11 ms·

Comparing Covid-19 Deaths to Flu Deaths Is Like Comparing Apples to Oranges

94 points by pmorici 6y ago

thedudeabides5 6y ago
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
m1117 6y ago
Why can't we compare apples and oranges? They're fruit. They have nutritions. I don't like this metaphor.
- HPsquared 6y ago
  How about oranges vs lemons? That way they are superficially similar but one is a lot more palatable than the other. Regular coronavirus = eating an orange. SARS-CoV-2 = eating a lemon...
- jordanbeiber 6y ago
  We can, but at the same time it would be different than a comparison of say a granny smith and a gala apple. Oranges share fundamental properties with apples - they are ”fruits” and ”pip” ones at that, and can be compared as such - but there’s a clear distiction and a reason for the grouping of ”apples” and ”oranges”.
- JamesG124 6y ago
  It's about comparison of individuals. Only when two individuals belong to the same specifies does it make sense to compare them. For example, "is Fred taller than John?" is much better defined than "is Fred taller than [some porpoise]?" It's certainly possible to compare species themselves, e.g. how does the typical orange differ from the typical apple. But the idea behind the popular saying concerns individual comparison, not species comparison
- ceejayoz 6y ago
  > Why can't we compare apples and oranges? We can! But, we must do so carefully. "They're both sweet" cannot be used to conclude "they are the same".
- ravenstine 6y ago
  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 6y ago
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?
- thetrumanshow 6y ago
  Why the downvotes for this guy? The article makes the specific claim that the flu death numbers are allowed to be inflated through lax CDC reporting rules so that people are encouraged to get vaccinated and practice good hygiene. Shouldn't that make us skeptical?
- HPsquared 6y ago
  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 6y ago
    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.
- klagermkii 6y ago
  This thing of misleading people on the details so that they make the Correct Decision in the short term seems very dangerous. I know in tech there's a tendency to do something similar when faced with clueless management, feeding just the information you know they need to hear to get them to make the right choice and think they came up with it themselves. Really don't like this applied on a society level though.
HPsquared 6y ago
Flu, seasonal pneumonia... what's the diff?
- SlowRobotAhead 6y ago
  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 6y ago
    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 6y ago
      > 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.
paleotrope 6y ago
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.
- bmat 6y ago
  The point was comparing reported COVID deaths to statistically extrapolated flu deaths is apples to oranges. What you quoted was a comparison of reported deaths to reported deaths.
  - lemagedurage 6y ago
    "Comparing reported COVID deaths to statistically extrapolated flu deaths is apples to oranges" I suppose this would be a better title of the article.
  - fullshark 6y ago
    I think comparing just reported deaths is probably even worse, the rate of undercounting of flu deaths and undercounting of covid deaths (in a pandemic with a ton of testing / heightened observation) is not going to be comparable.
    - bmat 6y ago
      Definitely. My takeaway is we should be skeptical of any comparison between COVID and flu statistics.
- SlowRobotAhead 6y ago
  >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-recoveries-deaths-worldwide/ https://www.statista.com/statistics/1087466/covid19-cases-re... [1] https://www.medicinenet.com/script/main/art.asp?articlekey=208914 https://www.medicinenet.com/script/main/art.asp?articlekey=2... EDIT: Article uses worst week covid compared to worst week flu... talk about Apples to Oranges!?
deleted 6y ago
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bryanrasmussen 6y ago
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.
macinjosh 6y ago
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.
- jarym 6y ago
  I agree. But within that same batch of people, faced with undeniable first-hand evidence of the severity of something like covid-19 will inexplicably choose to blame 5G antennas. Nutso people are nutso is my only conclusion.
- Hokusai 6y ago
  > have been 'substantially' inflating flu death numbers to manipulate public behavior (e.g. to get more people to take vaccinated). This is the article writer opinion, it is not the CDC official stand on the matter. Similar calculations are currently done for Covid-19. Many articles show the discrepancy between total reported deaths, Covid-19 reported deaths and medium values in previous years. It makes sense. That the numbers are not perfectly correct does not mean that they are not good enough to use for policies and to inform the public. > This patronizing behavior from the scientific and political class is destructive. I like the transparency of publishing the data and the methods to calculate it. That is the contrary of patronizing. I hope that transparency continues to be the norm, even when makes the number easier to criticize for people with little information.
- gpderetta 6y ago
  Agree that lying to people (even by selective omission) is a great way to undermine confidence and trust.
- hnburnsy 6y ago
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wyck 6y ago
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 6y ago
  so, how are his conclusions different than the research you're referring to?
thembones 6y ago
> 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-ICD-code-introduced-for-COVID-19-deaths.pdf https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-I...
donatj 6y ago
> 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-certificate-change-stirs-controversy https://www.mprnews.org/story/2020/04/07/covid19-death-certi... https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf
- bonzini 6y ago
  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-coronavirus-covid-19 https://www.rivm.nl/en/news/excess-mortality-caused-by-novel...
- gpderetta 6y ago
  Excess death in Italy is estimated about twice the reported death count. In the most affected regions it is 3-4x.
HPsquared 6y ago
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 6y ago
  It's possible, and it's being done. https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html https://www.nytimes.com/interactive/2020/04/27/upshot/corona... > 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/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... > 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 6y ago
    > 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 6y ago
      If it is killing people a couple of years earlier than they otherwise would have died, it is fair to consider them excess deaths.
      - deleted 6y ago
dominotw 6y ago
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/illinois-pritzker-coronavirus-cases-deaths-high-april-28 https://chicago.suntimes.com/coronavirus/2020/4/28/21240216/...
- martin-adams 6y ago
  I'd love to know the answer on this question too. The only theory I have is that it's being spread through key workers. So those caring for other like hospitals and care homes.
- ceejayoz 6y ago
  > 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 6y ago
    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 6y ago
      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.
    - SpicyLemonZest 6y ago
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zenpaul 6y ago
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 6y ago
  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 6y ago
    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 6y ago
      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.
minikites 6y ago
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.
rossdavidh 6y ago
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 6y ago
  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.
natch 6y ago
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 6y ago
  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.
bmat 6y ago
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/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... [2]https://news.sky.com/story/coronavirus-body-bags-begin-to-fill-new-yorks-makeshift-morgues-11969170 https://news.sky.com/story/coronavirus-body-bags-begin-to-fi...
bjt2n3904 6y ago
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.
- snarf21 6y ago
  "There are three kinds of lies: lies, damned lies, and statistics." - made popular by Mark Twain. Which as you point out, context matters, detail matters. You can make any point you want given enough caveats.
- gnusty_gnurc 6y ago
  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.
ben7799 6y ago
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.
cm2187 6y ago
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 6y ago
  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 6y ago
    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.
taeric 6y ago
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 6y ago
  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.
pmorici 6y ago
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.

