How Does the Coronavirus Compare to the Flu?

As new cases appear on the West Coast, some — including the president — see comparisons to the seasonal flu. Here’s a close look at the differences.


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Is this new coronavirus really a serious danger? Doesn’t the flu kill more people?

As the United States recorded its first coronavirus death on Saturday — and as other cases popped up in people without known risks on the West Coast — Americans wondered how to measure this new threat against a more familiar foe: influenza.

President Trump, a self-described germophobe, said on Wednesday he was amazed to learn that tens of thousands of Americans died from the flu each year, contrasting that number with the 60 or so known to be infected with the coronavirus. On Friday, Mr. Trump accused the news media and Democrats of exaggerating the dangers of the virus.

“The flu kills people,” Mick Mulvaney, the acting White House chief of staff, said on Wednesday. “This is not Ebola. It’s not SARS, it’s not MERS. It’s not a death sentence.”

To many public health officials, that argument misses the point.

Yes, the flu is terrible — that’s exactly why scientists don’t want another contagious respiratory disease to take root. If they could stop the seasonal flu, they would. But there may yet be a chance to stop the coronavirus.

In many ways, the flu is the best argument for throwing everything at the coronavirus. Here’s a closer look at the similarities and differences.

The coronavirus seems to be more deadly than the flu — so far.

On average, seasonal flu strains kill about 0.1 percent of people who become infected. The 1918 flu had an unusually high fatality rate, around 2 percent. Because it was so contagious, that flu killed tens of millions of people.

Early estimates of the coronavirus death rate from Wuhan, China, the epicenter of the outbreak, have been around 2 percent. But a new report on 1,099 cases from many parts of China, published on Friday in The New England Journal of Medicine, finds a lower rate: 1.4 percent.

The coronavirus death rate may be even lower, if — as most experts suspect — there are many mild or symptom-free cases that have not been detected.

The true death rate could turn out to be similar to that of a severe seasonal flu, below 1 percent, according to an editorial published in the journal by Dr. Anthony S. Fauci and Dr. H. Clifford Lane, of the National Institute of Allergy and Infectious Diseases, and Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention.

But even a disease with a relatively low death rate can take a huge toll if enormous numbers of people catch it. As of Sunday, there were about 87,000 coronavirus cases and 3,000 deaths. This week, for the first time, the number of new cases outside China exceeded the number within the country.

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Here’s what early research says about how the pathogen behaves and the factors that will determine how far it will spread.

So far, the new coronavirus seems to be more contagious than most strains of the flu, and roughly as contagious as strains that appear in pandemic flu seasons.

Each person with the coronavirus appears to infect 2.2 other people, on average. But the figure is skewed by the fact that the epidemic was not managed well in the beginning, and infections soared in Wuhan and the surrounding province. As an epidemic comes under control, the reproduction number, as it’s called, will fall.

The Coronavirus Outbreak

  • Answers to your most common questions:

    Updated Feb. 26, 2020

    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

By comparison, the figure for the seasonal flu is roughly 1.3. The reproduction number for the flu of 1918 was about the same as that of the new coronavirus, perhaps higher, but that was before modern treatments and vaccines were available.

In both flu and the illness caused by the coronavirus, people may be contagious before symptoms develop, making it difficult or even impossible to control the spread of the virus. Nobody knows how many people infected with the coronavirus have only very mild symptoms or none at all.

Both the coronavirus and influenza are most dangerous to people who are older than 65, or have chronic illnesses or a weak immune system.

Death rates among men infected with the coronavirus in China, particularly those in their late 40s and older, have exceeded those among women, a pattern not seen in the seasonal flu. The reason for the discrepancy is not known, although Chinese men do smoke more, often resulting in compromised lung function.

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There seems to be another important difference: The flu appears far more dangerous to children, particularly very young ones, who can become severely ill. Children infected with the new coronavirus tend to have mild or no symptoms.

The flu is also especially dangerous for pregnant women, who can become severely ill from it. Whether the new coronavirus poses as serious a threat to pregnant women is not known.

