COVID-19: Is it really like flu now?

Friends, I hope you are well.

In case you’ve been tuning out of the news and relying solely on this blog for information, I feel obliged to inform you that the COVID-19 pandemic is still here. But I think things are getting better!

I last wrote about the pandemic over a month ago on December 14, and there I commented that I didn’t have much to say. And since then I have frankly just not wanted to think about it!

I was prompted to look again at the situation, as the government seems to be moving to a stance that COVID is now ‘like flu’, and we just need to live with it.

I felt rather distrustful of this assertion, so I thought I would see if there really was any justification for this laissez-faire approach.

To my surprise, I have concluded that there is actually a fair amount of justification.

What?

In this article I compare current death rates in Wave#3 with what used to happen in ‘normal’ years. Can you remember normal years?

My conclusion is that death rates from COVID in its omicron variant, spreading in our heavily-vaccinated population seem to be similar to – or less than – winter death rates seen in ‘normal’ years between 2000 and 2017.

So it may be thatwith some caveats that I will discuss at the end – yes, COVID is becoming like flu.

Really? Yes. Let me explain.

COVID deaths so far

Click the image for a larger version. Logarithmic graph showing positive caseshospital admissions and deaths since the start of the pandemic. Numbers in panels highlight the numbers at the peak of Wave#2 in January 2021 and the peak of Wave#3 in January 2022. Also shown are the average values through the months of September, October and November 2021.

Even the most cursory glance at the graph shows that the pandemic is still with us, killing around 270 people per day (1,890 people per week) at the moment.

Infections, hospitalisations and deaths have been at a high level through the last 4 months of 2021, and rose strongly at the start of the new year.

Comparing peaks of the curves in January 2021 and 2022:

  • Cases in 2022 (omicron) are around 3 times higher than in 2021 (delta).
  • Hospitalisations in 2022 are around half the numbers in 2021.
  • Deaths in 2022 are around a fifth of the numbers in 2021.

So back in 2021, around 2% of people testing positive died. Now the equivalent figure is 0.1%.

These simple figures mask many complications.

  • In 2021 the death rate was for an almost unvaccinated population and the virus was controlled by severe social distancing: a lockdown.
  • Now the most vulnerable parts of the population are multiply vaccinated and there is a great deal of immunity acquired through prior infection.
  • In 2021 we were dealing with the delta variant and now we have omicron.
  • In recent months schools seem to have been the focus of transmission, and that is likely to stay that way for a little while.

So how does this level of COVID infection and death compare to influenza?

As far as I can tell, and rather to my surprise, the death rates from this third wave are similar to those seen in earlier winter flu episodes.

Let me explain how I have come to his conclusion.

I downloaded the weekly rate of deaths in England and Wales from the Office for National Statistics (ONS). The data shown below are extracted from Figure 4 of this document.

Click the image for a larger version. Weekly deaths in England and Wales from mid-1999 to mid-2017. Typically 8,000 to 9,000 people die each week in the summer, but the figure rises in the winter peaking between 1,000 and 3,000 deaths per week above the summer death rate.

Typically 8,000 to 9,000 people die each week in the summer, but the figure rises in the winter, peaking between 1,000 and 3,000 deaths per week above the summer death rate.

A significant fraction of this is due to flu – it correlates well with what the ONS call an index of “influenza-like illness (ILI) consultation rates”.

So I suppose we can consider that this is ‘normal’ for the UK.

The large peak in the winter of 1999/2000 is (I think) caused by flu, because the ONS note elsewhere (this document just after Figure 3) that in 2000, flu vaccination became commonplace.

So in all the years shown except the first, flu is being controlled by mass vaccination of the vulnerable population.

How does the COVID 19 death data look if overlaid on this graph? This is shown below.

Click the image for a larger version. Weekly deaths in England and Wales from mid-1999 to mid-2017. Also shown are the weekly deaths from COVID plotted above a nominal baseline of 9000 deaths per week. This is the same data plotted on the logarithmic graph at the head of the article. The three waves can be clearly seen.

The graph above shows weekly deaths from COVID plotted above a nominal baseline of 9,000 deaths per week. This is the same data plotted in black on the logarithmic graph at the head of the article, but scaled ‘per week’ rather than ‘per day’.

The three waves of the pandemic can be clearly seen.

The data are broadly comparable to what happens in normal years between 2000 and 2017, but larger. And remember, these are deaths from just a single cause.

Additionally we must remember that the peaks from Wave#1 and Wave #2 are only this small because of national lockdowns which wreaked immense disruption to all our lives.

