How the Coronavirus and Flu Are Not the Same

There has been much attention, too much in my opinion, comparing SARS-CoV-2 with Influenza B. SARS-CoV-2 and Influenza B are the specific names for the viruses in question when we generally short hand Coronavirus and Flu, there are many types of coronaviruses, including SARS, MERS, and some versions of the common cold (although most colds are caused by rhinoviruses). There are also multiple types of flu, including influenza type A, B, and C, although A and B are the most common. From here on out, I'll use Coronavirus and Flu as this is how most people and the media discuss them, but realize this is short-hand. (COVID-19 is the disease caused by Sara-CoV-2 and is not a pseudonym, much like AIDS is a disease caused by HIV.)

Both viruses are RNA viruses, their genetic material is RNA and this is converted into DNA after infection into a host cell. These viruses force the host cell to use this DNA copy to make all the proteins required to make new virus and to make complete RNA copies which will then be packaged into new viral particles before killing the host cell and infecting other cells and/or hosts.

Both Coronavirus and Flu cause significant respiratory illness. Indeed, SARS is an acronym for Severe Acute Respiratory Syndrome. These infections make breathing more difficult, in large part due to immune responses trying to keep you alive, but they also make a patient more prone to getting pneumonia, which can also kill you. These aspects of infection help explain why the elderly, immunosuppressed, and young are high risk groups (It appears that Coronavirus is not particularly lethal in the young, however data is still limited in my opinion.)

At first glance it looks like Coronavirus and Flu are similar. This could lead some, like an orange baboon, to directly compare them. If we do compare them directly, its easy to conclude that Flu is much much worse and its a plot by the universe to be concerned about Coronavirus. In the US, Flu infects 10s of millions, leading to hundreds of thousands of hospitalizations, and 10s of thousand deaths! Every year!!! To date world-wide, Coronavirus has infected over 100,000 people and caused about 4000 deaths. For non-viral comparison sake, car crashes kill about 40 thousand people in the US, comparable to the flu virus. Gin deaths are similar in the US.

Your basic Orange Baboon. From here, although I realize the image on the left is an infant orangutang and the image on the right is an actual orange baboon.

Since we don't shut down schools, concerts, etc for the flu and don't seem to care that much about vehicular deaths and definitely aren't willing to do anything about gun deaths, what is the concern about Coronavirus all about?

It's because because these comparisons are, at best, inadequate but more likely abysmal.

First, we need to consider what happens when someone gets sick with either virus. Maybe nothing both viruses cause symptomatic infections, although these patients can readily pass the viruses on to others who may not be so lucky. Next possibility is you get sick but not so severely that you go to the hospital. Hopefully you stay home and recover, but this being America, many people will have to go to work or are otherwise unable to rest because social safety nets are for commies, you know like every other developed country on the planet. More severe cases lead to hospitalization and of those a subset will leave the hospital in a casket. Here's one of the first places where Coronavirus and Flu differ. Roughly 2-3% of infected individuals will die of Coronavirus, aka leave in a casket, this number will likely change as more information is obtained (in other areas of the world because the US is wasting time and energy NOT testing even likely infected patients). However, the Flu leads to death in roughly 0.1% of patients.

Second, lets consider some other critical differences.

1. There's a Flu vaccine! That's right there's a vaccine against influenza, but somewhere between jack and shit for SARS-CoV-2, to be fair it's closer to shit than jack shit. Regardless of what orange baboons say, it will be a long time, at the earliest before, there's a vaccine. In fact, it may take many years before there's a vaccine. We still do not have anything close to a vaccine to HIV and we've been working on it since the 80s. The flu vaccine isn't perfect because it has to be developed before flu season begins so some years its more effective than others (if it were developed afterwards, it would be too late to be useful....hmmmm). To be clear, even when the vaccine doesn't match well, it still provides some protection and reduces mortality and severity, shortens length of illness, and reduces chance of infection. Also evolution matters and flu, much like other RNA viruses, I'm looking at you SARS-CoV-2, evolves quickly. This is why you should get a flu vaccine every year. By the time a Coronavirus vaccine is developed, in the best case scenario, most of the planet will already have been exposed.

