14 MARCH 2020

Aches and pains, sore throat, fever – although they may feel similar to those suffering from their symptoms, the novel coronavirus is not the same as the seasonal flu, experts stressed Wednesday.

COVID-19, the illness caused by coronavirus, proves deadly in around 3.5 percent of confirmed cases.

While this is not the same as its mortality rate, given many people may be infected but not realise it, it is significantly higher than seasonal flu, which typically kills 0.1 percent of patients.

“There is still considerable uncertainty around the fatality rates of COVID-19 and it likely varies depending on the quality of local healthcare,” said Francois Balloux, Professor of Computational Systems Biology at University College London.

“That said, it is around two percent on average, which is about 20 times higher than for the seasonal flu lineages currently in circulation.”

Serious cases

But the true danger of coronavirus is unlikely to be the death toll. Experts say health systems could easily become overwhelmed by the number of cases requiring hospitalisation – and, often ventilation to support breathing.

An analysis of 45,000 confirmed cases in China, where the epidemic originated, show that the vast majority of deaths were among the elderly (14.8 percent mortality among over 80s).

But another Chinese study showed that 41 percent of serious cases occurred among under 50s, compared with 27 percent among over 65s.

“It’s true that if you’re older you’re at greater risk, but serious cases can also happen in relatively young people with no prior conditions,” said French deputy health minister Jerome Salomon.


Disease experts estimate that each COVID-19 sufferer infects between two to 3 others.

That’s a reproduction rate up to twice as high as seasonal flu, which typically infects 1.3 new people for each patient.


Salomon said that humans have lived with influenza for more than 100 years.

“We’ve studied it closely,” he said. “This new virus resembles the flu in terms of physical symptoms but there are huge differences.”

Number one is the lack of a vaccine against COVID-19, or even any treatment shown to be consistently effective.

While some trials have shown promise delivering anti-retroviral drugs to serious cases, as well as some experimental therapies, their sample sizes are too small to roll out to the general population.

Hundreds of researchers around the world are working frantically to find a COVID-19 vaccine, but the development process takes months and is likely too late for the current outbreak.

Even if a vaccine magically appeared, getting everyone access it to it is no small order. Health authorities regularly complain that not enough people receive the flu vaccine to guarantee “herd immunity”.


But the new virus does share some characteristics with flu, notably the measures each one of us can personally take to slow the infection rate:

Avoid shaking hands, frequently wash your hands with soap and water, avoid touching your face and wear a mask if you are sick.

Such actions can limit new infections just as they can with the flu, gastro illnesses and other infectious diseases.

France’s health ministry says that only two in 10 people regularly wash their hands after using the bathroom.

“And only 42 percent of people cover their mouth with an elbow or tissue when they cough or sneeze,” it added, not encouragingly.

Covid-19 is not the flu. It’s worse.

It’s deadlier, more contagious, and more likely to severely disrupt our health care system.

In early March, President Donald Trump tweeted a statistic he said we all should “think about.”

It was a comparison of the flu to the current coronavirus pandemic. The flu kills tens of thousands of people a year, he reminded us. At the time, only under a dozen or so people in the US had died of Covid-19, the disease caused by the novel coronavirus. The tweet read a lot like much of the rhetoric coming out of the White House, which, for weeks now, has been trying to downplay the severity of the situation.

Donald J. Trump


So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!

A lot of people besides Trump have been comparing the coronavirus to flu. And it’s a question friends and family members who want to know how worried they should be keep asking me: Isn’t this like the flu?

So, a quick unambiguous answer: No, this is not like the seasonal flu. It is worse.

Put simply, while the exact death rate is not yet clear, this disease kills a larger proportion of people than the flu (and it’s particularly lethal for people older than 80).


A comparison of flu death rates to Covid-19 deaths in China in the period leading up to the peak of the country’s outbreak. The exact fatality rate of Covid-19 is not yet known, but it appears much deadlier than the flu.
 Max Roser and Hannah Ritchie/Our World in Data


It also has a higher potential to overwhelm our health care system and hurt people with other illnesses.

At present, there is also no vaccine to combat it, nor any approved therapeutics to slow the course of its toll on the human body. (Doctors can treat cytokine storm syndrome, an immune response that may in some cases be dealing the fatal blow to those dying of Covid-19.)

Sober-minded epidemiologists say, without exaggeration, that 20 to 60 percent of the world’s adult population could end up catching this virus.

Biologically, it behaves differently than the flu. It takes around five days for Covid-19 infection to develop symptoms. For the flu, it’s two days. That potentially gives people more time to spread the illness asymptomatically before they know they are sick.

