The World Health Organization has called attention to a COVID-19 "infodemic" – "an overabundance of information ... that includes deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals." Part of that inaccurate information is the patently false and misleading claim that COVID-19 is like the flu, only less lethal.
In less than a full year, COVID-19 has killed more than 380,000 Americans, been diagnosed in over 23 million, and certainly infected at least several times that number. Flu does infect large numbers of people but the illness is usually self-limited and without long-term consequences, and the average annual death toll over the past seven flu seasons has been about 35,000, according to the Centers for Disease Control and Prevention.
COVID-19 and the flu are both highly contagious respiratory viral diseases, but COVID-19 is much more severe. It is highly infectious, has a lengthier incubation period (during which infected persons can infect other people), and causes serious, sometimes fatal illness. COVID-19 causes pulmonary symptoms, including pneumonia and pulmonary fibrosis, and a range of non-respiratory symptoms, including loss of sense of smell or taste, confusion and cognitive impairments, fainting, sudden muscle weakness or paralysis, seizures, ischemic strokes, kidney damage, and, rarely, a severe pediatric inflammatory syndrome.
A comprehensive comparison of COVID-19 and the flu, recently published in The Lancet, compared the nationwide experience in France of the 89,530 patients who were hospitalized with COVID-19 between March 1 and April 30, 2020, and the 45,819 patients who were hospitalized for seasonal flu between Dec. 1, 2018, and Feb. 28, 2019, a particularly bad flu season. The study was revealing, and it found:
- Over a shorter time period – two months for COVID-19 versus three months for seasonal flu – almost twice as many people were hospitalized for COVID-19 than for seasonal flu.
- In-hospital mortality was much higher in patients with COVID-19 – 16.9%, compared to 5.8% for patients with flu.
- Patients with COVID-19 were more likely to need intensive care, and the average length of stay in the intensive-care unit for COVID-19 was twice as long – 15 days for COVID-19 versus eight days for flu.
- Patients with COVID-19 were more likely to require invasive mechanical ventilation than patients with flu.
Vaccination for flu in France likely lowered both the number of deaths and the disease prevalence, inasmuch as roughly 30% of the population under 65 were vaccinated and some 51% over 65 during the 2018-19 season. (Vaccination for COVID-19 should produce much greater effectiveness in curbing death and illness in the population than the seasonal flu vaccine since the COVID-19 vaccines have shown a much higher degree of effectiveness in clinical trials and are expected to get better uptake in the population.)
Unlike the flu, which usually resolves within a week, symptoms following the acute phase of COVID-19 infection "recovery" often persist. Even non-hospitalized patients who have mild illness can experience persistent symptoms or reappearance with severe symptoms. Finally, there are "long-haulers," the tens of thousands of Americans who have symptoms that can last for weeks or even months after recovery from the acute illness.
According to Anthony Komaroff, editor in chief of the Harvard Health Letter, long-haulers fall into two groups: 1) Those who experience some permanent damage to their lungs, heart, kidneys, or brain that may affect their ability to function. 2) Those who continue to experience debilitating symptoms despite no detectable damage to these organs, many of whom will develop symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Research from the CDC has quantified the risks facing the 85% percent of the persons who survive an initial hospitalization for COVID-19. Within two months, 9% were readmitted to the same hospital, and approximately 1.6% were readmitted more than once. The likelihood of readmission was higher for those 65 and older, and for those with chronic obstructive pulmonary disease, heart failure, diabetes (type 1 or 2 with chronic complications), chronic kidney disease, or obesity. Fewer than 0.1% of patients died during readmission.
COVID-19 has placed a huge burden on hospitals with overwhelmed intensive-care unit capacity, a threat to Americans suffering from not only COVID-19 but also other life-threatening diseases requiring intensive care. ICU occupancy rates are dangerously high in many parts of the country. With an even worse surge in COVID-19 infections, hospitalizations, and ICU admissions possible in late January, ICU care is already being rationed in many places, frontline medical personnel are experiencing burnout, and there are staff shortages.
Until COVID-19 vaccines begin to have a significant impact – probably not until well into 2021 – individuals need to protect themselves and others by the straightforward public health measures that prevent the spread of droplets and aerosols that transmit respiratory infections: masking, social distancing, frequent handwashing, and avoiding situations with more people than permitted by public health officials. The precautions we take now are literally matters of life and death.
John J. Cohrssen is an attorney who served in senior positions for White House agencies, including the office of Vice President Dan Quayle. Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. He was the founding director of the FDA's Office of Biotechnology.