Comparing Flu and Covid-19

People who keep calling Covid-19 "just the flu" haven't looked very closely at the numbers.

We seem to have gone full circle and some in conservative media are returning to the “it’s just the flu” mantra. For example, here’s former Secretary of Education, Bill Bennett, pontificating on Fox and Friends:

Bennett cites the projected death toll of 60K to Covid-19 and then cites he 2017-2018 flu death estimate of 61K. For context, here are the CDC flu-related death estimates from 2010 through 2018 (as well as the possible range, since these are all estimates and not actual counts):

SeasonEstimated Deaths95% U I
2010-201137,000(32,000 – 51,000)
2011-201212,000(11,000 – 23,000)
2012-201343,000(37,000 – 57,000)
2013-201438,000(33,000 – 50,000)
2014-201551,000(44,000 – 64,000)
2015-201623,000(17,000 – 35,000)
2016-201738,000(29,000 – 61,000)
2017-2018*61,000(46,000 – 95,000)
2018-2019*34,157(26,339 – 52,664)

First, note that 2017 is the highwater mark for flu deaths over this nine-year span. Not to be cynical, but it does make one wonder why that year is the one chosen as the exemplar (actually, forget being cynical, it is obvious that that is the worse year and makes the best comparison to the current Covid-19 death toll projection).

Second, that with 25,733 deaths as of this writing, Covid-19 has proven more deadly than the flu did in 2011 by a factor of more than two and has also surpassed 2015–all in a span of roughly three months, rather than a year. As such, the flu comparisons start to break down more than a bit.

Another area of breakdown is looking at New York to see if the deaths from flu really are comparable to Covid-19. Guess what? The death toll in New York from Covid-19 suggests that comparing it to the regular flu season is a massive mistake. As of the evening of April 14, 2020, New York has had 10,834 Covid-19 deaths. How does that compare to the flu? Well, The CDC has flu deaths for NY as follows for 2005, and 2014-2018 (I have no idea why this page has 2005 and then jumps to 2014):

  • 2005: 5,521
  • 2014: 4,702
  • 2015: 4,881
  • 2016: 4,513
  • 2017: 4,517
  • 2018: 4,749

So, in less than three months, Covid-19 has been over twice as deadly in New York state than the flu typically is over a twelve-month span. For example, if we just use three months to make it easy, Covid-19 has killed 3,611 residents of New York state a month. The worst flu season for which I have data is 2005, and that is a per month death rate of 459.

Calling this just the flu is irresponsible and inaccurate.

A key issue to highlight in this comparison to underscore that these flu death estimates are not just from people who have “influenza” on their death certificates or who have necessarily tested positive for the flu. From the CDC in answer to the question “Why doesn’t CDC base its seasonal flu mortality estimates only on death certificates that specifically list influenza?” (all emphases are mine):

Seasonal influenza may lead to death from other causes, such as pneumonia, congestive heart failure, or chronic obstructive pulmonary disease. It has been recognized for many years that influenza is underreported on death certificates. 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. Additionally, some deaths – particularly among those 65 years and older – are associated with secondary complications of influenza (including bacterial pneumonias). For these and other reasons, modeling strategies are commonly used to estimate flu-associated deaths. Only counting deaths where influenza was recorded on a death certificate would be a gross underestimation of influenza’s true impact.

All of this is relevant in terms of understanding, in general, how death estimates are not straight-forward processes of testing corpses and declaring the presence of a virus or not, and then assigning the cause of death. Further, if it is true that flu deaths which result from a regular and known annual process are undercounted, it is extremely likely that Covid-19 deaths are also being undercounted (especially given the dearth of tests available and since this is new to everybody).

In other words, beliefs such as those expressed by Brit Hume that I noted the other day that we are over-counting Covid-19 deaths because people die of multiple conditions makes no sense when you think about it all (or when you understand how we count flu deaths).

In simple terms: the people who are comparing the Covid-19 pandemic to the regular flu season are not doing a very good job of it. They are picking the outlier of recent years as the exemplar of the death toll of the flu, they aren’t doing a regional analysis, and they aren’t even taking the time to understand how flu deaths are recorded. And yet, they feel quite confident going on national television and pontificating about this is “just the flu.”

While I continue to agree that the toll on the economy of current social distancing policies are real and will need reevaluation as we go forward, I continually find the admonitions that “it’s just the flu” to be lazy and irresponsible at best and purposefully dishonest at the worst.

FILED UNDER: COVID-19, US Politics
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is a Professor of Political Science and a College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. Just nutha ignint cracker says:

    Bill Bennett, Book of Virtues notwithstanding, is simply another political animal who will say whatever is necessary to justify whatever position he holds on any given day. There is no compelling reason to give his bloviations any more credence than those of any rando on a street corner.

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  2. mattbernius says:

    First, note that 2017 is the highwater mark for flu deaths over this nine-year span. Not to be cynical, but it does make one wonder why that year is the one chosen as the exemplar (actually, forget being cynical, it is obvious that that is the worse year and makes the best comparison to the current Covid-19 death toll projection).

