The F-word in this case being flu.
This whole debate about how COVID-19 compares to influenza has been so poisoned by the nut-o-verse that it’s hard to have a rational conversation about it.
But things have changed a lot since that early disinformation regarding COVID being no worse than flu.
COVID hospitalization and mortality rates in the U.S. have fallen since that initial New-York-centered outbreak. And now, it appears that the latest mutation of the virus is resulting in far fewer hospitalizations and deaths.
And so, what was once a right-wing fantasy (“no worse than the flu”) is, in my opinion, no longer so far fetched.
Without beating this into the ground, I’m just going to show you the numbers that have me thinking about this.
First, you have to look up what the CDC gives for the closest analogs of case hospitalization rate and case mortality rate for the flu. You can find the CDC estimates at this link.
There are significant differences in methods between a “case hospitalization” or “case mortality” rate for COVID versus the flu. For COVID, a case is a formally diagnosed case — more or less, a positive test result. By contrast, the CDC’s “case” for flu is an estimate of all symptomatic cases. So the denominators differ. One is all persons with a positive test, the other is an estimate of all persons that had symptomatic disease.
The deaths for COVID are fairly straightforward, but deaths for flu involves considerable estimation, as reporting of flu diagnoses on death certificates is not as clear-cut.
So there are difference in methods.
That said, let me just lay out what appear to be the facts.
Per the CDC, eyeballing their chart, I estimate the following for a typical flu season:
- Flu case hospitalization rate 1.2%
- Flu case mortality rate 0.1%
For Delta, most recently, this is my recollection of the current rates:
- Delta case hospitalization rate 6.5%
- Delta case mortality rate 1.2%
If those aren’t exactly right, they’re close.
But now, per the South African study released today , the current estimate is that Omicron has about one-fifth the case hospitalization rate of Delta. If that’s true, then for the U.S., we should eventually find that:
- Estimated Omicron case hospitalization rate, 1.2%
Compare to flu above.
Further, I’ve already noted the near-total lack of deaths in South Africa from Omicron. So while I won’t attempt a formal case-rate calculation, it’s not beyond the pale to suggest that the Omicron case mortality rate is at least 80% lower than Delta, if not more.
Let me sum up.
Once upon a time, nobody was vaccinated against COVID, nobody had any immunity, and there were no effective treatments for it. Hospitals didn’t really know how to treat it. By contrast, just about everyone except newborns had some prior exposure to flu, 60% of the population got a modestly-effective vaccine each year, and hospitals had decades of experience treating the worst cases. During the initial outbreak, in the U.S., the case hospitalization rate for COVID was easily 10x that of flu, case mortality rate was nearly 100x that of flu. At that time, people who said that COVID was no worse than flu were just flaming idiots.
At present, most are vaccinated for COVID, others have some immunity via prior infection, hospitals have gotten considerably better at treating it, and there are some modestly effective treatments (monoclonal antibodies, anti-viral-replication drugs) available. Even then, with that, if you’d said Delta is no worse then flu, you’d have been an idiot.
Looking forward, if Omicron really results in cases with such lower average severity, you know, I don’t think I’m at all crazy for saying that Omicron’s case hospitalization and case mortality rates are starting to look flu-like.
There’s still an issue of total illness burden. Not just because a third of our population still has no immunity to it. But also because there is no comparison in this simple-minded analysis that looks at the average symptomatic-but-non-hospitalized case. Nobody talks about “long flu”, for example, but “long COVID” is a real thing.
That said, at some point, it looks like we’ve going to have to live with this in circulation. Assuming Omicron sticks around, and the South African estimates pan out, we probably need to start thinking of this the same way as flu. Get your vaccine every fall, stay home if you’re sick, and hope for the best.
I hope it remains legal and customary to wear face masks during winter flu/COVID season. This is common in Asian countries, and in hindsight now just seems like common sense. I don’t want to be denied the right to give myself a little extra protection.
But the bottom line is that if it reaches the point where the risks from flu and COVID are not so different, and the population has some resistance to it, we’re going to have to start using the F-word in this context, and just ignore the history behind that.
