
Comparing Covid-19 Deaths to Flu Deaths Is Like Comparing Apples to Oranges - pmorici
https://blogs.scientificamerican.com/observations/comparing-covid-19-deaths-to-flu-deaths-is-like-comparing-apples-to-oranges/
======
HPsquared
Flu or not, it's possible to compare all-cause mortality this year against
previous years. That's about as hard data as it gets. How does Covid compare
to "seasonal all-cause-winter-deaths"? That's what people are interested in -
how unprecedented is the death rate?

~~~
ceejayoz
It's possible, and it's being done.

[https://www.nytimes.com/interactive/2020/04/27/upshot/corona...](https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-
deaths-new-york-city.html)

> The recent death count reached six times the normal number of deaths for the
> city at this time of year, a surge in deaths much larger than what could be
> attributed to normal seasonal variations from influenza, heart disease or
> other more common causes.

[https://www.nytimes.com/interactive/2020/04/21/world/coronav...](https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-
missing-deaths.html)

> These numbers undermine the notion that many people who have died from the
> virus may soon have died anyway. In Paris, more than twice the usual number
> of people have died each day, far more than the peak of a bad flu season. In
> New York City, the number has spiked to six times the normal amount.

~~~
Fjolsvith
> These numbers undermine the notion that many people who have died from the
> virus may soon have died anyway. In Paris, more than twice the usual number
> of people have died each day, far more than the peak of a bad flu season. In
> New York City, the number has spiked to six times the normal amount.

I'm betting that in the next few years the death rate will drastically fall
because the only people left will be really healthy.

~~~
smnrchrds
If it is killing people _a couple of years_ earlier than they otherwise would
have died, it is fair to consider them excess deaths.

~~~
Fjolsvith
Are you counting more than one death per person?

------
natch
I have a friend who works in a stroke unit and he says almost nobody is coming
in for strokes. Instead some people are just suffering or dying at home. Of
strokes. Not every single one of them, but some alarming and as yet unknown
number.

All that sounds unrelated to Covid-19. But the reason they are not going to
the hospital is because they fear going into a medical facility, for fear of
Corona virus. Should these deaths be counted as Covid-19 deaths? As shelter in
place deaths? Or just as strokes? I'm not sure. It's complicated to sort this
stuff out.

~~~
cm2187
And death from other infectious disease will be down as well because of the
lockdown. But the demography of the victims from covid is largely skewed
against people with a low life expectancy in the first place. And then a
severe economic crisis will come with its own health issues.

So the net impact of covid will only really be known at the end of the year at
best.

------
zenpaul
Two important takeaways here.

"In fact, in the fine print, the CDC’s flu numbers also include pneumonia
deaths."

"If we compare, for instance, the number of people who died in the United
States from COVID-19 in the second full week of April to the number of people
who died from influenza during the worst week of the past seven flu seasons
(as reported to the CDC), we find that the novel coronavirus killed between
9.5 and 44 times more people than seasonal flu."

For the average person, COVID-19 is better described as "highly contagious and
extra deadly pneumonia".

~~~
makomk
Pneumonia is a common fatal complication of influenza, and I think there's
reasonably good statistical evidence that the cases counted towards flu deaths
are mostly caused by the flu especially in the bad flu epidemic years which
are most comparable to Covid-19. That sentence is a bit like claiming that
people don't die from falling out of airplanes because the actual cause of
death was hitting the ground.

~~~
pacala
I think you meant 'flu deaths are mostly caused by [bacterial] pneumonia'. One
thought along those lines is that the spike in deaths we see is due to covid19
killing directly, death coming like clockwork X weeks after infection.
Compared to the flu, which due to the requirement for a secondary bacterial
pneumonia, has a higher variability in the timing of the death: at what time
bacterial infection develops, which strain of bacteria, antibiotic
interference, etc. Thus, we're going to see higher spikes for covid, and
hopefully narrower.

~~~
makomk
Yeah, and apparently one of the more interesting consequences of this is that
people don't necessarily have detectable flu virus anymore once they're
hospitalized with pneumonia because it's the bacteria allowed in by the now-
gone flu infection that's killing them.

