COVID is Worse Than the Flu. Much Worse.

By Henry I. Miller, MS, MD — May 02, 2023
COVID is still killing more than 1,000 Americans a week; long COVID causes prolonged misery; and a new, more transmissible subvariant of the SARS-CoV-2 virus is spreading.

We all know people who said, “I had COVID, but it wasn’t too bad after the first couple of days.  After that, I had a cough and was tired for maybe a week.  Pretty much like the flu.” 

The thing is – and this should be obvious – you can’t generalize from a few, or even a large number of anecdotes in this case, and here’s why.  For illnesses that have a potentially lethal outcome, there’s a phenomenon called “survivorship bias” -- a cognitive shortcut that occurs when a visible successful subgroup is mistakenly thought to represent an entire group, due to the failure subgroup not being visible (such as because they’re dead). In other words, the bias occurs when only the observations of the “survivors” are considered, while ignoring those who didn’t survive.

In the case of COVID, we’re not hearing opinions from people who died, or who are so debilitated by long COVID – the persistence of signs and/or symptoms for weeks, months, or years after the initial infection – that they might not often be up and around.

To make a more accurate, quantitative flu-COVID comparison, Veterans Administration (VA) researchers analyzed electronic health records in their databases and compared death rates of the two infections during the winter just ended.  They found that mortality risk from COVID was about 6% among adults hospitalized in the U.S. compared to a 3.7% death rate from flu.  It is noteworthy that due to greater immunity against the coronavirus, improved treatments, and the appearance of new SARS-CoV-2 variants that were highly transmissible but less lethal, last winter’s 6% mortality rate in hospitalized patients was lower than the 17-21% seen in 2020. 

And although some pundits and politicians have dismissed COVID as no worse than the flu, federal data and articles in the medical literature beg to differ.  The CDC estimates that approximately 22,000 Americans died from flu in the 2019-2020 flu season, whereas COVID killed about 350,000 in 2020. 

But where COVID and flu are concerned, fatalities are not the whole story.  An article published in 2020 by the same VA group that compared COVID and flu death rates in the study described above compared complications in COVID and flu patients and concluded:

compared with patients admitted to hospital with seasonal influenza, those admitted with covid-19 have increased risk of systemic clinical manifestations (including higher risk of acute kidney injury, incident renal replacement therapy, incident insulin use, severe septic shock, vasopressor use, pulmonary embolism, deep venous thrombosis, stroke, acute myocarditis, arrhythmias and sudden cardiac death, elevated troponin [an indicator of cardiac damage], elevated aspartate aminotransferase [a measure of liver damage], elevated alanine aminotransferase [liver damage], and rhabdomyolysis [breakdown of muscle tissue], increased risk of death, and higher need for healthcare resources (mechanical ventilation, ICU admission, length of hospital stay). 

That last phrase, about “the higher need for healthcare resources,” deserves special attention.  The pandemic and its aftermath have boosted healthcare costs, stressed medical facilities, and compromised Americans’ health in several ways.  Much routine medical screening has been delayed or foregone, anti-vaccine activists have caused a decline in vaccine uptake, and long COVID will take a long-term toll – all at a time when burnout and retirements among healthcare providers have lowered their numbers. 

Where are we with COVID currently?  According to the CDC, as of April 26 the weekly death toll in the U.S. was over a thousand, and as of April 24 wastewater surveillance showed levels of SARS-CoV-2 virus increasing in 37% of U.S. sites where they are measured.  In addition, a new, more transmissible subvariant of Omicron, XBB.1.16, is gaining in dominance.

Does all that sound like flu, or that we have returned to pre-COVID “normality?”  Hardly.


Henry I. Miller, MS, MD

Henry I. Miller, MS, MD, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. His research focuses on public policy toward science, technology, and medicine, encompassing a number of areas, including pharmaceutical development, genetic engineering, models for regulatory reform, precision medicine, and the emergence of new viral diseases. Dr. Miller served for fifteen years at the US Food and Drug Administration (FDA) in a number of posts, including as the founding director of the Office of Biotechnology.

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