I listen to the Rick and Bubba Show for a few minutes most mornings. I wish I could listen to all 4 hours of it, but I simply don’t have that kind of time in my day (for some reason whereas I can listen to music while I work, I can’t listen to talk radio). I’m pretty much on board with most of their views and opinions — probably 95%. But yesterday they were discussing the current state lockdowns and the need to loosen up the quarantine and get the economy back going again. As support for his argument, at one point Bubba made the statement that the coronavirus has turned out to be no worse than the flu.
C’mon, Bubba. You’re better than that!
I’m not going to discuss (right now) the merits and drawbacks of when and how we should work on reopening the economy — that’s a topic for another time. But I have recently run across a lot of people arguing either that we should reopen the economy now, or that we made a horrible mistake in shutting it down in the first place, and in support of those arguments making one or both of 2 statements: (1) COVID-19 is no worse than other pandemics we have experienced in the recent past; and/or (2) COVID-19 is no worse than the flu. Let’s look at the facts and see just what the reality is.
In order to make an honest comparison, we need to establish a few criteria. The first is the timeline we’re going to look at — just how far back should we go. It probably isn’t fair to compare COVID-19 with the bubonic plague that hit Europe in 1347 and killed as much as 60% of the population (about 50 million people). So how far back is our relevant “recent past”? I chose anything after 1928, since that is when Alexander Fleming discovered penicillin, which was useful for treating secondary bacterial infections (most pandemics are viral, and thus not subject to primary treatment by antibiotics). This is an important date because if we were to back up less than 10 years (1918-1920) we would run headlong into the Spanish Flu pandemic, which was probably the third worst pandemic in the history of the world, infecting over 500 million people worldwide, and killing about 50 million, 675,000 in the United States. Because the Spanish Flu hit prior to the discovery of penicillin we won’t include it in our analysis. However, it’s significant to note that despite Fleming’s discovery in 1928, we didn’t actually start mass producing, distributing and using antibiotics as a standard treatment until 1945.
The second criteria to define is the scope of the epidemic. For our purposes, I’m going to limit our comparisons, except for seasonal influenza, to true pandemics — epidemics which encompassed all or most of the world. So, for instance, we won’t consider Ebola, which was truly an epidemic, but mostly just affected Africa.
Within those parameters, we will compare the following statistics to the extent available: (1) number of people infected, both worldwide and in the United States; (2) number of deaths, both worldwide and in the United States; and (3) communicability. So let’s get started.
Number of People Infected
Severe Acute Respiratory Syndrome (SARS): As most of you will probably remember, SARS hit between 2002 and 2004. Worldwide it infected more than 8,000 people.
Swine Flu (H1N1/09): Again within recent memory (2009-2010), the Swine flu infected approximately 1.4 billion people worldwide. During the first year, the CDC estimated there were 60.8 million cases.
Seasonal Influenza: It is really tough to come up with figures on this front, since it fluctuates a great deal from year to year. I don’t have influenza infection data from the rest of the world, but in the United States the CDC influenza infection estimates from 2010 to 2019 (as of the date of this writing) range from 9.3 million to 45 million per year, with a yearly average of 28.6 million.
COVID-19: Depending on your source, the coronavirus has infected over 3 million people worldwide to date (the date of this writing) with over 1 million of those in the United States.
So, as you can see, COVID has infected only a fraction (.2 percent) of the people the Swine Flu did, but exponentially more (375x) more people than SARS. And influenza does seem to have a nearly 30x greater infection rate (on average) than the coronavirus. But remember, SARS and the Swine Flu statistics cover 2-3 years, and those pandemics are essentially over. We are still on the front end — only a few months — of the current coronavirus pandemic, so while it almost certainly won’t get anywhere near the neighborhood of the Swine Flu infection rate, it may well approach or surpass the seasonal flu infection rate by the time this whole thing is over.
Number of Deaths*
The Asian Flu, also known as H2N2, hit the international scene from 1957-1958 (note: well after antibiotics were in regular use). Although I don’t have a figure for number of people infected, the Asian Flu killed more than 1.1 million people worldwide (some estimates put it as much as 4 million), and 116,000 in the United States.