Ok, the savvy among you are already thinking, if there's a vaccine but still a shit ton of people die from Flu, why should I care about Coronavirus? Well, most people are not vaccinated for the Flu, maybe 50%, which is well below what is needed for 'herd immunity'. However, health care workers, doctors, nurses, EMTs, etc. are almost uniformly vaccinated against flu. Thus, they are much less likely to miss work because they have the flu, which means they are available to care for those who do get sick and require hospitalization.

2. We know the flu is coming! Look there's a reason you need a vaccine every year. As above its due to evolution. But here's the thing, for well over a hundred years we've known this is coming. Every single year. And as our medical personnel are kind of smart and know this is coming, they are prepared. Besides being vaccinated, hospitals and clinics generally have the resources available to handle the influx of respiratory illnesses that will show up during flu season. We know thousands of patients are coming in, so its factored into the medical care equation. Don't believe me, think this is some kind of plot conceived by the MSM? Ask yourself why do insurance companies, the epitome of capitalism in the US, prepare for these expenses every year? In the US, hospitals are generally revenue generating, at least for the wealthy, so why aren't they prepared for this change in hospital cases every year? The short answer is: they are prepared. They are prepared for flu, they are also prepared for other cases, like heart attacks and broken bones. However, they are NOT prepared for dealing with fundamental changes in the status quo.

Coronavirus is a change in the status quo.

3. Here's the problem if hospitals plan for X number of beds being occupied, even during flu season, what happens if more than X number of beds are occupied due to Coronavirus? What happens to any potential extra patients, like Grandpa with a heart attack? In the US, we live in a firm capitalistic society, if someone isn't making money then why bother. So hospitals don't have a bunch of excess beds for, just in case. Hospitals don't have extra doctors, nurses, or other staff sitting on the bench for, just in case.

TV medical dramas give a false sense of time frames in regards to infectious disease testing. One thing they do give reasonable service to is bed availability. If two school buses crash into each other, the local hospital cannot compensate with the increased patient load. This becomes the plot focus for episode this week. In these scenarios, patients are triaged and sent to other hospitals or patients left to wait for a team to be available to treat them. This is the drama of the episode. So what does this mean in the real world in the face of a pandemic?

4. If a small percentage of health service professionals, EMTs, nurses, doctors, get sick then everything fails. There are a finite number of nurses available to serve at a given hospital, there are only so many goalies available on game day (2 in fact). If the goalies get injured you are basically fucked. Yes there was this one game this one year that the team won, just saying. However, the reason this is notable is that most third string goalies never get in and when they do they fail.

If fewer medical professionals are available more people fail to receive adequate care, so these people get worse results. Furthermore, new cases get pushed to the back burner making the problem last longer. Also Grandpa who shows up with a heart attack is part of this queue.

5. This leads to the St Louis vs Philadelphia conundrum. (Not fair to either city.) During the flu of 1918, problematically called the Spanish Flu, Philadelphia took a Trump MAGA approach, not doing shit, and St. Louis took a more draconian approach of closing dance halls (clubs), schools, and other gathering areas. This this led to the 'flattening the curve' idea that is all over the nets.

From here

The gif is better in my opinion: Flatten the Curve

Basically the idea is that if exposure and infections are delayed, severe cases do not overwhelm the health care infrastructure. The bad part of this is infections occur over a longer period of time. The good part is that fewer people die! To be clear without flattening the curve, there's a much greater chance of people dying from Coronaviruse, but also Grandpa dying of a heart attack, because the health care system is overwhelmed. If doctors, nurses, and other staff are home sick they are not helping Grandpa out and there are not people on the zamboni who can come into the game successfuly.

We, in the US and most other places, are not prepared for pandemics. It's not our business model. However, by taking steps to mitigate the potential, and almost certain problems, we can respond adequately. To be clear people will die, people will get sick, there's no denying that. However, we can significantly reduce the number who die and get profoundly sick.

As an academic, a skeptic, and a realist I doubt we will succeed. Overall I think we are Philadelphia, not St. Louis.

Prove me wrong.