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Why COVID-19 Is More Serious Than The Flu

Why COVID-19 Is More Serious Than The Flu

Both are highly contagious respiratory viruses but here are the key differences you need to understand.

Updated on March 24, 2020 at 8:00am EST.

There are many myths circulating about COVID-19 but one of the most troubling is that the novel coronavirus is “just a cold.” Younger adults, in particular, may have the misconception that this disease is only serious for older people and those with chronic health issues. In fact, adults of all ages have become seriously ill, according to a report from the Centers for Disease Control and Prevention on nearly 2,500 of the first recorded cases in the United States.

The report, issued on March 18 by the Centers for Disease Control and Prevention, found that nearly 40 percent of the patients sick enough to be hospitalized were between 20 and 54-years old. The risk of dying, however, is much higher among older people.

Early on, comparisons between COVID-19 and the flu—or even the common cold—among public figures may have contributed to some confusion. While these are all highly contagious respiratory infections, which are mild for many people. There are some key differences you should understand. 

COVID-19 vs. colds vs. flu
The common cold, the flu and COVID-19 are all spread from person to person through direct contact or droplet transmission.

Contact transmission includes direct exposure to someone who is sick. This includes shaking hands, hugging or kissing. It can also occur when people touch a contaminated surface and then touch their mouth, nose or eyes.

Those who are sick can also infect others when contaminated droplets from their coughs or sneezes land in a nearby person’s mouth or nose. Droplets can also travel about six feet before settling on a nearby surface where they can persist for hours or, for some viruses, even days.

Many types of viruses are responsible for colds, but they’re most often caused by rhinoviruses. Most of these infections are mild and people recover on their own without treatment. In fact, by the age of 2, most kids have had anywhere from 8 to 10 colds—more if they go to daycare.

The flu, on the other hand, is caused by different strains of influenza viruses. Symptoms of the infection come on more suddenly and tend to be more severe than a cold. While colds can lead to a sore throat, cough and runny nose, people with the flu may also develop a fever and experience chills, body aches and fatigue.

In most cases, people with the flu will recover within a couple of weeks. But some people—particularly older people, babies and very young children and those with underlying health issues—are more likely to develop complications such as pneumonia, inflammation of the heart, brain or muscle, sepsis or organ failure. In extreme cases, the flu can be fatal.

COVID-19 is more deadly
One of the most important differences between the flu and COVID-19: Their mortality rates.

A severe flu season has a death rate of about 0.1 percent, according to a February 2020 editorial in the New England Journal of Medicine written by Anthony S. Fauci, MD, head of the National Institute of Allergy and Infectious Diseases (NIAID), H. Clifford Lane, MD, NIAID’s Deputy Director for Clinical Research and Special Projects and Robert R. Redfield, MD, Director of the Centers for Disease Control and Prevention (CDC).

By comparison, the COVID-19 mortality rate appears to be higher. Just how much higher is still a matter of investigation. On March 3, the World Health Organization reported that about 3.4 percent of confirmed COVID-19 cases around the world are fatal. That would mean the novel coronavirus is more than 30 times more lethal than the flu, which claims tens of thousands of lives each year in the United States alone.

Keep in mind, researchers are still learning about the novel coronavirus and variables among countries, such as population demographics and the quality of health care, also influence estimates on its mortality rate. For example, in South Korea—where aggressive testing is taking place—researchers calculate a COVID-19 fatality rate of closer to 0.6 percent.

Moreover, the WHO estimates that more than 80 percent of those with COVID-19 will develop only a mild infection and recover. It’s widely believed that many more mild cases haven’t been detected and aren’t included in official counts.

If the number of mild, unreported cases far exceeds the number of more serious, confirmed cases, the COVID-19 mortality rate could actually be less than 1 percent, the NEJM editorial pointed out. This would be roughly in line with South Korea’s current estimates.

More people are vulnerable to COVID-19
Coronaviruses, like COVID-19, usually circulate among animals, particularly camels as well as cats or bats. When they mutate and infect people, most coronaviruses trigger mild to moderate illness. Only rarely do they lead to serious illnesses, as was the case with SARS-CoV, MERS-CoV and SARS-CoV-2. 

Still, unlike the seasonal flu, COVID-19 is new. People around the world have built up immunity to some strains of influenza. This isn’t the case for the novel coronavirus. No one has immunity, the WHO cautions.

Older people and those with pre-existing medical conditions—such as asthma, diabetes and heart disease—are among those at higher risk for potentially deadly complications associated with COVID-19, which include pneumonia, acute cardiac injury, irregular heartbeat, shock and acute kidney injury.

Keeping things in perspective
There are some other key facts that shouldn’t be ignored. So far, most people who are infected with COVID-19 get better on their own with supportive care to ease respiratory symptoms.