    It’s a standard dissembling tactic. It’s much like how climate deniers historically clung to the extreme outlier year of 1998 to claim that there was no evidence of sustained warming. They have recently been moving to more recent outlier years (which have exceeded 1998) in order to reset this empty line of argumentation.

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  3. @Just nutha ignint cracker:

    There is no compelling reason to give his bloviations any more credence than those of any rando on a street corner.

    I don’t. FNC viewers do, however (and therein lies the problem).

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  4. DrDaveT says:

    Of course, the fact that we would have twice as many deaths by now (and climbing rapidly) if we hadn’t taken extraordinary countermeasures is completely lost on these bozos. “It’s not any worse than the flu, if you lock down the whole country and shut down the economy” doesn’t sound quite as compelling as an argument.

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  5. Joe says:

    In order to do any real comparison, you would have to view COVID19 in the same no-response circumstances (other than flu shots) as the seasonal flu confronts. You would also then have to watch as COVID works its way through large a small population centers over the course of a year. In fact, with the greatest of social distancing, self-isolating and quarantining, we can at best to keep COVID19 from being only a major outlier and not approach a decimation of the country’s population. I still fear what it may still do in less developed, more crowded and more chaotic countries.

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  6. gVOR08 says:

    @Just nutha ignint cracker: Thanks for the confirmation. I was going, “Bill Bennett, wasn’t he the morality scold with the gambling problem?”

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  7. gVOR08 says:

    @DrDaveT:

    Of course, the fact that we would have twice as many deaths by now (and climbing rapidly) if we hadn’t taken extraordinary countermeasures is completely lost on these bozos.

    And in a month, if not tomorrow, the bozos will be saying, “See, we were right, it’s only X tens of thousands dead. Those anti-Trump pointy-headed experts said millions.” without noting it would be a million if we didn’t do what we’re doing.

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  8. Teve says:

    @gVOR08: they’re already saying it!

    linky

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  9. Kathy says:

    Keep in mind, too, that the regular flu didn’t take a holiday and let COVID-19 do its work. Many of the COVID-19 deaths are in addition to those caused by the flu.

    Also, if we had universal paid sick leave, and encouraged those with flu symptoms to stay home, as well as allowing those more at risk to work from home, flu-related deaths would go down. Add frequent hand washing, some more personal space, and they would go down further.

    We get flu shots every year, but these are a bit hit and miss, as there are several strains of flu and the vaccine only works for some. This is much better than nothing, but the current pandemic shows us avoiding a disease is far better than fighting it.

    We don’t need to close down the world’s economy for the flu, but we can plainly see we don’t do as much as we could to contain it.

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  10. Just nutha ignint cracker says:

    @Steven L. Taylor: @DrDaveT: @Teve: We have no control over what stupid people decide to believed. As I was noting yesterday, the owner of the clinic that I go to is touting the virtues of hydroxychloroquine, azithromycin, and zinc (wtf???) as the cocktail that will lead to an effective treatment for Covid-19–and he’s a board certified Internal Medicine specialist. Fortunately, I don’t have to rely on him personally for my medical advice because he has staffed his clinic with about 15 or so young competent practitioners who are as knowledgeable as he used to be about the stuff I care about (my PCP is the best one I’ve had in the US since a guy about 20 years ago). The same thing holds true about Bill Bennett and the other whack jobs out there carrying Trump’s water. The best that I can do is ignore them and shake my head when other people rely on what they say.

    But I can’t make stupid go away. None of us can–no matter how hard we wish for it.

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  11. Just nutha ignint cracker says:

    @gVOR08: Yeah, that’d be him. Glad to be of service. 😉

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  12. DrDaveT says:

    @Kathy:

    Also, if we had universal paid sick leave

    There are three OECM nations that don’t have universal paid sick leave:
    US
    Canada
    Japan

    Once again, we are a third-world nation in an important way, because Freedom!

    As it happens, I will be discussing an NBER working paper on this topic in a few days. It’s not a perfect piece of research, but it’s generally sound. Bottom line: paid sick leave mandates don’t hurt anyone, and might even make small businesses more profitable (due to higher productivity of workers and healthier workforces). On the other hand, mandating paid sick leave doesn’t actually lead to everyone having paid sick leave.

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  13. de stijl says:

    There is major issue in that many people think they have the flu when then have a norovirus.

    Flu will kick you butt hard for week. So hard that contemplating whether to get up and pee is a major life decision. Can I make it there and back without falling down?

    A half hour from now, I might have more energy. Crazy fever dreams.

    Influenza, actual flu, is nasty. Lost twenty pounds and I weigh like 155 soaking wet.

    Sometimes you do not have a choice. You are going to vomit and have diarrhea simultaneously. Pro-tip: sit and aim well; Be prepared to clean yourself.

    People compare Covid 19 and “The flu” spuriously because they have never actually experienced the flu.

    Actual influenza will kick your ass hard for a week.

    This is harder and stronger and way more lethal.

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  14. Kit says:

    @Just nutha ignint cracker:

    We have no control over what stupid people decide to believed.