------
bjt2n3904
As interesting as this article is... you absolutely can compare Covid-19
deaths to Flu Deaths. It's a far better comparison than, say, the people who
note that we are having a 9/11 Terrorist Attack every day. I think the fear is
that people will look at the death toll alone -- but if you include timespan
as a point of comparison, it becomes very helpful to developing an
understanding.

But as long as we're suddenly concerned about understanding the statistics
about deaths... the 40,000 people that die annually to "gun violence", over
half are suicides.

~~~
gnusty_gnurc
On a somewhat related note - the absolute death toll number isn't super useful
either. I was shocked to learn a couple days ago that it seems pretty
consistent around the world that 50% of that toll is from people in nursing
homes. I did a quick search and found a study that found median/mean stay in a
nursing home until death is 5/13 months. I'm not even examining the numbers
closely, but that would suggest a huge number of people dying that are in
absolutely precarious health. A death toll number does not convey that at all.

------
paleotrope
But let's compare them anyway.

"we find that the novel coronavirus killed between 9.5 and 44 times more
people than seasonal flu."

That was easy wasn't it.

~~~
SlowRobotAhead
>That was easy wasn't it.

Was it?

I don’t get it. I found that there so far have been covid 234,133 deaths [0]
and season flu can cause up to 646,000 deaths [1].

So I’m not seeing 9x to 44x by any reasonable metric or projection. What am I
missing?

If 9 to 44x is possible, there need to be models that would show that. Does
anyone have a model that shows we aren’t even remotely near peak deaths?

Even if the article is right and seasonal flu was vastly over reported by the
CDC as a “for your own good” tactic, I’m STILL not seeing 9x to 44x.

[0] [https://www.statista.com/statistics/1087466/covid19-cases-
re...](https://www.statista.com/statistics/1087466/covid19-cases-recoveries-
deaths-worldwide/)

[1]
[https://www.medicinenet.com/script/main/art.asp?articlekey=2...](https://www.medicinenet.com/script/main/art.asp?articlekey=208914)

EDIT: Article uses worst week covid compared to worst week flu... talk about
Apples to Oranges!?

~~~
ceejayoz
> What am I missing?

It's right there in your comment:

> so far

(Also, the rest of the paragraph that 9-44x number comes from:)

> To do this, _we have to compare counted deaths to counted deaths, not
> counted deaths to wildly inflated statistical estimates_. If we compare, for
> instance, the number of people who died in the United States from COVID-19
> in the second full week of April to the number of people who died from
> influenza during the worst week of the past seven flu seasons (as reported
> to the CDC), we find that the novel coronavirus killed between 9.5 and 44
> times more people than seasonal flu.

~~~
SlowRobotAhead
No, I don’t think I am missing that. Which is why I used those words.

I have no doubt covid is worse than flu and have no issue with being more
cautious than reckless.

But if you can find me a model that shows we’re no where near peak deaths and
are still looking to 9 to 44 times more, I’d like to see that.

Edit: anyone? Sources? Models?

~~~
simonh
The finding that in like periods in April this year compared to previous years
Covid-19 has killed from 9 to 44 times as many people is a historical fact,
not a projection. As for peak deaths, the number of people dying each day is
still going up. We don’t need a fancy statistical model to tell us this means
we haven’t reached peak deaths yet.

~~~
SlowRobotAhead
Do you think it’s legitimate to take covid single worst week, compare to a
week of flu and extrapolate our 9 to 44x worse?

Do you think there will be 10-30 million covid deaths this year?

~~~
simonh
It's not comparing it to 'a' week of flu, it's comparing it to the single
worst week of flu in the last 7 years. I think it's one useful and relevant
data point to see how Covid-19 deaths compare to flu, which of course is far
from telling the whole story.

I have no idea what the world is going to do over the next 8 months, or what
effect it's going to have. Do you?

------
dominotw
I have a simple covid related question, hopefully someone can answer this
here.

We have been under lockdown for over 6 weeks here in chicago. But chicago had
highest number of deaths all of this week[1]. If we were under lockdown 6
weeks ago how did the people who died this week get infected. Does this mean
ppl aren't following the guidelines properly ? I feel like I am missing
something obvious here.

1\.
[https://chicago.suntimes.com/coronavirus/2020/4/28/21240216/...](https://chicago.suntimes.com/coronavirus/2020/4/28/21240216/illinois-
pritzker-coronavirus-cases-deaths-high-april-28)

~~~
ceejayoz
> Does this mean ppl aren't following the guidelines properly ?