94 points by pmorici 6y ago

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

m1117 6y ago

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

HPsquared 6y ago
How about oranges vs lemons? That way they are superficially similar but one is a lot more palatable than the other. Regular coronavirus = eating an orange. SARS-CoV-2 = eating a lemon...
jordanbeiber 6y ago
We can, but at the same time it would be different than a comparison of say a granny smith and a gala apple. Oranges share fundamental properties with apples - they are ”fruits” and ”pip” ones at that, and can be compared as such - but there’s a clear distiction and a reason for the grouping of ”apples” and ”oranges”.
JamesG124 6y ago
It's about comparison of individuals. Only when two individuals belong to the same specifies does it make sense to compare them. For example, "is Fred taller than John?" is much better defined than "is Fred taller than [some porpoise]?" It's certainly possible to compare species themselves, e.g. how does the typical orange differ from the typical apple. But the idea behind the popular saying concerns individual comparison, not species comparison
ceejayoz 6y ago
> Why can't we compare apples and oranges? We can! But, we must do so carefully. "They're both sweet" cannot be used to conclude "they are the same".
ravenstine 6y ago
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 6y ago

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?

thetrumanshow 6y ago
Why the downvotes for this guy? The article makes the specific claim that the flu death numbers are allowed to be inflated through lax CDC reporting rules so that people are encouraged to get vaccinated and practice good hygiene. Shouldn't that make us skeptical?
HPsquared 6y ago
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 6y ago
  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.
klagermkii 6y ago
This thing of misleading people on the details so that they make the Correct Decision in the short term seems very dangerous. I know in tech there's a tendency to do something similar when faced with clueless management, feeding just the information you know they need to hear to get them to make the right choice and think they came up with it themselves. Really don't like this applied on a society level though.

