Thread by @jeremyfaust

Proud to share this new Viewpoint appearing in @JAMAInternalMed today that I wrote with my friend @CarlosdelRio7.

We argue that covid-19 and seasonal influenza statistics have been incorrectly compared.

We show data as to why covid-19 is FAR deadlier 1/

jamanetwork.com/journals/jamai…

As many of you now know, Covid-19 deaths are counted.

Seasonal flu deaths are *estimated using algorithms* Those estimates appear to overstate the case.

But it’s also becoming clear that covid-19 is (currently) being *undercounted*.

However, even adjusting for that, on average covid-19 killed 20x more Americans per week in late April than flu did during the *worst* week of flu season during the last 7 years.

That’s right. Covid19 killed 20x more Americans in one week in April than flu does at its worst week

Flu deaths are not “reportable” to authorities.

So people will say those are undercounted too.

We get that.

But we disagree with the logic that this means flu is as bad as the stats suggest.

Why? Flu as a cause of death also can appear with other causes of death.

If you had to pick just one cause of death, I believe flu counts would be even lower than they are.

Meanwhile, I believe that for the moment at least covid-19 is undercounted. Why?

Excess deaths.

We have more deaths in so many states across the nation than we ever see.

That just never happens during flu season.

Look at 2009 H1N1. A pandemic year!

You can’t even tell anything unusual occurred when you compare all cause death numbers of that period to the years before and after!

Not true of covid-19.

In fact, for the first time in modern history, our death numbers are off the charts. (Again, all cause deaths).

@CarlosdelRio7 and I wrote about this in @PostOpinions @washingtonpost last week. See washingtonpost.com/opinions/2020/…

These are clearly mostly Covid19 deaths.

What about the idea that many of these deaths are from missed care opportunities because people are not coming to the hospital for other reasons?

Nope. Not the reason.

Suicides are not known to be up.

Same for lots of other common killers.

In fact, deaths from some huge causes like car collisions are WAY down.

And we don’t save as many lives with our care as we might like to imagine.

Yes Type I heart attacks are lower than usual. That’s concerning. They’re happening at home.

But the numbers wouldn’t add up

So we know that the difference between all cause deaths and covid counts are MOSTLY explained by undercounting covid.

There’s no math I’ve seen to suggest otherwise. So suggest otherwise is pure drivel, so far.

To be fair, that COULD change in the future.

It just hasn’t yet.

“What about all the cancer we aren’t treating?”

Ask an oncologist.

They’ll tell you that we don’t see droves of people dying more on such a time frame like this because of missed care.

Again, down the road, we could see increases in cancer deaths if people don’t seek care.

We haven’t approached that in any meaningful sense.

Tons are dying from Covid19 now.

Very few if any are dying a lot more than usual from other causes of death.

So far, the shutdown is saving lives, and tens of thousands or more, not costing them.

In sum, we are undercounting Covid19 in many places.

We are probably still OVERCOUNTING influenza.

Comparing them is only valid if you compare counts to counts.

While all covid deaths are required to be counted (and not all flu deaths are), it’s clear that covid is far worse

We need to realize this so that we stop saying “this is just another flu”.

It isn’t.

It’s far worse.

20x is what we measured so far.

But it’ll be likely be worse, when we see this going on for longer and can compare not just peak weeks but months at a time.

Please see our Viewpoint for more on this. Thx! /fin. jamanetwork.com/journals/jamai…