessary because COVID-19 IS a reportable disease (required), I wanted to provide some idea of the possible range, knowing that some will doubt any numbers that are publicly available. Even if we are over-identifying by 20%, COVID-19 deaths still dwarf annual flu. However, a comparison between overall mortality data from months in 2019 and 2020 strongly suggests that COVID-19 mortality numbers are likely underestimating the true impact of the pandemic by as much as 20%. To me, all of this strongly indicates COVID-19 is orders of magnitude more severe than seasonal flu. The COVID-19 numbers represent approximately 5–6 months of data and our best models indicate that the 12-month total may ultimately end up somewhere between 300,000 and 500,000. That is a scary number and one that everyone should contemplate.
