(Editor’s note: Dr. Ben LaBrot, who is the founder and CEO of Floating Doctors, a professor in the Keck School of Medicine Dept. of Global Medicine at USC and a Pacific Palisades Optimist sent the article to his fellows Optimists on March 30 that is easily understood and answers the question, “Why we don’t stop everything for flu”? A portion is reprinted below; the entire article can be read:
By DR. BEN LABROT
A lot of people have been asking, “If Seasonal flu kills up to 500,000+ every year [worldwide], and this coronavirus pandemic so far has killed ‘only’ 30,000, why does everything have to come to a screeching halt, and for how long?
First, putting aside the problem with the phrase “has killed ‘only’ 30,000” (especially if you’re one of those unlucky families), influenza and Covid-19 and SARS may share outward similarities but are also very, very different.
An estimated 35 million Americans were infected last flu season, and about 500,000 were hospitalized. About 35,000 died in the United States alone, and it was considered a mild flu season. With more than 10 percent of the U.S. population affected by the flu most years, these are stunning numbers.
So why does Covid-19 need a response that is causing so much disruption? Covid-19, plain and simple, just kills way more people that get infected than people who get infected by flu.
There’s debate over the exact mortality rate (how many people who get infected end up dying), but for seasonal flu it’s known to be about 0.1%. This means that of ALL cases, serious or not, about 1 in 1,000 people infected by seasonal flu will die.
For Covid-19, most agree that it is somewhere between 2–4% on average, which means that between two to four people [out of 1,000] infected by Covid-10 will die.
There’s a difference between the burden of people dying from a disease and from getting very, very sick from it: the real burden is not from the number of deaths, but the number of people who get so sick they need to be hospitalized (or worse, put in an ICU and isolated and put on a ventilator).
We probably can’t stop lots of people from getting infected, but we CAN stop everyone from getting sick AT THE SAME TIME and overwhelming our health systems.
There are also still people who get cancer and heart attacks and car accidents and all of the other things that people need the hospital for. Not so good if every emergency room and intensive care unit is occupied by people in respiratory failure from Covid-19.
So far this flu season, about 1% of all flu-infected people in the United States have developed symptoms severe enough to be hospitalized: about a 0.061% chance of getting hospitalized if you have flu.
However, in a study of Covid-19 even in the early stages (between January 1 and February 11), 13.8% were severe enough to need hospital care, and 4.7% critical (respiratory failure, septic shock, and/or multiple organ dysfunction/failure).
A more recent U.S. study in the CDC journal “Morbidity and Mortality Weekly” found that a whopping 12% of sick were hospitalized. That means you are about 200 times more likely to be hospitalized by Covid-19 than by flu.
Covid-19 spreads MUCH more rapidly than flu, for several reasons.
Covid-19 sufferers probably infect about 2-3 other people. That’s a reproduction rate up to TWICE that of flu, which typically infects 1.3 new people for each patient.
Worse, a LOT more people infected with Covid-19 show little or no symptoms compared to flu. This is called “silent infection.” We get sick all the time and never know it because our body is constantly hurling back invaders.
When people with the flu are most infectious, they mostly lie in bed and stay home. But with Covid-19, up to 80% of infected people don’t feel sick at all but are still infectious for a pretty long period.
In fact, even though is true that you are probably much MORE contagious if you are sicker, the sheer volume of “silently infected” people walking around feeling fine means that these patients are likely the biggest cause of spread.
The U.S. has a much older population and is especially vulnerable.
Almost all infectious diseases like this generally affect three groups: the very young, the very old, and people at any age whose immune systems are compromised in some way. Some viruses target younger people — the 1918 pandemic, for example, appears to have really hit younger people hard.
Ironically this is a disease probably likely to land more heavily on more developed nations that have extensive movement of people, lots of big crowded cities, but most importantly much older populations. Probably a main reason Italy has been hit so hard is because Italy has the most elderly population in Europe (over 23% older than age 65) and this bug does really like older people.
There are about 76 million baby-boomers in the U.S. (aged 60–75) and many have other conditions like diabetes or high blood pressure or heart disease.
If they all got sick at the same time, along with other coexisting health problems that many of them have in their 70s, that too could terribly overwhelm the healthcare system rapidly.
Flu has been with us a long, long time, but Covid-19 is a ‘novel’ virus.
‘Novel’ means it’s a new type we’ve never experienced before. There have been at least 14 influenza pandemics in the last 500 years, on average about 40 years apart, and likely many more since ancient times. By now, most of the flu strains of the past that were a lot worse have died out with the people they killed.
