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Comment by dekhn | Hacker News Reader

I'm a biologist and I have no trouble saying with a straight face that, as of yet, COVID-19's true health impact has been lower than that of a bad year of flu. I don't care about TV commenters- by the metric of # of deaths (not potential number of deaths, or total cost to the medical system, or impact on economy), COVID-19 has been less than a bad year of flu.

This isn't to say COVID-19 isn't bad, or doesn't have the potential to become worse. Instead it's saying that i'm shocked we don't take a preventable disease like annual flu more seriously, and that we've internalized the cost of all those deaths.

(I know people get really riled up when I say the above. If it makes you angry, please take the time to write a cogent, reasoned response based on data, not anecdotes or emotions. We know that people's anecdotal experience has a strong effect on their personal feelings, and that this is an emotionally charged time.)

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You're looking at the impact of this virus AFTER we've already implemented shelter-in-place measures, banned certain international travel, tanked our global economy, attempted to prepare hospitals with additional supplies, and we've yet to hit the peak, right?

And you're also noting that the US currently has 9,616 recorded deaths from COVID-19? Whereas data puts the worst flu season since 2010-2011 at 61,000 (2017-2018) deaths over an entire year, right? Again, with various provisions to help slow this virus already in place?

And you're also noting that hospitalization rates would include the regular flu, typical hospital visits that require an ICU, AND hospital visits from COVID-19, right?

Sure, I get the point of taking the flu more seriously, and I agree 100% with you. But to try to make the point that COVID-19 has been less bad than a bad year of flu is pretty pointless and also misleading. A more appropriate comparison would be to go back in time to Dec 2019 and have no countries put anything in place and let COVID-19 run wild. But at that point, you're sacrificing people just to make a dumb comparison that COVID-19 isn't much worse than a bad year of flu.

Also it's disingenuous to pick the worst season of flu. Let's compare COVID-19 to 2015-2016's 23,000 influenza deaths and see how, after all these provisions, we're already at 9,616 COVID-19 deaths in the US in April.

https://public.tableau.com/profile/jonas.nart#!/vizhome/COVI...

https://www.cdc.gov/flu/about/burden/index.html?CDC_AA_refVa...

You may be a biologist, but you are definitely not an epidemiologist.

It is at least 10x more lethal and much more contagious. We will bear the brunt of it in the US because we didn't take it seriously for so long. The only reason we aren't at 2,000+ deaths per day in the US is because now we are taking it seriously. That death rate sustained for a typical flu season (4 months) would be 240,000 deaths. This is serious. If we never took it seriously the death toll would be well over a million. And that is just in the US. Downplaying the severity of it will get people killed.

Yes we should take flu more seriously. But that doesn't make this not so bad.

My training was in a hospital medical center and I'm familiar with epidemiology. I think most claims about total deaths due to covid are uninformed speculation based on incomplete data.

You are making predictions that we have absolutely no confidence about. That's not helpful. I'm saying we don't have the data to claim what you're claiming.

You're missing context. It's 10x more lethal in CERTAIN DEMOGRAPHIC GROUPS.

The data so far shows that it's the same lethality or less in people under 60 y.o. with no pre-existing conditions which is a huge proportion of the world and it may even be LESS because 80% of those tested have NO OR MINOR SYMPTOMS so who knows how many have it and haven't been tested!

It's not even remotely serious at all in that population.

Context matters in epidemiology am I incorrect?

No, it's more like 5-10% lethal in certain demographic groups. It is 10x as lethal (1% as opposed to 0.1%) in the general population. And there has been enough testing in some regions to know pretty well. The pandemic is stressing hospitals wherever there is a large enough concentration of people. The flu just does not do that. Mainly because we have vaccines to keep R0 1.2 to 1.3. When we get vaccines it may be even less contagious than the flu. But right now it is significantly more contagious and significantly more deadly.

It's an interesting point. The flu is "baked in" to our healthcare systems. Just like cancer and heart disease and a thousand other ailments that we can accommodate almost all of the time. Maybe the end game of this pandemic will be expanding our healthcare systems to accommodate the annual surge of COVID-19 cases?

But in the meantime, we're stuck with a pandemic that is not baked in, so while it may be "less bad" in some ways than the flu, it is catastrophically worse because no healthcare systems are prepared to deal with it.

Bad flu years aren't baked into healthcare systems; hospitals have to set up tents in parking lots to handle the extra flux of patients, and tens to hundreds of thousands of people still die.

When's the last time the annual flu caused upwards of 50-80% ICU occupancy rates in several countries simultaneously?

That's the difference between biology and medicine.

But given the severity and high death rate of flu, shouldn't it also have that high level of hospitalization, or perhaps covid shouldn't have such a high rate?

It's unclear at this team what purpose super-intensive hospitalization for covid serves. That's something we're only going to understand in time.

(note, I did my training at a hospital medical center and my biology work was health-oriented).

> But given the severity and high death rate of flu, shouldn't it also have that high level of hospitalization,

Your question is circular. It assumes that the severity and death rate of flu is the same as with COVID19. There's no reason to believe that's true at this point.

> or perhaps covid shouldn't have such a high rate?

