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Why it’s too early to compare COVID-19 with the flu

As novel coronavirus spreads around the world, some U.S. officials seem to be downplaying the potential global scope and severity of the disease by comparing it to a common illness — influenza.

In a press conference Wednesday, President Donald Trump softened the severity of the COVID-19 outbreak, saying that the virus is “a little bit like the flu.”

“We’ll essentially have a flu shot for this in a fairly quick manner,” he said, referring to efforts to develop a vaccine for the disease. According to experts like Dr. Anthony Fauci, who directs the National Institute for Allergy and Infectious Diseases, it’s still likely to be at least a year before a vaccine is ready for human use.

Trump also noted that far more Americans die from the flu each year than have been infected by the coronavirus thus far.

But experts say comparing COVID-19 to the flu understates what’s at stake.

“It’s a confusing tone that the president set,” said Lawrence Gostin, a professor Georgetown University who also directs the World Health Organization Collaborating Center on National and Global Health Law. He said the World Health Organization and the Centers for Disease Control and Prevention have underscored the seriousness of the virus, but Trump’s comments appear “to fluff it off as if it’s a common cold.”

Nancy Messonnier, director for the CDC’s National Center for Immunization and Respiratory Diseases, has warned that transmission of the virus in the U.S. is inevitable, that it is “not so much a question of if, but when.”

So far, there are millions of cases of the flu worldwide, compared to about 84,000 novel coronavirus cases, as of Friday afternoon. But public health officials warn that there is still a lot they don’t know about the new virus, including the various ways it’s transmitted, how pathogenic it might be, and how it could alter genetically.

That uncertainty creates an added urgency to containing the virus and, if those efforts fail, preparing for it to infect large swaths of the global population.

Here’s what we know now about the way these two infections compare, in terms of transmission, deadliness and scope.

How you get sick

Both the flu and COVID-19 are spread from person-to-person, transmitted through respiratory droplets that are formed when these people cough, sneeze or talk, according to the CDC. COVID-19 may also be transmitted when people touch surfaces that are infected, but this has not yet been confirmed.

“We know these viruses can potentially survive on surfaces depending on the number of hours or days,” said Dr. Brian Garibaldi, the director of the biocontainment unit at Johns Hopkins Medicine. “We don’t know yet if it’s more likely that you’re going to get [COVID-19] by coming into contact with droplets in the air.”

Neither the flu nor COVID-19 can be treated with antibiotics.

Garibaldi added that the one way it may be useful to compare COVID-19 with the flu is when talking about prevention.

“The method you can use to try to protect yourself from the flu is also going to help prevent you from getting the coronavirus,” he said. Practicing good hygiene, by throwing out tissues, covering your cough and washing your hands, will help prevent the spread of both diseases.

Number of deaths

Of the 83,652 COVID-19 cases confirmed thus far, there have been 2,858 deaths, according to the World Health Organization. A total of 2,791 of those deaths were within China. So far, 15 COVID-19 cases have been reported in the U.S., with zero resulting deaths thus far. Another 47 Americans contracted the disease abroad and have been brought back to the U.S. to be quarantined.

By contrast, the CDC estimates that at least 18,000 people in the U.S. have died from the flu since October, and at least 32 million have been infected.

Globally, the flu kills hundreds of thousands of people annually. A 2017 study published in the Lancet, a leading medical journal, estimated that between 291,000 and 646,000 people die from seasonal-related respiratory illnesses each year.

Nevertheless, just because the flu is a more severe threat to Americans than COVID-19 right now doesn’t mean that the virus couldn’t grow to become just as, or more, deadly in the future. “It’s precisely because the flu kills so many people that we should worry about coronavirus. We don’t want a mass-circulating virus that kills that many people,” Gostin said.

Harvard epidemiologist Marc Lipsitch estimates that between 40 percent and 70 percent of people around the world will be infected with the virus that causes COVID-19. Gostin said that these sorts of predictions are “exactly why we need to take it seriously.”

Mortality rate

A recent study estimated that the mortality rate from COVID-19 is 2.3 percent, more than 20 times the death rate from the flu.

It should be noted that the vast majority of COVID-19 cases confirmed by China — 81 percent, as of Feb. 11 — are mild, meaning they did not involve pneumonia. Symptoms could be so mild that they are confused with the common cold, which is in the same family of viruses as COVID-19.

Health officials caution that the fatality rate is dynamic and will likely change, particularly if more mild cases are confirmed, and as public health officials collect more data about cases in a growing number of countries.

“There have got to be a lot of infections out there that are not detected, just because they are mild. If you add another 100,000 people, then the rate drops,” said Gary Kobinger, the director of the Infectious Disease Research Center at Laval University.

In a briefing on Tuesday, Dr. Michael Ryan of the World Health Organization warned against reading too much into high fatality rates as the virus spreads to other countries. When asked about Iran, which recently reported an 11-percent mortality rate, Ryan said, “We need to be very careful in the first wave of infections and any newly affected country because we may only be detecting severe cases and the deaths will be over-represented in that.”

As researchers work to bolster our understanding of COVID-19, that disease currently appears to be more deadly to the smaller swath of the population it has infected. In contrast, with so many more known annual infections, the mortality rate from the flu is about 0.1 percent annually.

To put the current COVID-19 estimates in context, the 1918 Spanish influenza pandemic — one of the deadliest of all time — infected about 500 million people, and killed more than 2.5 percent of all those infected.

The fact that there is not yet a vaccine available for COVID-19 also makes the threat level different from that of the flu, at least for now.

Should the U.S. see transmission pockets start to form before a vaccine for COVID-19 is developed, Garibaldi said Americans could experience fatality rates that are just as severe as China’s.

“The Chinese health system is fantastic — they have all the technology that we do,” he said. “There’s no reason to suspect that we’re going to do better than China if the mortality rate is 1-2 percent.”