    I guess that depends on what you mean by control. The fact that these people’s views are remarkably consistent points to their being manipulated. What sort of control we as a nation can exert over that manipulation is a question that demands much more attention.

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  15. JB says:

    @Just nutha ignint cracker: In vitro, the zinc enters the virus-infected cells by pores created by hydroxychloroquine and inhibits an enzyme crucial for viral reproduction.

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  16. KM says:

    We need to start focusing on a different angle on this to get the seriousness across. When anyone complains that COVID-19 is like the flu, I respond with “how often does the flu put you in the hospital?”. Seriously, if “flu” is as common and non-lethal as everyone seems to think it is (it’s not), then why are so many people needing to be on vents? The natural lethality rate is actually higher since a vent is normally extraordinarily means for flu treatment but distressingly common for COVID-19.

    The normal hospitalization rate for influenza is around 2% , whereas COVID-19 is running at over 12% nationally. In some places it’s as high as 20% – 1 in 5 needing a hospital stay is *not* normal. Everyone’s looking at the single digital death rate and thinking “that’s a small number, I’ll be fine” and they’re not exactly wrong. However, having a 20% chance of racking up a huge hospital bill and permanent damage after being hospitalized for a sickness is something people would less likely to risk.

    Truth is, you aren’t likely to die from this. What it will do is ruin your health and saddle you with an economic burden you couldn’t pay off even when the economy was good. The odds of that are abnormally high, about the same odds as Russian Roulette with a six-shooter. This isn’t the Deer Hunter, folks – if that scene seemed risky to you, then so should COVID-19.

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  17. Jay L Gischer says:

    @KM: And…It’s about three times as infectious as the flu. It is more infectious than the common cold. One person can go to a business meeting or a concert or a church service (or a meat packing plant!) and get 200 other people sick in an hour.

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  18. gVOR08 says:

    @Kit:

    What sort of control we as a nation can exert over that manipulation is a question that demands much more attention.

    That. The Might RW Wurlitzer is the number two root cause of our problems, after money. If Rupert Murdoch tries to move to Canada I hope they have the good sense to shoot him at the border.

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  19. @Just nutha ignint cracker:

    We have no control over what stupid people decide to believed.

    Control? No. But there is always some hope of educating some. If human beings couldn’t learn, we’d still be living in caves.

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  20. Just nutha ignint cracker says:

    @gVOR08: Still, the MRW is most effective by figuring out what people want to buy and selling them that. It helps explain why Ayn Rand sold selfishness rather than altruism as a virtue. Also easier to sell racism than brotherhood, independence than community, meritocracy than equal opportunity, and so on.

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  21. KM says:

    @Jay L Gischer:
    But they don’t care about that. Anyone you have to bust my argument out on doesn’t give a damn that they’re a plague carrier. Self-interest is how you get their attention. They won’t care they’re killing someone’s Grandma but they are going to care that a medical bill running over $100K is very likely in their immediate future.

    Anyone itching to “open up” again too soon is someone who probably can’t afford to lose their house/car/everything they own after spending a week on a ventilator….. and that’s presuming they still had their job and insurance. I have *no* idea what unemployed people who catch it now are going to do when the hospital wants the bill paid. Too many people shirk on the bill and hospitals have to close, making the whole thing worse in an economic death spiral. Being furloughed/let go *sucks*. Being furloughed/let go, then catching COVID-19 and being left with devastating debts for life because you rushed out to try and restart the economy too soon? Horrifying and definitely going to happen to people.

    Dear “it’s just a flu” people: If you can’t do the right thing for the right reason, do it for the selfish reason. All that medical debt will hinder American economic revival (other countries won’t have this concern) and weaken us as a nation. It will ruin your life, your health and your ability to hold down a job. You can lose everything you’ve ever worked for and destroy your family’s future. Dying from COVID-19 is not your biggest concern should you get sick……

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  22. gVOR08 says:

    @Just nutha ignint cracker: True dat. Murdoch’s innovation was to apply the same principle as any other retail marketeer, give people what they want. Innocuous if you’re selling women’s fashions, problematic if you’re peddling the daily news. But he’s made a lot of money doing it.

  23. Just nutha ignint cracker says:

    …do it for the selfish reason. All that medical debt will hinder American economic revival (other countries won’t have this concern) and weaken us as a nation. It will ruin your life, your health and your ability to hold down a job. You can lose everything you’ve ever worked for and destroy your family’s future. Dying from COVID-19 is not your biggest concern should you get sick……

    There you go. Much easier to sell. 😉

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  24. Matt says:

    @gVOR08: Hell I’m already experiencing people doing that.

    There are even images popping up on facebook talking about the deaths from the flu in hong kong and such in the late 50s 60s and how we didn’t lock the country down then so why are we doing it now when covid has a fraction of deaths???? WHAT DO THEY KNOW!>?!?!?!?…

    It saddens me that there are people who look at that and can’t see all the fallacies.

  25. Hal_10000 says:

    Bennett has probably taken the over in the number of people who are going to die.