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August 25, 2020

4 Reasons Why COVID-19 Is More Dangerous Than the Flu

4 Reasons Why COVID-19 Is More Dangerous Than the Flu

Updated August 24, 2020; 4:45pm EDT

Early on, comparisons between COVID-19 and the flu—or even the common cold—may have contributed to some confusion about these highly contagious respiratory infections.

Younger adults, in particular, may have the misconception that COVID-19 is only serious for older people and those with chronic health issues. In fact, adults of all ages have become severely ill. The risk of dying is much higher among older people, but a report issued on March 18 by the Centers for Disease Control and Prevention (CDC) found that nearly 40 percent of the patients sick enough to be hospitalized were between 20 and 54 years old.

Here are some other key differences between COVID-19 and influenza that you should understand, especially as a new flu season is fast approaching.

People with COVID-19 may be infectious longer 
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 6 feet before settling on a nearby surface where they can persist for hours or, for some viruses, even days.

COVID-19, however, may also spread through the air via airborne spread, or aerosols—particles even smaller than respiratory droplets that may waft and linger in the air.

More research is needed to determine how much airborne transmission may be contributing to the spread of this disease.

People with COVID-19 may be contagious for at least 10 days, the CDC reports. Those with the flu, on the other hand, are contagious for about seven days. 

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

Most colds are caused by rhinoviruses. The majority 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.

The CDC estimates that on average, about 8 percent of the United States population gets sick from the flu each year. In most cases, they will recover within a couple of weeks. But some—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 muscles, sepsis or organ failure. In extreme cases, the flu can be fatal.

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 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 (WHO) 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 U.S. 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 has been 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 estimates.

What about Georgia? Flu season in the state begins in early October and can last until May. More than 2,500 Georgians were hospitalized with the flu during the 2019-2020 season, and at least 94 died. By comparison, as of August 24, Georgia has had over 256,000 confirmed cases of COVID-19. Of these cases, more than 23,000 required hospitalization and more than 5,100 were fatal.

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 (which lead to the 2002-2004 SARS outbreak) and MERS-CoV (first detected in 2012) and now, SARS-CoV-2 (the virus behind the COVID-19 pandemic).

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 chronic obstructive pulmonary disease (COPD), diabetes and heart disease—are among those at higher risk for potentially deadly complications associated with COVID-19. These complications include pneumonia, acute cardiac injury, irregular heartbeat, shock and acute kidney injury.

Doctors know less about managing COVID-19
Unlike the seasonal flu, there are currently no immunizations that protect against COVID-19. Moreover, for those who do become sick with the flu, there are four existing antiviral medications that 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.

But scientists in the U.S. and around the world are urgently working to develop a vaccine. There are more than 165 vaccines in development globally, and several antiviral treatments are also being tested. 

In May 2020, the U.S. Food and Drug Administration issued an emergency use authorization for the investigational antiviral drug remdesivir for the treatment of severe COVID-19 in adults and children. While research on the drug's safety and effectiveness is limited, remdesivir was shown in a clinical trial to shorten the time to recovery in some patients.

A relatively cheap, safe drug commonly used to treat a range of inflammatory conditions could also be a game-changer in the fight against COVID-19. In June, researchers in the UK announced some preliminary findings of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, which was launched in March to evaluate several existing drugs as possible treatments for COVID-19. The team found that low-dose dexamethasone could reduce deaths by up to one-third in very severe cases of COVID-19.

The RECOVERY trial is also investigating the effectiveness of the following drugs as potential COVID-19 treatments:

  • Lopinavir-Ritonavir, which is sold under the brand name Kaletra (an HIV drug)
  • Azithromycin (an antibiotic)
  • Tocilizumab, which is sold under the brand name Actemra (an injectable anti-inflammatory treatment)
  • Convalescent plasma with SARS-CoV-2 antibodies (collected from people who have recovered from COVID-19)

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 to and reduce your risk of infection from both the flu and COVID-19, including:

  • Getting a seasonal flu shot
  • Wearing a cloth face covering in public settings and when you’re around people who do not live with you
  • Practicing social distancing, or staying at least 6 feet away from others
  • 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

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) or the Georgia COVID-19 Hotline at (844) 442-2681 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 where you need to be tested.

Medically reviewed in March 2020.

Sources:

Georgia Department of Public Health. “Daily Status Report.” Accessed August 24, 2020.
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.”
Centers for Disease Control and Prevention. “How to Protect Yourself & Others.”
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.”
U.S. Food and Drug Administration. "Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment."
Centers for Disease Control and Prevention. "Similarities and Differences between Flu and COVID-19​."
Georgia Department of Public Health. “Georgia Weekly Influenza Report.” Week 20 (May 10 – May 16, 2020).
Centers for Disease Control and Prevention. “How Flu Spreads.”

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