COVID-19 Versus Influenza

Governments are either acting like old ladies with the vapors or plotting to restrict our freedoms for a host of nefarious reasons — please fill in the blank with your favorite conspiracy theory.  

To make it clear where I am coming from, I’m going to call these people ‘The Just Plain Wrongs.’ or JPWs for short.

JPWs suffer from several non-infectious afflictions, including, of course, everybody’s favorite bias de jour, confirmation bias. The late Roger Ailes, the disgraced founder of FOX News, understood the power of this psychological fault better than anyone. He knew that many of us don’t actually want to be informed. We want to have what we already believe confirmed. He changed the American political dynamic with this one simple insight.

As tempting as it is, I leave a discussion of confirmation bias for another time. But another mental hiccup found in JPWs must be called to account — preventive intervention bias. Let’s say you are a fervent vaccine skeptic who happens to live in a country where most of the population is vaccinated. You climb on your digital soapbox to decry the need for vaccination with the argument that there is hardly any flu in this country.

JPWs do this all the time as they furiously unearth whatever numbers they can find that “prove” that COVID is just another flu, blithely forgetting that we take no particularly vigorous measures to combat the flu. (only 42 percent of Canadians bother to get vaccinated.) So JPWs are busy comparing statistics concerning an annual infection that we accept rather blandly as that ho-hum seasonal inconvenience with a virus that has triggered unprecedented preventative measures around the world. And the most telling result of all that throwing of oranges at apples?  Even when the JPWs stack the deck, they lose.

The death rate for the annual flu per 100,000 people (I am using Canadian statistics here) is between 9 and 12 out of 100,000. As of the end of June, COVID was killing 23 people per 100,000 of Canada’s population despite the draconian preventive measures taken. A much more useful number is the case fatality rate (CFR), which is a simple percentage of the death rate among those who are diagnosed with the virus. This number is the one that should stop the JPWs in their tracks. The CFR for the annual flu is typically cited as 0.1 percent. For COVID, it is 1-to-1.6 percent —  higher by a factor of ten to sixteen.  That number is likely much smaller than it would be if testing were more vigorous, and co-morbidity factors for COVID infection were better understood.

Epidemiologists studying the COVID outbreak in Northern Italy have posited a CFR of 31.4 percent. This number is close to the death rate for the 14th-century bubonic plague pandemic that killed a third of the population of Europe. These regions of Italy were late to act, and their medical infrastructure was quickly overwhelmed. This Black-Death-like catastrophe is perhaps a better window into what COVID can do when it really gets a head start. Our annual influenza outbreaks are not anywhere close to this sort of grim viral reaper.

Another thing worth noting in the numbers is that influenza deaths are probably over-reported because these are estimated statistics that attribute most of the deaths from pneumonia among the elderly to an originating flu bug. But, other underlying ailments cause pneumonia, including COPD, bacterial infections, and cancer. As I stated earlier, COVID deaths, on the other hand, are likely to have been significantly underestimated. Early on, there was not enough testing available, and infection-related immunological problems were not well enough understood to attribute a lung-failure death to COVID directly.

The final number worth noting here is what scientists call the RO (infection reproduction) number. This number tells us how many other people are likely to be infected by an already infected person. For the annual flu, it is 1.3.  For COVID, it is between 2 and 3. In places that have taken less vigorous preventive measures, experts have estimated this infection reproduction number to be as high as 6.4. (That nasty seven to fourteen day pre-symptomatic incubation period, seven-times longer than the flu, doesn’t help.) The testing issue further compounds this. In the USA, the world leader in COVID, the head of the CDC, recently commented that in their estimation, the actual rate of infection in the country is probably 10- times higher than reported.

It is time for these JPWs to take off their ideological blinders and stop making inappropriate comparisons that spread confusion in the same way anti-vaccination zealots do. Of course, clear and actionable messaging from leaders would help. There are some inspiring examples out there of leadership during the pandemic. But forward-thinking Mayors, Premiers and governors have to compete for attention with leaders who spew false, politically convenient rhetoric.

It angers me that the damage these JPWs do comes down hardest on people with little or no statistical literacy, people who just want easy assurances and untroubled minds. This category includes many among the poor, people of colour, the elderly, and the incarcerated — groups who are already being hit hard by the virus. COVID is a nasty beast — it’s like nothing seen since 1919. Put on your masks, respect credible science, and let’s get through this.