An infographic that shows the goals of mitigation during an outbreak with two curves. The X-axis represents the number of daily cases and they Y-axis represents the amount of time since the first case. The first curve represents the number of cases when no protective measures during an outbreak are implemented and displays a large peak. The second curve is much lower, representing a much smaller rise in the number of cases if protective measures are implemented. Christina Animashaun/Vox


Around the country, health care providers are worried about their facilities being overrun with an influx of patients, and having to ration lifesaving medical supplies.

“We’re already overwhelmed here, in terms of patients coming in the middle of a terrible influenza season,” says Barbara North, the medical director of a small, rural clinic in Northern California. If the pandemic hits her community, her clinic is the only provider for miles. She fears they’d be overrun. “We are struggling to establish the isolation and infection precautions needed at the clinic.”

Three months ago, this virus was not known to science. No human immune system had seen it before January, so no unexposed human has any natural immunity to it. That means it’s more contagious than the flu — about twice as contagious, perhaps more; the numbers are still being worked out.

An illustration of the “R naught” estimates for various diseases, including COVID-19 and the flu.                                    Javier Zarracina and Christina Animashaun/Vox

This is bad. It’s bad enough to roil our stock markets, put people out of work, potentially cause a recession, and infect millions, if not billions, of people around the world. It could also kill millions, both here and abroad.

It’s possible that Covid-19 will become endemic — meaning it will be a disease that regularly attacks humans and will not go away until there’s a treatment or a vaccine.

Yes, flu variants kill tens of thousands a year in the US. But imagine if there was another kind of flu, “except potentially with a higher case fatality rate,” Angela Rasmussen, a Columbia University virologist, told me recently. “Which is definitely a problem because the seasonal flu kills 30,000 to 60,000 Americans every year. And even if it’s the same case fatality rate of seasonal flu, that still presents a substantial public health burden.”

It’s okay to feel fearful of Covid-19. It’s just human.

I think I get why Trump is so eager to compare Covid-19 to the flu.

Flu is a regular occurrence, and its toll is something that we’ve grown numb to. Psychology teaches us a depressing lesson here: As we think about larger and larger numbers of people, our empathy and our ability to care and take action decreases. It’s called psychic numbing — and studies show our willingness to take action to protect others even decreases when the number of victims increases from one, to two.

By mentioning the flu numbers, Trump is hoping to get people thinking of big numbers, and induce numbing. He might want us to think: Tens of thousands of people die of the flu, this new disease isn’t a big deal.

A patient is transferred into an ambulance from the Life Care Center nursing home in Kirkland, Washington, on March 7, 2020.  Karen Ducey/Getty Images

Paul Slovic, one of the lead psychologists who has studied psychic numbing, says he doesn’t expect Americans to grow numb to this growing crisis. It hits on a lot of the psychological buttons that tell us to be fearful.

Slovic does call comparisons to the flu “misleading.” But he doesn’t think people are going to fall for it.

“People are not numb with regard to this new virus,” Slovic writes in an email. “This virus hits all the risk perception ‘hot buttons’ … It is new, unfamiliar, and hard to control through individual or societal action. There is no vaccine and it spreads invisibly, adding to the difficulty of controlling it. It can be fatal and widespread (hence pandemic). All of these qualities ramp up the dread feelings that we have long known to be the major drivers of risk perception.”

It’s okay to be a bit scared in times like these. It’s natural, and extremely human. I can even understand why many people might be asking the flu comparison question themselves, in an attempt to maybe numb themselves to the stark reality we’re facing. (Trump, and other leaders, should know better, and not give people seeking psychological relief an easy out.)

But we can’t be numb. We can channel fear into useful tasks. The bigger concern is that people won’t act in the way they really need to. During a flu season, schools aren’t typically shut down; people don’t stop going to the movies. To fight Covid-19 requires a much larger disruption in our lives.

For what it’s worth, in his Oval Office address on March 11, Trump did outline the danger of the situation and gave basic, decent, public health advice. But it might not make up for the months of him trying to downplay the outbreak.

If you see people make the flu comparison, don’t be fooled into thinking that Covid-19 is an equivalent. It doesn’t look as bad as the flu in terms of raw numbers.

But the top minds modelling this outbreak fear that will change. And, again, we really need to act differently than normal to prevent contagion and deaths.


Influenza “the flu” and COVID-19, the illness caused by the new coronavirus, are both infectious respiratory illnesses. Although the symptoms of COVID-19 and the flu can look similar, the two illnesses are caused by different viruses.

You can find up-to-date information on COVID-19 at the Centers for Disease Control and Prevention (CDC).

President suspended all travel to the U.S. from Europe and declared a national emergency over COVID-19’s rapid spread

Some cite influenza as a reason not to be worried about COVID-19, the disease caused by the novel coronavirus, but health professionals say that comparison misses some very important points. On Wednesday, WHO declared it a pandemic.On Friday, President Trump declared a national emergency.

Coronavirus. It’s just like the flu, isn’t it?

