COVID-19 remains deadlier than the flu

Since the early days of the pandemic, health officials have estimated the threat of COVID-19 by comparing it to the flu.

First of all, it wasn't even close. People hospitalized with the then-new respiratory disease in 2020 were five times more likely to die from the disease than patients who were hospitalized with influenza during previous flu seasons.

Immunity gained from vaccines and previous coronavirus infections has helped control COVID-19 to such an extent that researchers found that hospitalizations due to COVID-19 during the height of the 2022-23 flu season And compared the mortality rate of seasonal influenza patients, they found that the probability of death was only 61% higher when the pandemic disease was.

Now the same researchers have analyzed data from the autumn and winter of 2023 and 2024. Dr. Ziad Al-Ali, director of the Center for Clinical Epidemiology at the VA St. Louis Health Care System, and his colleagues hope to find out why both respiratory diseases eventually went away.

“There's a narrative out there that the pandemic is over, that's a nothingburger,” El-Aly said. “We came in thinking we'd have this rematch and find out it's going to be like the flu from now on.”

The VA team examined the electronic health records of patients treated at Veterans Affairs hospitals in all 50 states between October 1 and March 27. They focused on patients who were admitted because they had fever, shortness of breath or other symptoms caused by COVID. 19 or influenza. (People who were admitted for some other reason, such as a heart attack, and then were found to have coronavirus infection were not included in the analysis.)

On average, COVID-19 patients were slightly older than flu patients (73.9 vs. 70.2 years), and they were less likely to be current or former smokers. They were also more likely to have received at least three doses of a COVID-19 vaccine and less likely to skip shots altogether.

Yet when Al-Ali and colleagues accounted for these differences and many other factors, they found that 5.7% of COVID-19 patients died from their disease, compared with 4.2% of influenza patients. happened.

In other words, the risk of death from COVID-19 was still 35% higher than from the flu. The findings were published Wednesday in the Journal of the American Medical Association.

“There is unquestionably a belief that [COVID-19] “There is no longer any major threat to human health,” Al-Aly said. “I think it's largely driven by opinion and an emotional desire to move on from the pandemic, so that we can leave everything behind. We wanted to believe it was like the flu, and we did – until we saw the data.

Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco, said the study results are consistent with what he sees in his hospital.

“COVID is making some people in our community very sick and dying — even in 2024,” he said. “While most people won't get seriously ill from COVID, for some it's like 2020 all over again.”

This is especially true for people who are older, who have not recently received the recommended COVID-19 booster, and who have not taken full advantage of antivirals like paxlovid. Chin-Hong pointed out that only 5% of COVID-19 patients in the study were treated with antivirals before hospitalization.

Al-Aly said even if the mortality rates for COVID-19 and flu patients were equal, COVID-19 would still be the bigger health threat because it is sending more people to hospitals.

Between October 1 and the end of March, 75.5 out of every 100,000 Americans were hospitalized because of influenza, according to the Centers for Disease Control and Prevention. The CDC says that during the same period, the hospitalization rate for COVID-19 was 122.9 per 100,000 Americans.

“The risk of hospitalization is still high with COVID,” Al-Aly said. “And among those hospitalized, more people will die as a result.”

Yet El-Aly noted with dismay that while 48% of adults in the U.S. have received a flu vaccine this year, only 21% of adults have updated their COVID-19 vaccination, according to the CDC.

Chin-Hong said more than 95% of adults hospitalized with COVID-19 last fall and winter did not receive the latest booster shot, according to the CDC.

Taking into account all the tools available to prevent hospitalizations and deaths — and especially the fact that they are readily available to patients in the VA system — COVID-19 is more likely than the flu. The 35% relative risk of death was “surprisingly high”, Chin-Hong said.

And it's not like the flu is a minor health threat, especially for senior citizens and those with weakened immunity. CDC data shows it routinely kills thousands of Americans each year.

“Influenza is a consequential infection,” Al-Aly said. “Even when COVID becomes on par with the flu, it is still serious and important.”

The researchers also compared the mortality rate of VA COVID-19 patients before and after Dec. 24, when the Omicron subvariant, known as JN.1, became the dominant strain in the United States. The difference was not statistically significant.

Over the past two weeks, JN.1 appears to have been overtaken by one of its descendants, a subvariant known as KP.2. It is part of a family of subvariants nicknamed “FLiRT”, a nickname that refers to certain mutations that have emerged on the spike protein of the virus.

Al-Ali said, so far, there is no indication that the KP.2 is more dangerous than the JN.1.

“Are the hospitals filling up? No,” he said. “Are ER rooms across the country filled with respiratory illnesses? No.” Nor has there been any worrisome change in the amount of coronavirus found in the wastewater.

“When you look at all these data streams, we don't see any ominous signs that KP.2 is something the general public should be concerned about,” Al-Aly said.

He said it's also too early to tell whether KP.2 — or whatever comes after it — will ultimately erase the mortality gap between COVID-19 and the flu.

“Maybe when we play again in 2025, it will be the same situation,” he said.

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