When a new disease appears (flu mutates very easily so we have to do this continuously) there’s a period of mutual adjustment (usually over hundreds of years): the people who are genetically most susceptible die out and the most deadly strains of the disease die out, too.
Look at it from the virus’ point of view: it doesn’t help the disease to kill you…if you die you can’t pass the disease on anymore — the ideal is that we become infected but not so sick we can’t continue to spread it.
Syphilis is a good example. When it first arrived from the New World back to Europe in the 15th century (most likely with Columbus’ returning ships), everyone in Europe was so vulnerable that there were huge syphilis plagues killing thousands.
As Jared Diamond describes it, “[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people’s faces, and led to death within a few months.”
Now syphilis can take years to manifest such severe symptoms. Most of the really vulnerable people died out long ago and most of the really bad syphilis strains died out long ago, too.
Because Covid-19 is totally new, that means there are many among us who will have a very strong genetic vulnerability to it compared to flu. This is probably why some younger and healthier people inexplicably are dying from it.
With a novel virus like Covid-19, we have no idea how it will behave for sure…novel viruses are predictably unpredictable. First, we thought it targeted older people almost exclusively, then it started taking younger people including otherwise healthy folks who dropped dead or had to be ventilated during a rapid deterioration even after days of relatively mild symptoms.
COVID-19 is totally new, so nobody has any acquired immunity to it.
We bask in the fiery glow of flu every year and we have huge numbers of people vaccinated globally and it still kills up to 500,000+. Think about that — with half the US population vaccinated for flu, and so many people exposed to it the previous year and gaining a little immunity to help next year, up to half a million people can still be expected to die worldwide.
Since Covid-19 is a novel, or a new virus, nobody has really any acquired immunity to it. So because we don’t really know what the true mortality rate and death rate will be until after this is all blown over, we have to treat it as though a LOT of people could be especially vulnerable to it.
Covid-19, like all RNA viruses, mutates pretty easily and more infected people mean more opportunities to mutate.
Here’s what you need to know about mutation and Covid-19. More infected = more chances for mutation = more resistance to our diagnosis or our medicines.
Mutation also increases the chance of antiviral medication resistance developing. If a drug wipes out all copies of the virus in a sick person’s body, the virus won’t have the chance to adapt.
But if someone is infected and even a few copies of the bug have a mutation that helps them survive the drug, and the sick person spreads them to somebody else, then those resistant viruses could spread and our treatments won’t work as well either.
That’s why we give several antiviral meds together, a “cocktail” like we give for HIV and tuberculosis. It’s a lot harder for a bug to mutate resistance to multiple drugs at the same time, and even if some have mutated to resist one medicine, one of the other drugs in the cocktail does them in.
One reason ‘only’ 30,000 have died so far is that all these massive efforts are working.
Although it’s too soon to know for sure, the end of this year’s flu season may well have been facilitated by all the prevention measures we are taking for Covid-19.
My prediction is that next year’s flu season will likely show less burden because people will be far more mindful and diligent about things we should be doing every flu season.
I can’t help but think much longer term…and when I see that although we are better prepared than we were for SARS, we are OBVIOUSLY not ready for a bug that is much worse than Covid-19…we weren’t even ready for Covid-19!
I’m really looking at this like a full dress rehearsal against the day a much worse virus arises—it is inevitable someday (remember, pandemics have occurred about every 40 years over most of human history) and could literally be ANY MOMENT, like “the big one” all of us in California know will one day come.
In 2018, the anniversary year of the 1918 Spanish flu pandemic, the World Health Organization warned that a flu pandemic could cost the U.S. $60 billion or more, while pandemic preparedness would cost about $4.5 billion a year.
That’s expensive insurance, but I can’t help but wish we’d all taken the WHO’s prophetic 2018 warning a bit more to heart. Preventive medicine, right? If it ain’t broke, who wants to spend money to fix it when we have pressing immediate problems every day? And yet here we are.
I think the real question is not why we must take such strict measures with this virus, but why are most of us not very diligent (including myself) about even the basic disease prevention methods we all know about during flu season every year?
A report from 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. Yuck.
We don’t have to shut down our whole society every year, but just doing the bare minimum of personal mindfulness would probably save tens of thousands of lives (or more). I know next flu season will be interesting to watch.
So, thank goodness this is a full-dress rehearsal and not opening night or we’d be in a lot more trouble than we already are.