140 times deadlier than the flu? The U.S. and Italy are on the same curve

There are a surprising number of people in the U.S. who believe that the coronavirus is all just make-believe.

You may think that’s an exaggeration. It isn’t. Someone insisted to me on Facebook just yesterday that the virus is a “hoax,” designed to make President Donald Trump look bad. And across the most popular social media networks, people of influence who suddenly consider themselves experts on infectious diseases are lining up to tell everyone else how the coronavirus really isn’t all that bad.

I’m certainly not one of those infectious diseases experts and won’t claim to be. But I know how to make sense of numbers. And, so, when I continue to see people insist that COVID-19 is no worse than the flu, all I can do is shake my head.

It’s true — as coronavirus naysayers have told us over and over and over, and as I pointed out myself at one point — that the flu has killed 22,000 Americans so far this flu season. Coronavirus, by contrast, has claimed fewer than 50 lives. But it’s not about the sheer numbers. It’s about how many might die unnecessarily, if we don’t do something to stop it.

The flu has killed 20,000 Americans because of how many people it’s infected. Like coronavirus, the flu disproportionately affects the elderly and the immunocompromised. (Unlike coronavirus, the flu also disproportionately affects the very young.) But its death rate is just 0.1%. That means, on average, about one out of every 1,000 people who have the flu will die. The 20,000 deaths — a number that’s still climbing, incidentally — are because the U.S. and much of the rest of the world take virtually no precautions against the flu. We do have a vaccine, but only about half of Americans accept it; health experts have estimated that if greater than 80% of Americans received the vaccine, the flu would ultimately be wiped off the face of the earth for ever. We don’t practice social distancing. We don’t close schools. And no one, obviously, is going to argue that we should.

Coronavirus, by contrast, has a death rate of 3.4%, according to the World Health Organization. That fatality rate varies from nation to nation, but at face value, according to the world’s leading authority on health, coronavirus is more than 30 times deadlier than the flu.

Just for perspective, and because coronavirus naysayers are quick to throw out flu statistics: the CDC’s estimate is that 36 million Americans have been sickened by flu this year, resulting in the 22,000 deaths. Currently, 2.1% of the known coronavirus cases in the U.S. have ended in death. Now imagine that the same number of Americans contracted coronavirus as have contracted the flu. If the same fatality rate applied, there would be 756,000 Americans dead from coronavirus.

The most obvious flaw with this math is that we don’t know if the fatality rate is actually 2.1%. There’s a strong chance that more people — probably far more — have been infected with coronavirus than have actually tested positive. Due primarily to a shortage of testing supplies, only those who are seriously ill or who are thought to be at risk have been tested, for the most part. Many who may have had coronavirus and had only mild symptoms may have gone untested.

But, by the same token, all evidence available suggests that coronavirus spreads more easily than the flu, and there is no vaccine for coronavirus. Thus, if we don’t heed the advice of health care professionals and take measures to prevent its spread (if, in other words, we treat it like seasonal flu because it’s “just another strand of flu”), there will be far more than 36 million Americans who contract it. No one knows how many, but some estimates — conservative ones, critics have argued — suggest that as many as 1 in every 2 Americans could eventually be infected.

If we assume that to be true, that would mean that more than 160 million Americans will eventually contract coronavirus. And even if you use the lowest fatality rate from nations that have experienced significant outbreak — 0.6% in South Korea — that would equate to 960,000 American deaths.

Even if you are optimistic and say it’s no deadlier than the flu, that would mean 160,000 American deaths.

Either way, this virus is poised to kill far more Americans than the flu.

And it could be far worse than we know.

Remember, America is still very early in this outbreak. Exposure here came later than in many parts of the rest of the world. Someone argued on Facebook on Friday that it will soon end here because it is nearly over in China. That’s incredibly shortsighted. Infectious diseases don’t just end out of the blue, for no reason. China is only reporting a very small number of new infections because of strict quarantines. Likewise, the disease appears to be past its peak in South Korea because of strict quarantines. In the U.S., it has an entire nation of 327 million potential hosts to exploit. We can hope that the coming warmer weather helps kill it out — similar to what happens to the flu virus each year — but there’s no guarantee that will happen.

With so many unknowns, no one can say for sure what will happen. So perhaps it’s best to look at what could happen.

And Italy presents a perfect example of what could happen.

