Since the early days of the pandemic, fitness has assessed the risk of COVID-19 by comparing it to the flu.
At first, it wasn’t even close. People hospitalized in 2020 for this new respiratory illness were five times more likely to die from their illness than patients hospitalized with influenza in previous flu seasons.
Immunity to vaccines and beyond coronavirus infections has helped control COVID-19, so much so that when researchers compared the death rates of hospitalized COVID-19 patients and seasonal flu patients at the height of the 2022-2023 flu season, they found that the pandemic disease is only 61% more likely to cause death.
Now, the same researchers have analyzed data from the fall and winter of 2023 and 2024. Ziyad Al-Aly, director of the Center for Clinical Epidemiology at VA St. John-Louis and his colleagues hoped to discover that the two respiratory diseases had finally equalized.
“There’s a narrative that the pandemic is over, that it’s nothing,” Al-Aly said. “We came into this thinking we’d do this rematch and find out that from now on it’s going to be like the flu. “
The VA team reviewed the electronic fitness records of patients treated at Veterans Affairs hospitals in all 50 states between Oct. 1 and March 27. They focused on patients who were admitted because they had a fever, shortness of breath, or other symptoms due to COVID-19. 19. 19 or flu. (People who were admitted for some reason, such as an attack on the center, and then were inflamed with a coronavirus were not included in the analysis. )
COVID-19 patients were, on average, slightly older than flu patients (73. 9 vs. 70. 2 years) and were less likely to be smokers or former smokers. They were also more likely to have received at least 3 doses of the COVID-19 vaccine. and even less likely to have avoided the injections altogether.
However, after Al-Aly and his colleagues accounted for those differences and a host of other factors, they found that 5. 7% of COVID-19 patients died from their illness, compared to 4. 2% of flu patients.
In other words, the death threat from COVID-19 is still 35% higher than that of influenza. The findings were published Wednesday in the Journal of the American Medical Association.
“It’s undeniable that there’s a perception that [COVID-19] is no longer a major risk to human health,” Al-Aly said. “I think a lot of this is due to public opinion and an emotional drive to move beyond the pandemic, to leave everything behind. We need it to be like the flu, and that’s what we did, until we saw the data. “
Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco, said the study’s findings better match what he sees at his hospital.
“COVID continues to cause some people in our network to be in very poor health and die, even in 2024,” he said. “While most probably won’t get seriously ill from COVID, for other people it’s like 2020 is just beginning. “all over again. “
This is especially true for seniors, who have not received their last COVID-19 booster dose and have not fully reaped the benefits of antivirals like Paxlovid. Chin-Hong noted that only 5% of COVID-19 patients in the study had been treated with antivirals before being hospitalized.
Even if the death rates of COVID-19 and flu patients had been the same, COVID-19 would still be the biggest health risk as it sends more people to hospitals, Al-Aly said.
Between Oct. 1 and the end of March, 75. 5 out of every 100,000 Americans were hospitalized with the flu, according to the Centers for Disease Control and Prevention. During the same period, the COVID-19 hospitalization rate was 122. 9 per 100,000 Americans, according to the CDC.
“COVID carries an increased threat of hospitalization,” Al-Aly said. “And among those who are hospitalized, more will die. “
Still, Al-Aly noted with frustration that while 48% of adults in the U. S. are not aware of the fact that they are not adults. UU. se flu shots this year, 21% of adults are up to date on their COVID-19 vaccines, according to the CDC.
Chin-Hong added that more than 95% of adults hospitalized with COVID-19 last fall and winter had received the newest booster shot, according to the CDC.
Given all the equipment available to prevent hospitalizations and deaths, and especially the fact that they are readily available to patients in the VA formula, the 35% relative risk of death from COVID-19 compared to the flu is “surprisingly high,” according to Chin, Hong said.
And it’s not like the flu is a negligible health threat, especially for older adults and those who are immunocompromised. It kills tens of thousands of Americans each year, according to CDC data.
“The flu is a consequential infection,” Al-Aly said. Even when COVID becomes the flu illness, it is still concerning and significant. “
The researchers also compared the death rates of VA COVID-19 patients before and after Dec. 24, when the Omicron subvariant known as JN. 1 became the dominant strain in the United States. The difference is not statistically significant.
In the past two weeks alone, JN. 1 appears to have been overtaken by one of its descendants, a subvariant known as KP. 2. It is part of a family circle of subvariants that is nicknamed “FLiRT”. , a nickname that refers to some of the mutations that have affected the spike proteins of viruses.
So far, there is no indication that KP. 2 is larger than JN. 1, Al-Aly said.
“Are the hospitals filling up? No,” he said. Are emergency rooms across the country flooded with respiratory illnesses?No. ” Changes in the amount of coronavirus detected in wastewater are also of concern.
“When you look at all those knowledge streams, we don’t see any symptoms of concern that KP. 2 is something that the general public is involved in,” Al-Aly said.
It’s also too early to say whether KP. 2, or what’s to come, will, nonetheless, close the mortality gap between COVID-19 and the flu, he added.
“Maybe when we do a rematch in 2025, that’s how it will be,” he said.
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