Likewise, I don’t have infection numbers for the Hong Kong Flu (H3N2) (1968-1970), but it killed about 1 million people worldwide, and about 100,000 in the United States.
SARS killed “only” 770 people worldwide, and none in the U.S.. Not too bad, if you weren’t one of the 770, or their family or friends.
The Swine Flu killed anywhere from 151,700 to 575,400 people worldwide, and about 12,500 in the U.S.
Again, U.S. death statistics for the seasonal flu over the last 10 years vary greatly, from a low of 12,000 to a high of 61,000, and a 10-year average of approximately 37,500. The 2017-2018 seasonal flu killed somewhere between 60,000 and 80,000 people in the United States.
As of the date of this writing, COVID-19 has killed 219,397 people worldwide, over 58,000 of which were in the United States.
Let’s crunch the numbers. COVID has, in 3 or 4 months, already killed half the number of people in the U.S. that the Asian Flu and Hong Kong Flu did (respectively) in a couple of years. It has killed over 4x the number of U.S. citizens than the Swine Flu. Here’s the real eye-opener, though: the coronavirus has already killed nearly the same number of people as the 10-year high of deaths due to the seasonal flu, and has far surpassed the 10-year average. Again, it bears repeating: this is only 3-4 months into the current pandemic. The number of infections and deaths are continuing to go up (over 24,000 infections and 2,000 deaths just since yesterday!), and although the rates will hopefully start to drop at some point, the raw numbers will never go down (e.g. nobody who died from COVID will stop being dead).
Communicability
Communicability is, as you might expect, how difficult or easy it is for a person who is infected with a virus to infect someone else. Scientists use a designation called the R0 factor to describe a certain virus’s communicability. An R0 of 1 means that a person with a virus will likely communicate (share) it with 1 other person, absent precautionary measures. The seasonal flu has an R0 factor of 1.3, meaning that the average person with the flu, absent precautionary measures, will likely give it to 1.3 other people. One of the reasons this number isn’t higher is that the flu is typically only transmittable via direct contact, either with the person or with their bodily fluids. In other words, you usually can’t get it via airborne transmission, simply being in the same space as someone who has it.
COVID-19, on the other hand, has an R0 factor of 2.0-2.5, which means that someone infected with COVID, absent precautionary measures, will likely give it to 2-2.5 other people. One of the reasons this is higher, and is a range rather than a firm number, is because experts believe COVID may be transmittable through airborne communication, which is why we’re all trying to stay at least 6 feet apart. So, you could say that COVID is approximately 50% more communicable than the flu. At first glance this doesn’t seem to jibe with the infection rates above, until you remember that we are still on the front end of this pandemic, and that number will only go up over the coming days, weeks, months — especially as testing continues to ramp up.
Conclusions
So what can we conclude from the facts? I think it’s fairly obvious to any reasonable person that the COVID-19 coronavirus is substantially deadlier than previous pandemics, as well as the seasonal flu. I also think that reasonable people could conclude that COVID is probably close to as contagious, if not more contagious, than the flu.
As I said above, we can and should have a grown-up discussion about when and how to restart the economy and our lives. But let’s proceed with a clear-eyed vision about the seriousness of this virus. To be willfully blind to the facts is irresponsible in the extreme, and could cost lives that could otherwise have been saved.
This is not just any other flu.
*Someone is going to object that the official number of deaths is inflated because hospitals are counting any death during this period as a coronavirus death — the popular theory is that hospitals get more money that way. However, that’s pretty much speculation and/or conspiracy theory. Factcheck.org has looked into this, and determined that there is nothing nefarious going on here, and the facts do not bear out the conspiracy theories. In fact, “hospitals have profound disincentives for “upcoding,” which can result in criminal or civil liabilities, such as being susceptible to being kicked out of the Medicare program.” It went on to say that “while it’s true that some deaths attributed to COVID-19 likely would have occurred regardless of the disease, other factors — like the deaths of undiagnosed COVID-19 victims, including those that occur at home — contribute to a more significant problem of under-counting the deaths” (emphasis mine). Look, if someone with diabetes is hospitalized because of coronavirus, and the virus causes them to die from complications due to their diabetes, I think it’s fair to count that as a coronavirus death.
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