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Is COVID Finally Like the Flu?
August 30, 2023

Is COVID Finally Like the Flu?

Reading Time: 6 minutes

This COVID Wave Is Different. Here’s What That Means for You., Or: how to live with the waves of this disease., COVID surge: Here’s how to handle the waves, which will keep coming.

Yes, we’re in yet another wave of COVID. Maybe people in your circles are getting sick; maybe you’ve called out from work yourself. Maybe you’re trying to figure out whether you can trust an expired test (the answer is: perhaps!), or maybe you’re just biting the bullet and ordering more. You’re probably going to need them, after all.

But this wave is distinctly different. Hospitalizations, while they are ticking up and may well continue to, are currently not much higher than they were at a previous pandemic low point, and they’re at a third of what they were this time last year. So it’s definitely not a wave with as serious implications as the other ones—it’s maybe just a wave that is … attributable to waning immunity, or increased travel, or increased travel with waning immunity. Although there is a new variant going around called EG.5—informally, eris—it’s an offshoot of omicron, and it doesn’t appear to elevate our risk of severe disease, according to the World Health Organization.

What is even considered a ‘wave’ now is much different from a wave pre-vaccine, or that first explosive go-round of omicron, when so many people faced their inaugural COVID infection. These days, a wave is decoupled from the severe overburdening of hospitals. Staying home is no longer a primary form of infection control.

We have not only vaccines but an effective treatment that can be taken at home that can greatly reduce the likelihood of severe disease for people who are at high risk. If you catch COVID and you are otherwise healthy, you can expect maybe a few shitty days of sickness. In a COVID wave today, experts advise putting a mask on if you’re somewhere crowded, or testing before seeing elderly family members—not rearranging your life.

This is not to say that COVID is not a concern at all. But it is a concern in the way that other illnesses that we deal with all the time are a concern. We have a special, even impossibly heightened level of awareness around COVID; we have lived through the deadly peaks of a pandemic. This awareness was correct. But these days, we are somewhere a little bit different, and many of us are probably still trying to figure out exactly how much concern is warranted. To that end, if early observations of COVID being on par with the flu were deadly wrong, it’s now worth revisiting them: Are we finally at the point where we, in our day-to-day lives, can think about COVID like the flu?

A little bit, but not entirely. COVID still stands to kill more people than the flu does. A report published in JAMA in April compared death rates of COVID and flu patients, finding that COVID still killed hospitalized patients nearly twice as often (though it used to be several multiples). The flu appears to be confined to a clearer season than COVID currently is. Epidemiologist Katelyn Jetelina laid out in a recent edition of her newsletter the scenarios that could happen if BA.2.86—that’s the next variant that’s on scientists’ radars—either explodes or fizzles in the coming months. In an optimistic scenario, according to models, COVID kills 55,000 Americans over the next two years; in a worst-case scenario involving a new variant, it could be as many as 450,000 Americans. (That’s roughly the death count due to COVID in a single year, 2021.) For reference, the flu kills some 12,000 to 52,000 Americans annually. Estimations like these are, well, estimations, but the takeaways are still useful. What I’m taking away is that even in an upper bound of a worst-case scenario with COVID going forward, we are in a better spot than we were previously. In the best case, it really is on par with the flu.

‘I think we’re probably past the era where we have to worry about hospitals getting overrun,’ Bob Wachter, the chair of the University of California, San Francisco, Department of Medicine, told me, noting that the variants at play, contra a worst-case scenario, do seem to be ‘respecting our immunity.’ And ‘there is essentially no one that doesn’t have some level of immunity at this point,’ he said, whether that’s from vaccines, infection, or both.

Globally, and mostly out of sight from the increasingly unconcerned public, health leaders have been thinking for months now about a shift in how we consider COVID. ‘I think we’re coming to that point where we can look at COVID-19 in the same way we look at seasonal influenza: a threat to health, a virus that will continue to kill, but a virus that is not disrupting our society or disrupting our hospital system,’ said Michael Ryan, executive director with the WHO’s Emergencies Program, at a press conference in March. That specific point—a squishy one, based on metrics but also qualitative observations—seems to have come in May, when the WHO downgraded COVID from a global public health emergency. COVID ‘has achieved a level of equilibrium, a certain type of coexistence with the human host,’ K. Srinath Reddy, the former president of India’s Public Health Foundation, put it to the Times.

Given this shift in global public health thinking, the question of how to handle an uptick in COVID as an individual is perhaps less about COVID and more about how we should all handle illness in general. How you deal with COVID can become more and more like what you do when there is any kind of gnarly bug going around. What do you do when you’re sick with anything else? What do you do to accommodate others, perhaps particularly those with heightened risk of getting sick? How should we organize our lives given that we exist alongside many viruses, balancing the need for connection with the need for safety?

Each person will answer this slightly differently, perhaps based on how they lived their lives before, but also, probably, with an increasing awareness of what we all just went through, and what we learned from it. For my part, I think that the answers should shift in the direction of not taking COVID quite as seriously as we did (well, as a portion of Americans did), but also in managing other infectious disease in our daily lives a little bit more like we managed COVID. One of the reasons we should do this is due to one of the chief remaining concerns around COVID—that it can lead to lingering symptoms, and even, in some instances, severe disability. This risk is real, even if recent data suggests that risk of ongoing symptoms is relatively low (and that the risk can be made lower by taking Paxlovid).

The concept of post-viral illness has particular salience when it comes to COVID, but it’s actually not unique. Patients with extreme cases of long COVID joined those who had long been suffering from ME/CFS, an illness that may be caused by a viral infection. Some researchers are studying symptoms now referred to as ‘long flu.’ ‘Long symptoms after any viral illness—this is something that we in infectious diseases know is actually not an uncommon thing,’ Celine Gounder, a physician, told Andy Slavitt on a recent episode of In the Bubble. The fact that so many people were feeling these post-viral effects all at once ‘just made it much more obvious that this was the case,’ Gounder told Slavitt. Our idea of what it means to catch whatever bug is going around should factor in the small possibility that the sickness will not necessarily pass within a matter of a week or two. ‘Long COVID should wake us up to the fact that getting sick is not good,’ said Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital.

In early 2020, a formulation of headline went: Don’t worry about the novel coronavirus—worry about the flu. That directive turned out to be very, very wrong. COVID killed more people than the flu does. Now it’s finally true that the flu could actually use more of the attention that’s been paid to COVID, a disease that earns headlines every time there’s a shift in its prevalence. The flu, after all, kills so many people. It has for years and years. We even have better treatments for COVID than we do for the flu, notes Faust, and there should be more urgency around finding medicines that work against the latter. ‘We need a much better antiviral than frickin’ Tamiflu.’

So perhaps here is the final takeaway of where we are today, with this pandemic, and yes, even after this pandemic: It is useful to be aware of COVID and how much it is currently spreading. That allows you to know when to mask if you want to, and it might also serve as a good reminder to stay up to date on boosters and vaccines. But also, keep the lessons we learned during this pandemic, and apply them to everything. When you are sick, don’t soldier through it; rest, and try not to spread it. It doesn’t have to change your whole life. But with a little attention, what we went through with COVID might apply, just a little bit, to everything else. Waves of COVID may never end; in that way, it will become like any other illness. We’d do well to stop considering it so special.


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