Magazine May 18, 2020, Issue

COVID-19 Is Not the Flu

Mount Richmond Cemetery on Staten Island prepares to receive the coffins of COVID-19 victims, April 24. (Tayfun Coskun/Anadolu Agency via Getty Images)
Experience has shown that the coronavirus is much more dangerous

On January 23, the Chinese government initiated a draconian quarantine of the city of Wuhan in order to stop the spread of SARS-CoV-2, the coronavirus that only recently began infecting human beings. The army surrounded the city of 10 million. Soon thereafter, doors of some apartment buildings in the city were welded shut.

Not to worry, some voices in the media reassured Americans. “Get a Grippe, America. The Flu Is a Much Bigger Threat than Coronavirus, for Now,” read the headline of a February 1 Washington Post story. “Don’t Worry about the Coronavirus. Worry about the Flu,” BuzzFeed News declared on January 28.

Although President Trump acted on January 31 to sharply curtail the number of people entering the United States from China, he suggested as late as March 9 — even as Italy was hours away from initiating a national lockdown — that the threat of the coronavirus was no greater than that of the flu. By the middle of March, of course, the president had changed his mind. “It’s not the flu,” he said at a March 31 press conference. “It’s vicious.” He was right then.

There is still much we don’t know about the coronavirus, but we know enough to say that it is far more dangerous than the flu. It took twelve months and 61 million infections for the H1N1 swine flu to kill 12,500 Americans in 2009–10. The Centers for Disease Control estimated that the seasonal flu killed 34,200 Americans during the 2018–19 flu season. In 2019, car crashes killed 38,800 Americans.

As for the new coronavirus? On February 26, the United States had not yet recorded its first COVID-19 death. By March 26, the death toll had topped 1,200. By April 26, the coronavirus had killed more than 55,000 Americans.

Despite the fact that the coronavirus has killed more Americans in the past month than the seasonal flu kills in one year, some have continued to argue that the epidemic will end up being no more serious than a bad flu season.

On Fox News on April 13, Bill Bennett, the former education secretary, said, “We’re going to have fewer fatalities from this than from the flu. For this, we scared the hell out of the American people.” He pointed out that the model created by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington was projecting that COVID-19 would kill 60,000 Americans and that the seasonal flu killed 61,000 Americans in 2017–18, a particularly bad flu season.

But the coronavirus has now killed about 60,000 Americans in six weeks — and that was with lockdowns to stop the virus from spreading at an exponential rate. What’s more important to keep in mind: The IHME projection is only an estimate of the death toll for a first wave of infections, and most of the country will still be vulnerable to infection after the first wave passes. Harvard epidemiology professor Marc Lipsitch tells National Review he’s unaware of any epidemiologist who thinks there will be only one wave of coronavirus infections.

To estimate how many people any disease could kill, it helps to have a sense of two things: the fatality rate and the total number of people who may be afflicted by it. A virus with a 25 percent fatality rate that infects 1,000 Americans would kill 250 people. A virus with a 0.25 percent fatality rate that infects 100 million Americans would kill 250,000 people.

As Bloomberg columnist Justin Fox recently reported, the first round of studies that test for coronavirus antibodies indicates that the infection-fatality rate for the coronavirus could be anywhere from 0.12 percent to 1.08 percent. These antibody tests attempt to account for asymptomatic and otherwise undetected infections, and there are many such coronavirus infections. Epidemiologists told Fox that when asymptomatic infections of seasonal flu are similarly accounted for, its infection-fatality rate is 0.04 percent (that’s different from the 0.1 percent case-fatality rate often cited in the press). So the infection-fatality rate could be anywhere from three to 27 times greater than the flu’s, according to initial studies.

Even if the fatality rates of the flu and the coronavirus were close, the latter would still be more dangerous because it could infect many more people.

“This is worse than the flu. There’s no question about it,” Dr. Jay Bhattacharya of Stanford Medical School tells National Review. He notes that, as is not the case with the coronavirus, there is a vaccine for the flu. We also have some immunity from previous infections.

Bhattacharya recently helped conduct a study that found that 2.5 percent to 4 percent of the population of Santa Clara County in California have already been infected with the coronavirus, and the study concluded that the infection-fatality rate in the county could be between 0.12 percent to 0.20 percent. In a recent interview on Peter Robinson’s program Uncommon Knowledge, Bhattacharya cautioned that we do not yet know how much immunity those who recover from the infection have and how long it lasts, but “if we were to talk about herd immunity, 3 [to] 4 percent [of the population having been infected] is nowhere near” the threshold.