If we had not had lockdowns, then the scale would likely have been something on the order of 10 times this size – quite comparable with the 1918 influenza pandemic. Things would have been truly catastrophic.

However the death rate in Wave#3 – the wave we are currently experiencing – is much smaller than the previous waves and this has been achieved mainly (but not entirely) by vaccinations.

From this, I conclude that deaths from COVID in Wave#3 do appear to be at a level similar to deaths from “Influenza-like illnesses” over the years 2000 to 2017.

Caveats

Before concluding that ‘it’s all over’, we need to remember that the situation is still serious. People are still becoming seriously ill and dying.

What I am pointing out is that this is now occurring at a rate that is similar to previous ‘normal’ winters.

We should also recall that COVID is a completely new disease and may have other mutations which may surprise us still.

Given this, it seems to unwise to throw out all mitigations against transmission while viral prevalence is so high.

For example, I will continue to mask up in shops and I would feel comfortable if other people did too.

However, I can understand that other people may disagree.

Conclusion

But is COVID really on its way to being ‘like flu’.

Yes. Amongst vaccinated populations, that’s how it looks to me.

======================

P.S. As pointed out in a comment: I did not consider the impact of Long COVID – or the disease burden on hospitals.

8 Responses to “COVID-19: Is it really like flu now?”

  1. Martin Says:

    Hi Michael. I see lots of conflicting figures about “flu” or “pneumonia” -like illnesses. People seem to be arguing about this. E.g. see this tweet https://twitter.com/GabrielScally/status/1482736195113295872/photo/1
    I’m not sure how clear the stats really are.

    Possibly long covid is a reason not to treat it like flu anyway. I suspect the way new variants are likely to arise, potentially more deadly, in a world which is far from protected by vaccines, is another equally worrying reason.

    • protonsforbreakfast Says:

      Martin

      Thanks for that. Honestly I was surprised by the numbers. I expected that when I looked I would see crazy levels of excess deaths. But that is not what I saw.

      I am happy to be corrected, and I am way out of my comfort zone here, but that’s how it looked to me.

      I am sure you know the situation and in the end you just have say what you see.

      Best wishes

      Michael

  2. Dan Grey Says:

    Well, can’t really ignore the evidence for the protective effect of vaccines declining with time. While the protection against death from covid is holding up, we don’t know if that will change.

    It’s also quite possible that another variant with a strong ability to reinfect/overcome vaccine immunity but without omicron’s relative “mildness” will come along.

    • protonsforbreakfast Says:

      Indeed. It is very hard to see ahead. Many people predicted that there would be new variants, but no one could predict their particular properties.

      And I am not sure about the severity of COVID illness compared to flu: I only considered the lethality.

      But the opacity of the future is normal.

  3. Martin Says:

    https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/englandandwalesinfluenzadeaths

    From the above link, it seems that flu deaths themselves (from 2013-2020) were usually very low, and far lower than covid deaths. (Even at present, a week’s worth of covid deaths is larger than a year’s worth of flu deaths.) It’s combining figures with other respiratory infections that bumps up the numbers.

    • protonsforbreakfast Says:

      I acknowledge that data, but the link I gave showed that there is a strong correlation to an index of “Influenza-like illnesses” – an odd phrase. Perhaps that is what you mean by “combining figures with other respiratory infections”. Maybe back then we didn’t test for the cause of a respiratory infection, but just treated the resulting pneumonia.

      Nonetheless, looking at the weekly all-cause death totals, the current Wave#3 of COVID does not look exceptionally large – unlike Waves#1 and #2.

      It may be that COVID illness is worse than flu, I don’t know. But unless I have made a mistake with the maths (possible!) it looks to me that the death toll from COVID-Wave#3 is comparable to previous winter deaths from “Influenza-like illnesses”.

      All the best

      Michael

      • Martin Says:

        Yes I completely agree that this latest wave has much lower mortality (especially given so many infections), no doubt mainly due to vaccination. Excess mortality figures are not anything like the first waves, as your graphs make clear. Fingers crossed of course …

        I simply note that people on social media get upset or annoyed (not me!) when told “it’s just like flu”. I can understand that, since (i) people are worried (ii) ONS figures for flu alone are surprisingly (to me) small and (iii) it’s not only the absolute numbers driving the discussion with this new disease, but things like long covid, arguments overs masks and “freedom”, lack of fairness in vaccination of poorer countries, concerns about new variants … the list goes on.

        I long for a return to normality but I suspect it won’t be for a while yet!

      • protonsforbreakfast Says:

        I agree with everything you said.

        I think that longing is widespread.

        Stay well: M

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