Yes, most likely. Folks still have to go out for groceries. Essential workers
spread it to their families. The city had to close down various beaches and
trails because people weren't staying far enough apart. etc. etc. etc.

~~~
dominotw
So if make groceries pickup only and hefty fines/jail times for flouting
guidelines. We would've had lockdown only for 2 weeks, in theory?

~~~
ceejayoz
Or civil unrest.

You'd have to do something about the grocery pickup folks, healthcare workers,
people maintaining other critical infrastructure, etc. too.

China can manage this (but it took more than two weeks). We probably can't
with our current political system.

------
rossdavidh
It should be said, there's all kinds of situations where it makes sense to
compare apples and oranges. You could compare their nutrition, to see which
you should eat. You could compare their price, to see which you should buy. As
long as you're aware that you're comparing two things that aren't identical
(and you always are), it's often perfectly valid to compare apples and
oranges. Just don't claim they're both apples.

I don't think anyone comparing Covid-19 and influenza, is unaware that they
are different viruses. But, as when we compare gun violence to drug overdoses
to traffic fatalities, it is often a useful and justifiable thing to do, to
compare different dangers. Should I take the risk of flying (e.g. after 9/11),
or drive 500 miles? Well driving and flying are very different, but it can
make sense to compare them.

~~~
me_again
I have to wonder whether you read the article. Your comment is technically
correct but doesn't address the point that it is making: that we are not
counting the apples and oranges in comparable ways.

------
bmat
For people getting hung up on the apples to oranges analogy: imagine you're a
farmer. You're hearing reports that there's a huge surplus of oranges and
everyone is cutting production. You have a lot of orange trees, so you're
understandably upset by this and decide to look into it. Some journalists,
politicians, and your uncle Jimmy say it's all overblown—there are about as
many apples as there are oranges on the market this year. No surplus, no need
to cut production.

Then Agricultural American puts out an article showing that data on oranges is
being reported by farmers as oranges are picked, whereas data on apples is
being estimated based on much fewer reports. The conclusion is that the
apples-to-oranges comparison should be taken with a grain of salt.

This is in addition to reports that show orange yields are likely
underreported based on overall measures of fruit on the market[1], as well as
anecdotal reports of fruit storage being overwhelmed by oranges[2].

Ok I think we can go ahead and report this analogy as another COVID-19-related
death.

[1][https://www.nytimes.com/interactive/2020/04/21/world/coronav...](https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-
missing-deaths.html)

[2][https://news.sky.com/story/coronavirus-body-bags-begin-to-
fi...](https://news.sky.com/story/coronavirus-body-bags-begin-to-fill-new-
yorks-makeshift-morgues-11969170)

------
pmorici
The surprising thing here is that the often quoted flu death number isn't an
actual count it is a statistical estimate based off the must lower recorded
count. Not surprising in retrospect but not obvious when people trot that
number out.

------
taeric
I think boiling it down to a number is killing understanding. This is far more
deadly for elderly than even this estimate makes it sound. The CFR for over
sixty year olds in WA being an absurd 28%!! Under sixty? The flu is probably
more deadly. Certainly understand 20.

So, just like with different fruits, you can't compete easily when boiled to a
single facet. Almost like comparing the color of two fruits, without
acknowledging the wide variety in color about the fruits.

~~~
gnusty_gnurc
I suspect political leadership will avoid bringing up the abject failure of
government to protect the elderly. Meanwhile they'll use this as an
opportunity to ratchet up emergency power, make precedents, etc.

