COVID-19 Day 58: Stop treating COVID like the Flu. Treat the Flu like COVID

“People in the US should be way more worried about the flu…”?—?BuzzFeed News, January 28.

“Get a Grippe, America. The Flu Is a Much Bigger Threat than Coronavirus, for Now,…”?—?Washington Post February 1.

“We went through this before: Zika virus, Ebola, et cetera. But let’s have some connection to the reality of the situation, and as the doctor said, catching the flu right now is a much greater risk than anything that has anything to do with Coronavirus.”?—?Governor Andrew Cuomo, February 1

“This is a flu. This is like a flu…”?—?President Trump, February 26

Many have made comparisons of COVID-19 to the seasonal flu. As of this writing, over 60,000 people have died from COVID-19 in the US, and have made such statements seem either nieve or irresponsible. In a little over a month-and-a-half, more people have died from COVID-19 than in all 5 months of the H1N1 flu season. Obviously, this new virus isn’t like the flu. Except in one way that it’s not. I’ll explain.

In early March when the pandemic fears shutdown most of America, the CDC and WHO reported an alarming 2.3%-4.7% case-death rate in China (now known to be ‘inaccurate and suspect’) and a terrifying 7.2% case-death rate in Italy. These numbers were 20x and 70x higher than the seasonal flu (0.1%).

By April, New York was the worlds worst COVID-19 hotspot, with emergency rooms quickly filling with patients, exhausting health care workers. As of this writing, the NYC numbers are 171,723 confirmed cases and 13,724 confirmed deaths, a case-death rate of 7.9% (slightly higher than Italy). The US case-death rate stands at 5.8%. But many now think these numbers are the tip of the iceberg.

Researchers in California used antibody tests on a random sample of their local population that were not previously identified as having COVID-19. A large number of tests came back positive, which suggests that 28 to 55 times more people had been infected with COVID-19 than officially counted. If this is true, and true for the rest of the country, that would drastically reduce the case-death rate of COVID-19 to .26%-0.1%, practically the same as the seasonal flu.

So maybe Trump and everybody else was right back in February? Well…not quite. In addition to more serious symptoms (the flu doesn’t cause you to gasp for air and need to be intubated), COVID-19 spreads more easily and infects more people in the same amount of time as seasonal flu. Even with the same 0.1% case-death rate, more total infections mean more total deaths.

What is the secret to COVID-19’s greater infection rate? Part of the reason are the symptoms and how we behave before and after we experience them. Or not, as some people don’t even feel them.

The flu comes on quickly and noticeably. On average it takes about 12–24 hours for the flu to incubate in our bodies before we feel our first symptoms; aches and fever. These symptoms are not actually caused by the virus but by our immune systems discovering and reacting to infection.

Studies of flu indicate that we shed the most virus for 2–3 days after our first symptoms. But as soon as we feel like we’re coming down with the flu, we tend to isolate ourselves at home or in our bedrooms, so transmission is usually limited to family members. Though some of us choose (or feel forced) to work through our illness using pain-killers, decongestants, and other drugs. It’s ironic that we’re helping to spread the flu by “fighting it.”

SARS2 (the coronavirus that causes COVID-19) is a new virus mutated from a bat virus, that our immune system isn’t prepared for. Unless you’re one of the few people who got SARS1 in 2003, your body has no antibodies its bloodstream to trigger your immune system to react. That’s why it can take from 2–14 days (on average 5.6 days) before your body realizes it’s been infected and you experience your first symptom. Some people even experience very mild or no symptoms (asymptomatic) because our immune system isn’t reacting to a familiar virus.

So, for up to 14 days, SARS2 is replicating in your throat and you are actively shedding viruses as you breathe, infecting people around you without you realizing you’re even sick. A German study suggests that most COVID-19 infections were transmitted during this ‘pre-symptomatic’ phase. If that wasn’t bad enough, one study showed that SARS2 virus continues to be shed for up to 20 days after your first symptom. So even a 2-week quarantine period may not be long enough to ensure that you’re not infectious.

A long pre-symptomatic period, mild or asymptomatic people, and a long post-symptomatic shedding period, are why COVID-19 has spread so easily and quickly. And how it has spread all over the world thanks to overnight air travel. This is the reason we encourage everybody to wear face-masks, keep their distance, hands frequently, and stay home. The key insight from the viral shedding research is that if you’re feeling like you’re ‘coming down’ with something, you’ve already got it and you may have had it for days.

These cautions also apply to the flu or even a cold. Let’s not forget, the seasonal flu kills 20,000–61,000 Americans each year. We don’t close our country for the seasonal flu (nor should we), but that’s not an insignificant number of deaths. Whether by flu or COVID we could have far fewer cases and far fewer deaths every year, if we exercise the same cautions. We already know we shouldn’t treat COVID-19 like the flu. But maybe we need to start treating the flu more like COVID-19.

 


SOURCES

https://www.whitehouse.gov/briefings-statements/remarks-president-trump-vice-president-pence-members-coronavirus-task-force-press-conference/

https://www.nationalreview.com/magazine/2020/05/18/covid-19-is-not-the-flu/

https://www.washingtonpost.com/health/time-for-a-reality-check-america-the-flu-is-a-much-bigger-threat-than-coronavirus-for-now/2020/01/31/46a15166-4444-11ea-b5fc-eefa848cde99_story.html

https://jamanetwork.com/journals/jama/fullarticle/2763667

https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200317-sitrep-57-covid-19.pdf?sfvrsn=a26922f2_2

https://www1.nyc.gov/site/doh/covid/covid-19-data.page

http://publichealth.lacounty.gov/media/coronavirus/

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