Hundreds of thousands of people die of the flu every year, some say, and people need to calm down about coronavirus, which was declared a pandemic by the World Health Organization this week. On Friday, President Trump declared a national emergency.

So what do we do now? Everyone should wash their hands for 20 seconds, elbow bump, stop buying face masks because they don’t protect against the virus, note that airplane air is filtered 20 to 30 times an hour, avoid cruise ships, and just relax.

That appears to be the accumulated advice of exasperated Americans on Twitter and Facebook FB, +10.23% just a week or two ago who despaired at the long lines at Trader Joe’s and Whole Foods AMZN, +6.46% (where people apparently have been stocking up on oat milk), and the panic buying and empty shelves at Costco COST, +8.01%.

“Toilet paper is golden in an apocalypse,” one customer told MYNorthwest.com.

They’re overreacting, right? Not quite.

Last week, the president announced that he was “marshaling the full power of the federal government” by suspending all travel from Europe to the U.S. for one month. A couple of days earlier, Trump wrote on Twitter TWTR, +9.37%, “Last year 37,000 Americans died” from the flu: “Nothing is shut down, life & the economy go on,” he added.

‘This is additive, not in place of. Yes, the flu kills thousands of people every year, but we’re going to have more deaths.’

— Amesh Adalja, Infectious Diseases Society of America

As this dramatic change-of-heart illustrates, we still have a lot to learn about the novel coronavirus and, experts say, that alone should be enough to motivate communities to work together to slow its progress. Studies suggest the differences between the flu and coronavirus are more nuanced than some people suggest.

In fact, health professionals point out important distinctions between COVID-19, the disease caused by coronavirus SARS-CoV-2, and other viruses. They don’t advise mass hysteria, obviously, but nor do they believe doing nothing and/or going about your business as usual is a smart move either.

On Wednesday, WHO said coronavirus has become a pandemic. WHO had characterized the illness late last year as a series of epidemics. An epidemic is a disease that infects regions or a community. The 1918-19 “Spanish flu” and Black Death from 1347 to 1351 were two of the most extreme pandemics recorded in modern and medieval times.

So what are the differences between coronavirus and the flu? For starters, there is no vaccine for COVID-19 and it could take many months or years to get one to market, and, unlike the influenza viruses for which there are several vaccines, humans have not built up an immunity over multiple generations. What’s worse, doctors fear the virus will mutate.

The first known person was reported to have contracted the virus on Dec. 1 in China. Today, it’s spread to at least 126 countries. Experts advise changing your behavior to limit its spread. Public officials in New York have said people should avoid taking mass transit, if possible. Italy has effectively quarantined its entire population. Israel, among other countries, has closed its land borders.

Of course, there are similarities between influenza and COVID-19. Both viruses are untreatable with antibiotics, and they have almost identical symptoms — fever, coughing, night sweats, aching bones, tiredness and, in more severe cases of both viruses, nausea and even diarrhea. They can be spread by touching your face, coughing and sneezing.

But doctors say their differences are just as varied. “It’s a little simple to think the novel coronavirus is just like flu,” Amesh Adalja, a senior scholar at the John Hopkins Center for Health Security and a spokesman for the Infectious Diseases Society of America, told MarketWatch.

“We don’t want another flu,” he said. “This is additive, not in place of. Yes, the flu kills thousands of people every year, but we’re going to have more deaths.”

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There are reported to be some 1 billion influenza infections worldwide each year, with up to 45 million cases in the U.S. per year, tens of thousands of U.S. deaths, and 291,000 to 646,000 deaths worldwide.

Seasonal flu has a fatality rate of less than 1%. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases on Capitol Hill, estimates that the fatality rate of flu is closer to 0.1%. But even accounting for the mild, yet undiagnosed cases of COVID-19, he said Wednesday, it would still make it “roughly 10 times more lethal than the seasonal flu.”

Another reason not to compare the two viruses: Influenza has likely been around for more than 2,000 years. Scientists say the “novel influenza A viruses” in humans lead to a pandemic approximately once every 40 years. But, again, flu vaccines exist. “The flu has been with us since the birth of modern medicine,” said Adalja.

Flu has likely been around for 2,000 years. This coronavirus is three months old and, as yet, there is no vaccine.

Hippocrates of Kos, the Greek physician who was born around 460 BC, mentioned what we now know as the modern influenza virus in his writings, some historians say. He called it the “Fever of Perinthus.” Others wonder whether this was flu, another illness, or a combination of illnesses.

“In 1173 and 1500, two other influenza outbreaks were described, though in scant detail. The name ‘influenza’ originated in the 15th century in Italy, from an epidemic attributed to the ‘influence of the stars,’” which, according to historical documents, “raged across Europe and perhaps in Asia and Africa,” a 2016 paper in the Journal of Preventive Medicine and Hygiene reported.