------
bryanrasmussen
every now and then I am reminded that there are in fact lots of different
metrics that can be used to compare Apples and Oranges.

------
thedudeabides5
Yeah, but they are both denominated in the same thing, human lives.

Bit easier for people to get their head into than QALYs

[https://en.wikipedia.org/wiki/Quality-
adjusted_life_year](https://en.wikipedia.org/wiki/Quality-adjusted_life_year)

------
ben7799
One of my takeaways from his article is it sounds like he never actually tests
his mortally ill patients to see if they have influenza.

Sounds like he is misleading everyone as bad as the CDC.

I had a bad "flu-like" illness in February and they diagnosed me over the
phone and never tested me.

Could have been Covid, could have been the flu, could have been neither.

Even if we're not testing everyone for Covid-19 they're clearly taking it more
seriously than flu.

------
thembones
> The CDC should immediately change how it reports flu deaths. While in the
> past it was justifiable to err on the side of substantially overestimating
> flu deaths, in order to encourage vaccination and good hygiene

Yeah... except this is exactly what they are doing for COVID deaths, read the
below.

[https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-I...](https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-
ICD-code-introduced-for-COVID-19-deaths.pdf)

------
m1117
Why can't we compare apples and oranges? They're fruit. They have nutritions.
I don't like this metaphor.

~~~
ravenstine
The metaphor can apply to some things, but there's no good reason as far as I
can tell for us to not compare COVID-19 to influenza. Experts desperately want
to be right, so they're going to publish articles like this, which are
effectively saying "Hey! Look at my shiny penny!"

------
toolz
so we go from

>3,448 to 15,620

confirmed deaths to

>25,000 to 69,000

estimated deaths? It's no wonder Americans have trust issues with medical
experts. That's an absurd number created just to scare people into getting
vaccinated. Which appears to be the authors opinion as well.

> While in the past it was justifiable to err on the side of substantially
> overestimating flu deaths, in order to encourage vaccination and good
> hygiene

I feel like trust is entirely undervalued in the scientific community. How are
lay people expected to follow scientific advice if we can't trust the
scientists?

~~~
HPsquared
After this is all settled we can compare all-cause mortality. It may be
complicated by lockdown side-effects though, so we might never know.

~~~
gpderetta
There are countries that are under lockdown with relatively small exposure to
covid which can be used as control.

Even within a country, lockdown rules are often homogeneous, while the spread
of the virus can be quite patchy, allowing for some form of control.

------
HPsquared
Flu, seasonal pneumonia... what's the diff?

~~~
SlowRobotAhead
Flu are caused by the viruses, pneumonia is the serious bacterial infection of
the lungs potentially caused by having influenza.

You would count seasonal pneumonia if you wanted to see how serious that
seasonal flu was.

~~~
gpderetta
Technically no, in addition to bacterial pneumonia (which is often caused by
opportunistic infection after a virual invection), there is straight viral
pneumonia without any bacterial infection. Even fungi by themselves can cause
pneumonia.

The difference is that flu does not always cause pneumonia.

~~~
SlowRobotAhead
> The difference is that flu does not always cause pneumonia

Did not think I implied it did. But no, you’re right, it’s why the flu is more
dangerous old people.

My understanding of fungus introduced to the lungs is that it’s also carrying
bacteria. But yes, there are lots of things you can introduce the lungs cause
light to severe pneumonia.

If you want to pro tip, stirring your protein powder well, if you don’t and
inhale as powder it on your first sip you can have a bad couple weeks.

------
macinjosh
From the article:

> The CDC should immediately change how it reports flu deaths. While in the
> past it was justifiable to err on the side of substantially overestimating
> flu deaths, in order to encourage vaccination and good hygiene

Doctors, scientists, and the CDC, basically everyone we've been told to always
trust when it comes to these matters, are and have been 'substantially'
inflating flu death numbers to manipulate public behavior (e.g. to get more
people to be vaccinated).