The hospitalization rate is what it is. People aren't going to the hospital with COVID19 for the fun of it. They're terribly sick.

The difference is that biologists look at macro data and medical professionals look at micro data.

OF course there are a few ICU's with high occupancy rates due to the nature of the disease and the intensity with which it hits high population areas with older populations.

However, overall on a MACRO level WORLD wide it's no worse than a season of the flu.

If the crux of your argument relies on looking at what has happened so far without looking at projections into what could happen, then I have some stock to sell you. You'll buy at the top since the last quarter's earnings were good, right?

Can you keep the discussion fact-based?

The facts presented do not support the conclusion because COVID-19 is not the flu. This is the logic I see in the post:

1. COVID-19 has not killed more people than the flu in the US so far

2. Therefore COVID-19 is comparable to the flu

3. We have not responded so seriously to the flu in the past as we are to this new virus

4. Therefore... people are messed up, I'm shocked

I'm pointing out that [1] does not imply [2] for the very basic reason that the situation is still unfolding. I think you even recognize this ("This isn't to say COVID-19 isn't bad, or doesn't have the potential to become worse"), so I'm wondering why you would pin your conclusion on COVID-19 being comparable to the flu.

A pretty good video summary: https://www.youtube.com/watch?v=FVIGhz3uwuQ

You're a biologist who also was in the Navy special forces and you also worked at Google for 20 years? I'm guessing you were the Google company epidemiologist on staff, right?

You're so accomplished! Is there anything you aren't a 100% certified expert on?

Simple numbers tell us the deaths so far from covid-19 have been less than an average flu season. But so what?

You're not actually suggesting anything so there's nothing to get directly angry about. But since you don't suggest anything, you leave it to people to infer what you really mean, and then there may be good reason to get angry.

Are you suggesting that we should have treated covid-19 like the flu -- although one without a vaccine -- and just went about our normal lives? If so, how much faster do you think our medical systems would have been overwhelmed and what do you think we could have done about that? You can crunch numbers... estimate the numbers dead from covid-19 without any curve-flattening efforts and the additional dead due to the medical system being overwhelmed.

Or are you suggesting something else? We can't read your mind over the internet.

Hmm, that's a good point. my main point is that we should treat flu more seriously (personally I would prefer legally mandated vaccines with extremely limited exceptions, and more funding into improved vaccines that have a higher effectivity).

My second point is about the response to covid. To me it's unclear (and it won't be clear to the epidemiologists for a few years) whether the reactions we have taken had the effects we predicted. Much of what we're doing now, it's actually unclear what would have happened if we hadn't has social distancing etc, due to the extremely low rate of testing.

Another issue is that large numbers of scientists have dropped their regular work and are working on covid... most of them will not produce useful results (in terms of health care) and instead, their daily work is being forgotten. This will have long-term consequences for scientific productivity without having a large outcome for covid.

I think making predictions on how many people "could have died" when we're doing extremely limited testing isn't helpful.

> we should treat flu more seriously

Agreed (though in the US we do have a yearly nation-wide vaccination program, imperfect as it is, and largely staff and equip hospitals to handle the high-water mark of cases).

> I think making predictions on how many people "could have died" when we're doing extremely limited testing isn't helpful.

I disagree with that. The alternative to making imperfect predictions (predictions are imperfect by nature) is to not make predictions. Without predictions you can't make reasonable decisions to direct your future.

Of course, when your predictions are too far off you can't make good decisions to direct your future either, but that just suggests you should try to make the best predictions you can (hence the science and study of epidemiology), not that you shouldn't make predictions.

If you don't make predictions (or you make them based on hunches or by other low quality means) you're just throwing yourself randomly into the future and are unlikely to get good outcomes.

Since there's no vaccine...what you're suggesting is a perpetual game of Covid whack-a-mole.

We come out of quarantine it blows up again, we go back into quarantine.

That's as infeasable solution as this current lockdown quarantine.

So far most data I've seen shows that people who were infected have some immunity. However, it's not clear yet what the annual effect of immunity will be - for example, we haven't sampled enough people/viruses to know in detail whether that immunity persists when the virus mutates.

Epidemiologists are likely to know the answers to these sorts of questions in a few years.

Every single other known Coronavirus builds immunity.

Hundreds of thousands of patients and no reports of repeat healthy patients.

Preliminary studies with macaque monkeys show that an immunity is built.

There's plenty of data to show that an infection is built.

*immunity to infection

Completely agree. The data backs you up as far as infections/fatalities.

The rational data is: under 60 with no pre-existing conditions..you're basically immune.

This whole thing appears to be a massive fear campaign.

But if you bring up ANYTHING counter to the prevailing narrative, you're viciously attacked by people. VICIOUSLY. Like you're some sort of murdering child killer.

No one is interested in discussion or thinking about this. They just repeat the narrative.

The people I've discussed this with... it's all mantric repetitions of 'flatten the curve' of 'social distancing saves lives' and people have not looked at the data or anything to back this up!

I feel like the average person could be told to wear a dog cone to 'stop covid' and we would have a population of people walking around with dog cones around their necks.

It's actually disappointing and embarrassing.

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