“Scholars and historians debate whether influenza was already present in the New World or whether it was carried by contaminated pigs transported on ships,” it added. “Some Aztec texts speak of a ’pestilential catarrh’ outbreak in 1450-1456 in an area now corresponding to Mexico, but these manuscripts are difficult to interpret correctly and this hypothesis seems controversial.”

What has all this got to do with COVID-19? There is an advantage to coming down with a virus that has been around for hundreds, if not a couple of thousand, years. Humans, ideally, will have built up more natural defenses to fight it.

Complicating matters: influenza and COVID-19 come from different virus families, and COVID-19 is brand new. “There are four other strains of the coronavirus, but the attack rate of this virus is relatively high as there is no immunity to it,” Adalja said.

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To put that in perspective: In 2017–18, the worst flu season on record in the U.S. outside of a pandemic, approximately 80,000 Americans died. The four other coronavirus strains that already exist are responsible for around 25% of our common colds, Adalja added.

“But it doesn’t seem like there is cross-immunity with this coronavirus as there are with the other coronaviruses,” he added. In other words, the natural defense systems in our body that help us ward off flu are unlikely to apply here.

Luis Ostrosky, a member of the Infectious Diseases Society of America, said humans have a “herd immunity” to flu. “When there are enough people in the community who are immune it protects people who are not immune.” That is the case with flu, but not with COVID-19. Ostrosky said this is especially critical when no vaccines or therapeutic treatments for a virus.

“Both can be spread from person to person through droplets in the air from an infected person coughing, sneezing or talking,” Lisa Maragakis, senior director of infection prevention at Johns Hopkins Medicine in Baltimore, wrote. Based on the estimated distance viruses travel, scientists recommend “social distancing” of at least six feet in enclosed public spaces.

In the meantime, the virus continues to spread, likely helped by people who have mild symptoms or who are asymptomatic.

As of Sunday evening, there were 169,387 confirmed cases globally and 6,513 deaths, according to data the latest rally from the database of Johns Hopkins University’s Center for Systems Science and Engineering; the database also reported 77,257 recoveries. The U.S. has had at least 3,774 confirmed coronavirus cases and 69 deaths.

Neither the flu nor COVID-19 viruses is treatable with antibiotics, and the two illnesses have roughly identical symptoms  MarketWatch photo illustration/iStockphoto

While estimates of coronavirus fatality rates vary, they remain far higher than those for the flu. COVID-19 has a fatality rate of 3.4%, WHO director-general Tedros Adhanom Ghebreyesus said earlier this month. That’s more than previous estimates of between 1.4% and 2%, although some observers say his analysis was a blunt interpretation of incomplete data, and were probably skewed by a higher death rate in China.

COVID-19 rates may fall closer to those of the flu, assuming many more people are infected. JAMA recently released this paper analyzing data from the Chinese Center for Disease Control and Prevention on 72,314 COVID-19 cases in mainland China last month, the largest such sample of this kind. The sample’s overall case-fatality rate was 2.3%, in line with the earlier estimates.

‘As coronavirus spreads it threatens to put a much greater burden on health systems than flu does.’

— Antigone Barton, ScienceSpeaks

Fatality rates also varied dramatically depending on the age of the individual. No deaths occurred in those 9 and younger, but cases in those aged 70 to 79 carried an 8% fatality rate, and those aged 80 years and older had a fatality rate of 14.8%. The rate was 49% among critical cases, and elevated among those with pre-existing conditions, to between 5.6% and 10.3%, depending on the condition.

Other differences between coronavirus and flu lie in what we don’t know. Adults with the flu, which has an average incubation period of two days, can infect others 24 hours before symptoms develop and 5 to 7 days after becoming sick. Novel coronavirus has a median incubation period of 5.1 days, longer than that other human coronaviruses (3 days) that cause the common cold.

The agency said the number of cases outside China has increased tenfold and the number of countries affected has tripled. “We expect to see the number of cases, the number of deaths and the number of affected countries climb even higher. WHO has been assessing this outbreak around the clock,” Tedros told reporters. “And we’re deeply concerned. Most by the alarming levels of spread and severity. And by the alarming levels of inaction.”

Coronavirus appears to be transmitted with ease to around 2.3 people by each person infected in the community, said Antigone Barton, editor of ScienceSpeaks, a medical website. Drug companies and the medical community, she said, are scrambling to come up with a vaccine before more people die, and health services are overwhelmed with sick people showing up at their doors.

The potential demand for hospital beds, ventilators, masks and medications, and the pressure all of this would put on staff worries her. “Because there’s no proven therapy or vaccine; as coronavirus spreads,” Barton said, “it threatens to put a much greater burden on health systems than flu does, and greater than most or many are prepared for.”

How COVID-19 is transmitted