If herd immunity is possible, how many people would need to be infected nationwide to reach it? “Let’s say there’s a component of folks who are sort of naturally immune for whatever reason that we don’t understand. Well, then herd immunity would be a lower number,” Bhattacharya says, declining to offer a low-range estimate. “If that’s not true, you need, you know, 70 to 80 percent [of the population infected]. That could happen.”

“If the [fatality rate is] 0.1 percent and 30 percent of the country gets infected, that’s about 90,000 deaths,” says Bhattacharya. What’s the upper range of potential deaths? “I don’t want to speculate. That’s not responsible,” he replies. Of course, it’s no more speculative than calculating the lower-range estimate. If 70 percent of Americans were infected with a virus that kills 0.2 percent of those infected, that would result in a death toll of over 460,000 people.

Harvard’s Marc Lipsitch tells National Review his latest estimate is that anywhere from 35 to 75 percent of the population could get infected before herd immunity is reached. Former FDA commissioner Scott Gottlieb has estimated that herd immunity would likely kick in at 50 to 70 percent of the population — far above the current 1 to 5 percent of Americans estimated to have already had the coronavirus.

You don’t need to rely on statistical models to come to the conclusion that the coronavirus is much more dangerous than the flu. You just have to look at the reality of what has already happened around the world and in our own country.

The Wall Street Journal reported that confirmed coronavirus deaths in the month of March in the Italian province of Bergamo (population 1.1 million) were equal to 0.2 percent of the entire population. The true percentage may be higher: There were 4,000 more deaths in Bergamo in March 2020 than the average number of deaths in March in recent years, but only 2,000 of those deaths were attributed to confirmed COVID-19 cases.

The coronavirus has already killed more than 0.1 percent of the entire population of the state of New York. That may seem like a small percentage. But imagine the entire country getting hit as badly as New York State: 0.1 percent of the U.S. population is 330,000 people.

In New York City, antibody testing indicates that 25 percent of residents have already been infected, which equals 2.1 million residents. The city recorded 11,500 confirmed COVID  deaths and an additional 3,700 probable COVID deaths from March 11 to April 25, but the New York Times reports that there were 21,000 more deaths recorded in the city during that same period this year than in a typical year. The numbers indicate a fatality rate in the city of at least 0.55 percent but likely closer to 1 percent.

There are other signs of the unusual lethality of the coronavirus. It has killed 100 Italian doctors. That doesn’t happen during a bad flu season. It has killed 30 employees of the New York City Police Department. That doesn’t happen during a bad flu season. It’s entirely possible the virus is more contagious and lethal in densely populated cities, but those facts are cause for concern.

It’s unclear where the fight against the coronavirus goes from here. Having a reasonable understanding of the ongoing danger does not dictate how long lockdowns must go on, or whether less stringent measures would have made more sense in the past, but it will help the government, businesses, and individuals take precautions that could limit the virus’s death toll in the months to come.

Some have said that the lockdowns and “flattening the curve” of the epidemic will merely spread out deaths over time without saving any lives, but that’s not necessarily true. The death rate is higher when the health-care system is overwhelmed. And buying time provides the opportunity to ramp up a system of widespread testing and tracing that can slow the spread of the virus. If the transmission of the virus slows enough that an effective antiviral drug (or vaccine) hits the market when 15 percent of the population has been infected rather than 30 percent, many lives would be saved.

With herd immunity, it becomes impossible for a virus to gain a new foothold. But even if herd immunity is what ultimately stops the virus, “flattening the curve” of the epidemic still “saves cases and lives because of the phenomenon of overshoot,” says Lipsitch. Essentially, “overshoot” means that the people infected with the virus at the time that herd immunity is reached will still infect many others before the virus dies out. The fewer cases there are at that time as a result of measures to suppress them, the fewer deaths will result from overshoot.

No nation can afford to endure a hard lockdown until a vaccine is developed for the new coronavirus. We need to have “a functioning economy as well,” says Lipsitch. “It’s really good for people to have a job and a salary.” He says the least bad solution could involve some “economic disruption but not paralysis.” His hope is that widespread testing for infections and tracing the contacts of those infected, combined with wearing masks, washing hands, and social distancing, will mean the virus “just sort of trundles along at a reproduction number near 1 and we don’t get very close to the herd-immunity threshold but we also don’t completely shut down.” (The reproduction number is how many new cases each existing case creates, and a reproduction number of 1 would mean the virus does not spread at an exponential rate.)

There are still many things we don’t know about the coronavirus: How much will heat and sunlight slow it down this summer? How soon will an effective drug be on the market? Or even a vaccine? We’ll know the answers in time. For now, we know enough to say it’s not the flu.

This article appears as “It’s Not the Flu” in the May 18, 2020, print edition of National Review.

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