Assessment of Deaths From COVID-19 and From Seasonal Influenza
MD, MS Jeremy Samuel Faust, MD Carlos Del Rio
JAMA Internal Medicine, doi:10.1001/jamainternmed.2020.2306
Influenza As of early May 2020, approximately 65 000 people in the US had died of coronavirus disease 2019 (COVID-19), 1 the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This number appears to be similar to the estimated number of seasonal influenza deaths reported annually by the Centers for Disease Control and Prevention (CDC) ( https://www.cdc.gov/flu/about/burden/preliminary- in-season-estimates.htm ). This apparent equivalence of deaths from COVID-19 and seasonal influenza does not match frontline clinical conditions, especially in some hot zones of the pandemic where ventilators have been in short supply and many hospitals have been stretched beyond their limits. The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons. Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic. The root of such incorrect comparisons may be a knowledge gap regarding how seasonal influenza and COVID-19 data are publicly reported. The CDC, like many similar disease control agencies around the world, presents seasonal influenza morbidity and mortality not as raw counts but as calculated estimates based on submitted International Classification of Diseases codes. 2 Between 2013-2014 and 2018-2019, the reported yearly estimated influenza deaths ranged from 23 000 to 61 000. 3 Over that same time period, however, the number of counted influenza deaths was between 3448 and 15 620 yearly. 4 On average, the CDC estimates of deaths attributed to influenza were nearly 6 times greater than its reported counted numbers. Conversely, COVID-19 fatalities are at present being counted and reported directly, not estimated. As a result, the more valid comparison would be to compare weekly counts of COVID-19 deaths to weekly counts of seasonal influenza deaths. During the week ending April 21, 2020, 15 455 COVID-19 counted deaths were reported in the US. 5 The reported number of counted deaths from the previous week, ending April 14, was 14 478. By contrast, according to the CDC, counted deaths during the peak week of the influenza seasons from 2013-2014 to 2019-2020 ranged from 351 (2015-2016, week 11 of 2016) to 1626 (2017-2018, week 3 of 2018). 6 The mean number of counted deaths during the peak week of influenza seasons from 2013-2020 was 752.4 (95% CI, 558.8-946.1). 7 These statistics on counted deaths suggest that the number of COVID-19 deaths for the week ending April 21 was
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