As of Feb. 22, in the current season there were at least 32 million cases of flu in the United States, 310,000 hospitalizations and 18,000 flu deaths, according to the C.D.C. Hospitalization rates among children and young adults this year have been unusually high.

There would be even more illnesses and deaths if there were no flu vaccine. Most people recover in less than two weeks, and sometimes in just days.

By contrast, about 70 people in the United States have been infected with the new coronavirus, and there has been one death. There are no treatments or vaccines for the coronavirus, only supportive care for infected people.

Most cases of coronavirus infection are not severe, but some people do become quite sick. Data from the largest study of patients to date, conducted in China, suggests that of coronavirus patients receiving medical attention, 80 percent had mild infections, about 15 percent had severe illnesses, and 5 percent were critical.

The first symptoms, fever and cough, are similar to that of the flu, so the diseases can be hard to tell apart without a test to identify the virus. Pneumonia is common among coronavirus patients, even among those whose cases are not severe.

Experts think there may also be many people with no symptoms at all, or such mild ones that they never bother to seek medical attention. Because those cases have not been counted, it’s not possible now to know the real proportion of mild versus severe cases.

Antibody tests, which can determine whether someone has ever been infected, may eventually help to establish how many people had mild or asymptomatic coronavirus infections.

After viral infections, people generally develop antibodies in their blood that will fight off the virus and protect them from contracting it again. It’s reasonable to assume that people who have had the new coronavirus will become immune to it.

But it is not known how long that immunity will last. With other coronaviruses, which cause the common cold, immunity can wane.

There are vaccines for the seasonal flu, of course, and these induce at least partial immunity to influenza.

ImageHealth workers administered flu shots at Eastfield College in Mesquite, Tex., last month.
Credit…LM Otero/Associated Press

There is no approved antiviral drug for the coronavirus, though several are being tested. Doctors can recommend only the usual remedies for any viral illness: rest, medicine to reduce pain and fever, and fluids to avoid dehydration.

Coronavirus patients with pneumonia may also need oxygen, and a ventilator if breathing trouble worsens.

For the flu, however, there are four prescription medicines. All work best if they are taken within a day or two of when symptoms start.

They’re not miracle cures: They can lessen the severity of the illness and shorten its course by a day or so, and they may lower the risk of serious complications.

The drugs are also recommended for people who have been exposed to a flu patient, to try to prevent the illness.

The flu, like the coronavirus illness, can also cause pneumonia and breathing trouble. Anyone who becomes short of breath needs medical attention quickly.

An experimental vaccine for the coronavirus may be ready for testing in humans within a few months, but will take much longer, at least a year or two, to become available for widespread use.

Flu vaccines, on the other hand, are widely available and generally 40 percent to 60 percent effective, which means they will reduce cases by that amount in a population that has been vaccinated, compared with one that has not.

The vaccine for the current season falls into that range, according to the C.D.C., which said on Feb. 21 that people who have not been vaccinated should still get the shot, because the flu season is ongoing.

Experts have been urging people to get the flu shot for all the usual reasons. But now there’s another: If there is a coronavirus outbreak in the United States, hospitals will need all the beds, equipment and staff they can muster.

It will be important not to have those resources taken up by patients with flu that could have been prevented.

Mr. Trump has said repeatedly that the coronavirus will retreat as weather warms, just as influenza does. In fact, because this is a new virus, there is no information about how the weather might affect it.

Even if the virus were to diminish in the spring, it might rebound later in the fall, as the weather cools. This is a pattern often seen in severe flu seasons.

Containment is becoming less likely, because of the contagiousness of the virus, the possibility that people can spread it before they have symptoms and the increasing number of outbreaks around the world.

The cases in California, Oregon and Washington State without known links to overseas travel, reported on Friday, may be a warning sign that the new coronavirus has already begun to circulate.

Reporting was contributed by Gina Kolata and Knvul Sheikh.


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