In Italy, the coronavirus fatality rate topped 14% on Friday — making it 140 times deadlier than seasonal flu. Why? It’s probably due to several factors, but not the least among them is that Italy failed to act soon enough, and its health care system was overwhelmed. Doctors are said to now be rationing equipment in some northern hospitals, which is the effective equivalent of choosing who lives and who dies. It has been argued that Italy’s older population is responsible for the unusually high fatality rate there, and that’s partially true. Italy is an old nation, with an average age of 45. By contrast, the average age in the U.S. is only 38. But that alone doesn’t explain a fatality rate of 14%. It’s also been argued by some that Italy’s government-run, universal health care system is to blame … but South Korea, where the fatality rate is only 0.6%, also has universal health care.

Now consider this: Italy has more hospital beds and more doctors per capita than the U.S.

Iran, another hard-hit country, is also experiencing a higher fatality rate. Based on what the Iranian government is sharing with the rest of the world, 4.8% of known coronavirus cases there have ended in death. But critics say the Iranian regime is lying, pointing to satellite photos of mass graves being dug for coronavirus victims as evidence that Tehran is not being honest about the overall toll the disease is taking.

So what if the transition from winter to spring doesn’t cause coronavirus to decline? What if it spreads just as easily in the U.S. as it’s feared that it might? What if 1 in every 2 Americans are eventually infected? We ran the numbers above using the current fatality rate in the U.S. and the flu’s fatality rate. But what if our fatality rate was as high as Iran’s? That would be 768,000 deaths.

What if our fatality rate was as high as Italy’s? That would be 2.24 million deaths.

This is not just another strand of the flu. It’s best that we not treat it as such.

Ben Garrett

Ben Garrett is a journalist from East Tennessee. He is publisher of the Independent Herald, a weekly newspaper serving the Big South Fork region of the Cumberland Plateau, with a sideline in website development and digital marketing. He is also an erstwhile blogger.

1 comment

  • We are still moving too slowly, but that has been the case everywhere so far. It is an unfortunate aspect of human psychology, just as the panicked buying of toilet paper (what is that about, anyway?) is as well. People struggle to see the data. The data is what the data is.

    The data is repeating itself from country to country as the disease spreads globally, generally with the exact same reactions – an outcry that everything is overreaction by medical professionals and other alarm sounders, local officials making missteps because people just want their normal lives to continue, to, slowly, the central government exerts more control and more drastic “social distancing” is enforced. If only people would move quicker more lives could be saved and more economic impact could be avoided – I’m afraid the toll there, economically, will be a while in coming.

    The disease seems to be quite infectious with an R0 of, conservatively, somewhere between 2.25 and 2.5. Fortunately, most cases are mild as has been widely discussed. But unfortunately, these mild cases and asymptomatic cases just continue the spread (assuming no countermeasures, i.e. “social distancing”), eventually tipping the scales in the healthcare systems ability to deal with the severe cases that emerge.

    China’s initial reaction was very muted, hand waving – there is nothing to see here – until they were having to build 2 additional hospitals in Wuhan to avoid collapse of their hospital system. Ultimately, they locked down very large portions of their population in extreme measures, their economy was operating at 40-50% capacity during the lockdown according to Time magazine. Wuhan is going to be beginning to slowly return to normal operations beginning this week, nearly two months since the quarantine.

    South Korea, perhaps, had the fortunate super-spreading event where 1000s became infected in a church service/setting. Their government quickly mobilized the largest per capita testing in the world to date with aggressive contact tracing and isolation subsequent to the super-spreading event. They stemmed the tide quickly. Certainly, a gold standard in response so far.

    The West has largely followed the same path, according to the data (https://twitter.com/HW_Youngg/status/1238876844339998720/photo/1). Italy has been the bellwether of the Western world. Their national lockdown occurred March 9th. They initially locked down about 50,000 people in their northern provinces on Feb 21st. They locked down the entire northern provinces on March 8th and followed suite on the 9th nationwide. Looking back, do you think they wish they had been more aggressive with their “social distancing” efforts? Ben’s article well describes why their national lockdown had to happen in Italy.

    Spain is introducing their national lockdown on Monday morning. Where will Seattle, the bellwether in the States, be in a week? Where will the U.S. be in a month? What we are doing today won’t be have impact on case load for 14-28 days, based on the trajectory of the disease, i.e. 2-14 days of incubation and 7+ days before severe disease typically sets in.

    I hope we don’t look back 4 weeks from now and say, we really should have been more aggressive with distancing efforts. But, I’m afraid that we won’t be able to see the data until it is our health care system that is straining under the load resulting in a mortality rate in the U.S. that is higher than it could have/should have been.

    Keep watching Italy, Spain, France, Germany, Seattle, New York, Boston…

    While I’ve been typing this, France has now announced a national lockdown as well.

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