2 doctors explain why COVID-19 is not 'just another flu' — and why comparing the death tolls leads to inaccurate conclusions

• Comparisons of the number of deaths due to the coronavirus and the seasonal flu likely undercount the former and overcount the latter, according to a new report from two doctors.
• Comparing these numbers can lead to "inaccurate" conclusions that cause people to underplay the pandemic's threat, the doctors wrote.
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The seasonal flu and the novel coronavirus seem to lend themselves to an easy comparison, given their overlapping symptoms.

But it's not that simple.

In a report published Thursday in the Journal of the American Medicine Association, doctors Carlos del Rio and Jeremy Faust suggest that people are incorrectly using the flu-to-coronavirus comparison to downplay the severity and deadliness of COVID-19.

"Public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic," they wrote.

The doctors explain that comparisons of the two diseases' death tolls are sometimes based on false assumptions, which makes them unreliable. That's because the number of deaths from the flu is always an estimation, while the reported number of deaths from the coronavirus is delayed and likely undercounted.

"Although officials may say that SARS-CoV-2 is 'just another flu,' this is not true," del Rio and Faust wrote.

Flu deaths are calculated differently than COVID-19 deaths

The number of people killed by influenza isn't reported the same way COVID-19 deaths are — which can cause confusion when comparing the numbers.

The Centers for Disease Control and Prevention estimates the number of flu infections in the US via its influenza surveillance system, which gathers flu data from state and local partners, then projects nationwide totals using infectious-disease models. Between the 2013-2014 and 2018-2019 seasons, the number of counted annual influenza deaths ranged from 3,448 to 15,620, and the CDC's official estimates for the entire US ranged from 23,000 and 61,000.

The estimations are meant to account for flu deaths that occurred outside of hospitals and other circumstances in which a deceased person never received an influenza test. This data can lag by up to two years, since it takes CDC researchers a while to collect flu data and look through death certificates.

"Conversely, COVID-19 fatalities are at present being counted and reported directly, not estimated," del Rio and Faust wrote.

That means that comparing flu-death estimates to confirmed coronavirus deaths likely discounts the scale of the latter's true toll.

The researchers also pointed out that the CDC is likely not reporting fully accurate numbers of deaths from the coronavirus. For one, the CDC's numbers lag behind real-time local counts. Plus, official numbers may not include people who died in their homes, and many deaths weren't counted early in the outbreak because the US' limited testing capacity prevented many patients from receiving diagnostic tests.

Indeed, preliminary data on excess deaths and frontline observations from funeral directors and emergency responders in New York City also suggest that the US is severely undercounting deaths from the virus.

Comparing one week of flu and coronavirus deaths

To demonstrate a more apt comparison of flu and coronavirus deaths, del Rio and Faust looked at numbers from "peak weeks" of seasonal flu outbreaks (not estimated numbers) and a week during the coronavirus outbreak. During the week of April 14-21, there were 15,455 COVID-19 deaths in the US, whereas the average number of counted flu deaths during the peak week of influenza seasons from 2013-2020 was 752.

That's more than a 20-fold difference.

A full understanding of the numbers will come with time, they wrote — and more accurate data would allow us to compare "apples to apples" instead of "apples to oranges" Until then, comparing the estimated death toll of the flu and the actual recorded COVID-19 deaths dangerously understates the impact of the pandemic.

"The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons," the researchers wrote.

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