Roughly 16 percent of COVID-19 cases result in severe illness and complications, including pneumonia and trouble breathing. Fewer still, about 5 percent, will develop very serious issues, including respiratory failure, septic shock and organ failure. That means tens of thousands of people around the world have already recovered from the infection—far surpassing the number of confirmed deaths.

Hope on the horizon
The CDC cautions that additional community spread of COVID-19 in the U.S. is inevitable. Health officials believe many more people will be infected and diagnosed with the coronavirus before it is eventually contained.

The outbreak has disrupted the lives of millions across the country and around the world, amid lockdown, travel restrictions, the closing of schools, restaurants and other businesses. Large-scale gatherings have been be cancelled or postponed. Workers have been forced to telecommute. Hospitals and urgent care centers are facing dire shortages of essential medical supplies as they face a growing number of patients who need care at the same time. 

And unlike the seasonal flu, there are currently no immunizations that protect against COVID-19. But scientists in the U.S. and around the world are urgently working to develop a vaccine.

As of February 28, the WHO Director-General, Tedros Adhanom Ghebreyesus, PhD, reported that more than 20 vaccines are in development globally, and several antiviral treatments are also being tested.

One phase I clinical trial of an investigational vaccine against COVID-19 is already underway. The vaccine will be tested on several dozen healthy patients to assess their immune response and the drug’s safety.

Even under a best-case scenario, however, a COVID-19 vaccine will likely not be available for at least another 12 to 18 months, according to Dr. Fauci. 

Moreover, for those who do become sick with the flu, there are four existing antiviral medications have been effective in reducing the severity and duration of the infection.

Antiviral medications to help manage COVID-19 infection, on the other hand, are still in development. A randomized, controlled clinical trial evaluating the safety and effectiveness of an experimental antiviral drug for the coronavirus called remdesivir is also underway at University of Nebraska Medical Center in Omaha. This is the first U.S. clinical trial to evaluate a possible treatment for COVID-19.

Remdesivir was previously tested on people with the Ebola virus. It also showed promise in animal studies as a potential treatment for other coronaviruses, including SARS-CoV and MERS-CoV.

How to protect yourself
You don’t need to wait for a vaccine or other antiviral treatments to help protect yourself and others from COVID-19. There is a lot you can do to avoid exposure and reduce your risk of infection, including:

  • Washing your hands well and often with soap and water for at least 20 seconds each time
  • Not touching any part of your face, including your eyes, nose or mouth with unwashed hands
  • Avoiding people with suspected or confirmed infections

Many people, particularly those in affected areas, have chosen to wear face masks to protect against COVID-19, which have led to critical shortages among medical health professionals in certain parts of the world. Otherwise healthy people trying to protect themselves against COVID-19 should not wear medical masks, according to the CDC.

Masks can be costly, and they are not a foolproof way to prevent infection—especially if they are used incorrectly or people touch their face more often with contaminated hands. Hoarding them or using them unnecessarily could not only give people a false sense of security but also lead to shortages among medical personnel who need them.

If you think you might be sick
Anyone who believes they may be infected with COVID-19 or might have been exposed to the coronavirus should take immediate steps to isolate themselves and avoid spreading their illness to others.

If you develop any warning signs of infection you should call your health care provider (HCP) for instructions. Before going to a doctor’s office or emergency room, be sure to call ahead and inform the medical staff that you may have been exposed to COVID-19. Your HCP will work with your local public health department and the CDC to determine if you need to be tested for the coronavirus.

Medically reviewed in March 2020.

Sources:
Anthony S. Fauci, MD, H. Clifford Lane, MD, and Robert R. Redfield, MD “Covid-19 — Navigating the Uncharted.” New England Journal of Medicine. Feb 2020.
Whitehouse.gov. “Remarks by President Trump, Vice President Pence, and Members of the Coronavirus Task Force in Press Conference.”
Mayo Clinic. “Common Cold.”
Healthchildren.org. “Rhinovirus Infections.”
Centers for Disease Control and Prevention. “Flu Symptoms & Complications.”
Centers for Disease Control and Prevention. “Key Facts About Influenza (Flu).”
Centers for Disease Control and Prevention. “Transcript for the CDC Telebriefing Update on COVID-19.”
World Health Organization. “Rolling updates on coronavirus disease (COVID-19).”
Moderna. “Moderna Ships mRNA Vaccine Against Novel Coronavirus (mRNA-1273) for Phase 1 Study.”
National Institute of Allergy and Infectious Diseases. “NIH Clinical Trial of Remdesivir to Treat COVID-19 Begins.”
The Aspen Institute. “7 Things to Know About the Novel Coronavirus, According to the Experts.”

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