As well intentioned as that may be it is exactly why some people are skeptical
about the flu vaccine. They sense manipulation and run from it. This
patronizing behavior from the scientific and political class is destructive.

~~~
hnburnsy
Does anyone feel like this happens with some approaching hurricane coverage
where the scientists may overestimate things like storm surge to try and prod
people to evacuate? Now when the next hurricane approaches they remember what
happened last time and might be less likely to leave.

------
wyck
Article critiques data set and gives zero details on the CDC calculation
methodology, and provides zero relevance to any new or interesting data
analysis, but it surely mentioned Trump a few times.

A simple Google search will provide you with actual data sets, nationally,
state wide, and even globally, by very competent scientists, some of whom have
studied this specifically for decades.

There are various places you can research for example: FluView, FluMomo,
Virologic Surveillance, Journal of Infectious Diseases, etc.

I recently read, Influenza-attributable deaths, Canada 1990–1999 Published
online by Cambridge University Press , so this MD's Scientific American blog
post comes across as pure garbage.

~~~
allannienhuis
so, how are his conclusions different than the research you're referring to?

------
minikites
Inaccurate comparisons like this one are often made in bad faith by someone
who knows full well that it's misleading but it serves a political purpose.

Assuming good faith intentions by the current US political leadership is
comically naive at this point.

------
donatj
> The former [COVID] are actual numbers; the latter [Flu] are inflated
> statistical estimates

With doctors being instructed by the CDC to count every death that could have
potentially been COVID as a COVID death, in the face of near total lack of
testing, saying that the numbers are _not inflated_ is a bold faced lie.

[https://www.mprnews.org/story/2020/04/07/covid19-death-
certi...](https://www.mprnews.org/story/2020/04/07/covid19-death-certificate-
change-stirs-controversy)

[https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf](https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf)

~~~
bonzini
Fortunately you can look at mortality rates and you can see that in Europe
it's even worse than the official statistics. Excess mortality is twice higher
than recorded COVID deaths in the Netherlands for example.[1]

Even though there is a harvesting effect and you can expect mortality to be
lower than average in the next few months (the famous "people that would have
died anyway"), the data is not exactly substantiating conspiracy theories such
as yours.

[1] [https://www.rivm.nl/en/news/excess-mortality-caused-by-
novel...](https://www.rivm.nl/en/news/excess-mortality-caused-by-novel-
coronavirus-covid-19)

------
cm2187
The author may have a point but his numeric example is also comparing apples
and oranges:

> _If we compare, for instance, the number of people who died in the United
> States from COVID-19 in the second full week of April to the number of
> people who died from influenza during the worst week of the past seven flu
> seasons (as reported to the CDC), we find that the novel coronavirus killed
> between 9.5 and 44 times more people than seasonal flu_

He is comparing the number of deaths from a disease to which we are largely
immune (the flu, through flu shot or previous strains) to a new disease to
which we have no immunity. Of course the number of cases will widely differ.
But I think most of the educated people who compare covid 19 to the flu mean
in term of IFR, i.e. the ratio of death to the number of people infected. Of
course if that ratio is applied to a much greater number of infections you
will get more absolute deaths.

Also is the way we account for deaths between flu and covid that different? I
understand people accounted as covid death don't really die from the virus but
from the effects of the virus (pneumonia, heart attack, etc). Isn't the flu
killing the same way, and do we do flu tests for each death from pneumonia (or
whatever the flu ends up inducing)?

~~~
krtong
he's just pointing out that nobody writes the flu as the cause of death on a
death certificate. The CDC simply releases estimates, while we've been
tracking the severity of COVID-19 deaths by asking clinicians to write the
cause of death as COVID-19 on the death certificate if they tested positive.

Patient has flu and dies of a stroke? Flu can increase the chance of stroke by
50% but the cause of death was the stroke, not the flu. Same thing happens to
covid-19? They died of covid-19.

The point is that the data collection methods are so different there's no
possible way you can really look at the numbers and tell if one kills more
than the other.

~~~
cm2187
Your explaination seems sensible but I don't think this was the point that the
author made. The way I read it was he meant that the CDC overestimates the
number of flu deaths and therefore anyone thinking covid's lethality is
comparable to flu is wrong as the flu kills a lot less.