HPsquared 6y ago

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

SlowRobotAhead 6y ago
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 6y ago
  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 6y ago
    > 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.

paleotrope 6y ago

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.

bmat 6y ago
The point was comparing reported COVID deaths to statistically extrapolated flu deaths is apples to oranges. What you quoted was a comparison of reported deaths to reported deaths.
- lemagedurage 6y ago
  "Comparing reported COVID deaths to statistically extrapolated flu deaths is apples to oranges" I suppose this would be a better title of the article.
- fullshark 6y ago
  I think comparing just reported deaths is probably even worse, the rate of undercounting of flu deaths and undercounting of covid deaths (in a pandemic with a ton of testing / heightened observation) is not going to be comparable.
  - bmat 6y ago
    Definitely. My takeaway is we should be skeptical of any comparison between COVID and flu statistics.
SlowRobotAhead 6y ago
>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-recoveries-deaths-worldwide/ https://www.statista.com/statistics/1087466/covid19-cases-re... [1] https://www.medicinenet.com/script/main/art.asp?articlekey=208914 https://www.medicinenet.com/script/main/art.asp?articlekey=2... EDIT: Article uses worst week covid compared to worst week flu... talk about Apples to Oranges!?

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bryanrasmussen 6y ago

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.

macinjosh 6y ago

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.

jarym 6y ago
I agree. But within that same batch of people, faced with undeniable first-hand evidence of the severity of something like covid-19 will inexplicably choose to blame 5G antennas. Nutso people are nutso is my only conclusion.
Hokusai 6y ago
> have been 'substantially' inflating flu death numbers to manipulate public behavior (e.g. to get more people to take vaccinated). This is the article writer opinion, it is not the CDC official stand on the matter. Similar calculations are currently done for Covid-19. Many articles show the discrepancy between total reported deaths, Covid-19 reported deaths and medium values in previous years. It makes sense. That the numbers are not perfectly correct does not mean that they are not good enough to use for policies and to inform the public. > This patronizing behavior from the scientific and political class is destructive. I like the transparency of publishing the data and the methods to calculate it. That is the contrary of patronizing. I hope that transparency continues to be the norm, even when makes the number easier to criticize for people with little information.
gpderetta 6y ago
Agree that lying to people (even by selective omission) is a great way to undermine confidence and trust.
hnburnsy 6y ago

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wyck 6y ago

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 6y ago
so, how are his conclusions different than the research you're referring to?

thembones 6y ago

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

donatj 6y ago

> 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-certificate-change-stirs-controversy https://www.mprnews.org/story/2020/04/07/covid19-death-certi... https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf

bonzini 6y ago
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-coronavirus-covid-19 https://www.rivm.nl/en/news/excess-mortality-caused-by-novel...
gpderetta 6y ago
Excess death in Italy is estimated about twice the reported death count. In the most affected regions it is 3-4x.

HPsquared 6y ago

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 6y ago
It's possible, and it's being done. https://www.nytimes.com/interactive/2020/04/27/upshot/coronavirus-deaths-new-york-city.html https://www.nytimes.com/interactive/2020/04/27/upshot/corona... > 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/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... > 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 6y ago
  > 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 6y ago
    If it is killing people a couple of years earlier than they otherwise would have died, it is fair to consider them excess deaths.
    - deleted 6y ago

dominotw 6y ago

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/illinois-pritzker-coronavirus-cases-deaths-high-april-28 https://chicago.suntimes.com/coronavirus/2020/4/28/21240216/...

martin-adams 6y ago
I'd love to know the answer on this question too. The only theory I have is that it's being spread through key workers. So those caring for other like hospitals and care homes.
ceejayoz 6y ago
> 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 6y ago
  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 6y ago
    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.
  - SpicyLemonZest 6y ago

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zenpaul 6y ago

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 6y ago
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 6y ago
  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 6y ago
    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.

minikites 6y ago

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.

rossdavidh 6y ago

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 6y ago
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.

natch 6y ago

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 6y ago
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.

bmat 6y ago

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/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... [2]https://news.sky.com/story/coronavirus-body-bags-begin-to-fill-new-yorks-makeshift-morgues-11969170 https://news.sky.com/story/coronavirus-body-bags-begin-to-fi...

bjt2n3904 6y ago

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.

snarf21 6y ago
"There are three kinds of lies: lies, damned lies, and statistics." - made popular by Mark Twain. Which as you point out, context matters, detail matters. You can make any point you want given enough caveats.
gnusty_gnurc 6y ago
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.

ben7799 6y ago

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.

cm2187 6y ago

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 6y ago
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 6y ago
  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.

taeric 6y ago

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 6y ago
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.

pmorici 6y ago

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.