A lot has been written lately that compares the new SARS-CoV-2 virus, which causes the COVID-19 disease, to the much more common and more familiar seasonal influenza virus that causes the dreaded flu. Personally, I think this is a very bad comparison, and one that should really be avoided at all costs, but it seems everyone from politicians to pundits to people in my friends lists is using the flu as the benchmark to measure by, so who am I to argue with consensus. So, let’s compare the experience Italy has had thus far this year with seasonal flu and COVID-19, and see which one is truly a bigger deal.

Okay, so it has been brought to my attention that my earlier numbers were incorrect (original analysis pasted at the end of article and struck through for transparency).  After checking various sites and sources, this seems to be the case, so I wanted to correct that error.  I originally quoted the total death toll for Influenza in Italy this year at 240 deaths, and that was NOT correct.  I misread both the site I was using as my original jumping off point and the original source data (which is in Italian).  The 240 deaths is for 1 week of the flu in Italy this year, not the whole season.

So, I went back and ran the numbers again using THIS website to draw data from.  Now, my Italian is a little rusty, so I’m relying on translators here.  But my understanding from this data is the chart is for observed vs estimated death toll from flu by week for those over the age of 65.  This will give a pretty good comparison for the flu vs COVID-19 argument since, according to Italian officials, all deaths from COVID-19 currently recorded in the country are over the age of 60.

My goal is to compare the death toll in Italy from Influenza during the time period from the first COVID-19 case (Jan 31st) to the present.  That’s roughly 7 weeks.  So, starting at the 2nd week of the year and adding to the 9th week, where the chart ends, you get a total death toll for the above mentioned age range of 1,791 deaths due to Influenza. Now, since the first COVID-19 case in Italy there have been a total of 3,405 deaths due to the COVID-19 disease.  That’s nearly double the death toll from the flu in the same age group during the same time period.

I’ve searched and searched through the internet trying to find a valid total for the death toll and case count this year for the flu in Italy, and since Italian is not my native language, the search has been more than a little frustrating.  The best I can come up with is that there have been a total of around 6.95 million cases of flu in Italy this year.  In one week during the peak of the season there were more than 400,000 cases.  As of right now the total confirmed case count for COVID-19 is around 41,000.  The bottom line is that with astronomically fewer cases, the COVID-19 disease has still managed to account for nearly twice the number of deaths in the most at risk age group, the 65+ year old group, during the same time period in Italy.  And given the disparity in the case count, this increase in death toll is even more alarming. Since I can’t find a reliable source for the total deaths this year in Italy due to flu I won’t try to compare the apparent case fatality rates of the two, the total death toll should suffice to get the point across.

And, given these relationships, I believe the rest of the article still holds true even if my original statistical analysis was based on incomplete data, to say the least.  Even with a more direct “apples to apples” comparison of the death toll on the elderly over an 8 week period, the COVID-19 disease is still orders of magnitude worse, and it is continuing to grow as we speak.

This is concrete, empirical confirmation that the COVID-19 virus represents a far graver threat to public health than Influenza does at this time. That may change in the future, but for now the comparison is one that does not even merit consideration. COVID-19, because it is a new disease without specific therapeutic treatments and without specific vaccines available, along with a complete lack of naturally acquired resistance or immunity, is a serious threat. Individual risk may be low for some, or even most people in a country, but this does NOT change the overall threat to public health and to the people who may eventually acquire this illness.

And one thing the Italian experience is teaching the world, or should be teaching it, is that COVID-19 is NOT the seasonal flu, and it is NOT a mild cold or cough. It is a very serious respiratory disease that may take a long time to materialize, both in individual cases and in regional epidemics, but it can also accelerate with frightening speed. There are reports of some patients from the WA state nursing home who went from no symptoms to critical condition in a matter of hours. Right now the US is lagging about 2-3 months behind the situation in China and about 3-4 weeks behind the situation in Italy. When Italy saw the number of serious COVID-19 cases suddenly surge in its healthcare systems, they began wide testing on a surveillance scale to look for more, and that’s when the case count there suddenly exploded. That doesn’t mean those cases are all new, just that the Italians weren’t looking for them at first.

The United States is currently in that lag time between when a significant number of people in multiple areas are infected and when they begin to develop serious enough symptoms to show up in the health care system. That situation can change VERY rapidly, though, as we have seen in multiple other instances around the world. This is true of any highly infectious disease, and it is especially true of a highly infectious respiratory disease to which the population has never been exposed. The numbers, both in Italy and in America, clearly illustrate the fact that Influenza is an incredibly serious, sometimes fatal, respiratory disease that should not be taken lightly or underestimated.  After all, if you applied the currently apparent

The numbers for COVID-19, often gathered from the same sources as the numbers for influenza, just as clearly illustrate that, at least for the time being, the threats to public health from COVID -19 and the SARS-CoV-2 virus that causes is are orders of magnitude more serious than the flu. It’s time to act and prepare accordingly.

Also, thank you to all of my readers for checking the numbers and letting me know when I get things wrong.  I do my best to only use accurate, dependable sources, but even doing that I still sometimes get things wrong and need to correct them.  Hope the changes above help clarify things.

 

Original (erroneous) statistical analysis:

Based on this article, Italy has had a moderate flu season thus far, one that is well within the predicted parameters for their seasonal burden (what epidemiologists call the cumulative effect of a disease on health care systems) is from flu for the 2019-2020 season to this point (their source data). Remember, flu season is still active in Europe and the rest of the world (including the US), so it’s still an ongoing circulation of seasonal flu, and it could end up being compounded by the COVID-19 situation, but more on that later.

At this point Italy has seen just shy of 3 million cases, with an estimated 2,768,000 cases from Oct. 2019 through about Jan. of 2020. January was the peak of flu season in Italy, with around 488k cases that month. That sounds terrible and terrifying, and it would be, if the incidence of serious and critical illness were higher. As it is, though, even with almost 3 million cases in a 4 month period, there were only 240 deaths from the flu in Italy, and that was actually lower than the expected number (258). That’s an incredible statement! To have over 2.5 million cases and have fewer than 250 deaths is a cumulative case fatality rate (CFR) of 0.009%. A true testament to the efficiency and skill of Italy’s healthcare system, as well as an objective statement about the risk and severity of an average flu epidemic.

COVID-19, in the same health system, presents an entirely different picture. As of right now there are a fraction of the known flu cases in Italy with COVID-19 at 9,172 as of writing this vs. the 2.7 million cases of flu (source is constantly updated). However, the deaths from COVID-19 already far outstrip the deaths from flu in Italy with COVID-19 responsible for 463 deaths as of this writing, and flu a little more than half that at 240 deaths as of January. Seasonal flu killed an average of 0.009% of its victims while COVID-19 in Italy has killed 5.04% of its victims, 540 times the CFR for flu. COVID-19 has been responsible for roughly 0.33% of the number of flu cases in Italy, but has resulted in 192.9% of the deaths caused by flu. However you choose to relate and compare these numbers, it is absolutely inescapable that COVID-19 is currently the more severe of the two diseases.