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Just like the flu

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For almost two years now, one of the favorite claims of the right wing scream machine is that COVID-19 is “just like the flu,” which is to say it’s not really that significant of a public health problem, in that it kills mostly old people, and really not that many when you consider [some totally innumerate conspiratorial nonsense here].

I looked at the CDC’s annual flu stats and discovered the following:

(1) The actual annual disease burden of influenza on the American population is very hard to estimate with more than very loose accuracy. This is for complicated methodological reasons that come down to the observation that influenza seems to be seriously under-diagnosed, and that in particular simply counting up the number of death certificates that list influenza as the cause of death probably leads to something like a 100% to 400% undercount, depending on the season.

(2) The number of people who die from influenza in any flu season (the vast majority of deaths occur in December through March, so calendar years aren’t the best metric for the relative severity of a particular season) varies a great deal. Between the 2010-11 and 2019-2020 flu seasons, the lowest seasonal death total was estimated to be 12,000 (2011-12) while the highest was estimated to be 61,000 (2017-18). The average over the decade was 36,000 per season. But note that these estimates are pretty loose, statistically speaking. For example the estimated range in regard to deaths during the 2017-18 flu season is between 46,000 and 95,000, using a 95% confidence interval.

(3) We don’t have the CDC estimates for the first COVID flu season (2020-21; the 2019-2020 season was almost over by the time COVID hit), but the death certificates numbers are now almost completely in — about 98% to 99% of them — and they are pretty astounding. Per the latest CDC tabulation of death certificates, only 1,033 people died from influenza in the USA in 2021! Now again that figure probably has to be multiplied by something like two to five times, to account for under-reporting, but even that produces a death total that is radically lower than pretty much any previously recorded year. Basically, almost nobody died from the flu last year in the USA.

This at least suggests that even fairly modest COVID mitigation measures produced enormous benefits in regard to an illness that kills several tens of thousands of Americans in a typical year.

BTW, the considerable uncertainty that surrounds the exact cause of death in many instances — did this person die “from” influenza, or “with” influenza, etc. — is why all-cause mortality rates are so important, since the total of number of deaths in the USA in any year is a number that’s subject to only trivial error rates (a body is a body).

As of right now, the excess death total in the USA for 2020 and 2021 collectively is looking to be around 1.05 to 1.1 million people, as the final statistics continue to be collected. (This the excess number of deaths that have been recorded in those two years, assuming changes in all-cause mortality rates would have remained constant but for the COVID pandemic).

About 850,000 of those deaths will have been officially attributed to COVID. ETA: This is not a correct statement. About 850,000 deaths in the USA in 2020 and 2021 will have been attributed to COVID, but perhaps roughly 775,000 to 800,000 of those deaths could be characterized as excess deaths, in the sense of people who died in those years who would not have died but for COVID. This suggests that somewhere in the neighborhood of 300,000 excess deaths over the past two years are not being attributed to COVID. It’s likely that the large majority of those deaths are COVID deaths that have been mischaracterized on death certificates.

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