COVID-19 is not the 1918 Spanish Flu, which killed 50 million people—the lurid fear-mongering of some media outlets notwithstanding. But it’s not the regular flu either, and a lot of people across the political spectrum erred in making that comparison at the outset.
Scientific American last week published an important article by Jeremy Samuel Faust, a Harvard Medical School instructor and emergency room doctor, which helps explain why so many did, and why they weren’t wrong to distrust the health “experts.” Unfortunately, the headline, “Comparing COVID-19 Deaths to Flu Deaths Is like Comparing Apples to Oranges,” which suggests yet another “It’s not the flu, you dumb deplorables” lecture, and the obligatory digs at Donald Trump, obscure the lede.
Faust buries that lede in the sixth paragraph, after discussing how Trump and others had sought to put early COVID-19 death projections in perspective by comparing them to figures issued by the Centers for Disease Control and Prevention purporting to show that the flu kills upwards of 70,000 Americans (or more) each year:
It occurred to me that, in four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu. . . . Most of the [colleagues around the country] I surveyed couldn’t remember a single one over their careers. . . . For too long, we have blindly accepted a statistic that does not match our clinical experience.
He goes on to note that the CDC estimates of annual flu deaths are based on highly dubious (to say the least) algorithms that overstate the actual number of deaths by six times. The CDC applies multipliers of between 2.1 and 5.2 (depending on age group) to reported flu-related hospitalizations, further extrapolates estimated flu deaths based on these multipliers, then adds in an estimate of at-home flu deaths for good measure—all regardless of the stated cause of death on the death certificate. In so doing, it classifies not only many patients who were never tested for influenza as flu-related fatalities, including patients who tested negative.
The result has been a statistic that flies in the face not only of the clinical experience of Faust and other doctors but of the everyday experience of the average person. How many people do you know who’ve died of the flu? (In my case the answer is two in 60 years: a young girl when I was a child, and Federalist writer Bre Payton in 2018. But the very shock of Payton’s tragic death at 26 emphasizes what a statistical outlier it was.)
Yet, like Faust, we blindly accepted the CDC figures.
What we’d gotten wrong in comparing the coronavirus to the flu was that the real hype was not about COVID-19 but about the flu.
I think this is a big reason why many of us initially underestimated the coronavirus. Ignoring Groucho Marx’s rule of social science methodology, “Who are you going to believe, me or your own eyes?” we believed the CDC—perhaps assuming, as Faust notes, that such a large death toll would be barely noticeable in a country of 300 million. Yet, as he points out, the claimed flu death figures are higher than the number who die each year in auto accidents or from opioid overdoses or gun violence and we’re all aware of those kinds of fatalities.
Having accepted that 70,000 flu deaths per year were a statistical drop in the bucket with no significant impact on American life, political figures as disparate as Trump and Andrew Cuomo and Bill de Blasio were not wrong or stupid or “scientifically illiterate” (as charged by some people who couldn’t tell you the chemical formula for water) to make the obvious comparison when faced with initial COVID-19 death projections in the same range, or even several times higher.
“Why would COVID-19 ‘overwhelm’ the healthcare system when the flu doesn’t?” was not a dumb question, and the health establishment never satisfactorily answered it.
The typical responses concerning the concededly greater mortality and severity of the coronavirus were not an answer, since the question was only about those patients who did become sick enough to die of either disease. Don’t all those people who allegedly die of the flu become critically ill before dying (the way just about every other patient who doesn’t die suddenly does), and often require ICU beds and ventilators?
The answer to these questions began to dawn on me when COVID-19 did begin to overwhelm some New York hospitals in early April even while total deaths were still well below the claimed number of flu deaths. What we’d gotten wrong in comparing the coronavirus to the flu was that the real hype was not about COVID-19 but about the flu.
Flu deaths never overwhelmed the healthcare system because the numbers were always fake. Public health “experts” who are both philosophically and bureaucratically inclined towards excessive fearfulness have cried wolf about a host of wolves in recent years. And the flu has been the biggest wolf of all.
As in the original story, these bogus warnings understandably contributed to complacency. If we’re parceling out blame for being underprepared for COVID-19 at the beginning (I don’t think we should be, but if we are) a lot of it needs to be parceled there.