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Dr Dan Goyal

Mar 13 • 24 tweets • 12 min read

Much of the scientific community railed against a wide-reaching Financial Times article:

“Vaccines and Omicron mean Covid now less deadly than flu in England”

As a fact, it was a bold claim. In regards to journalistic duty, there are other questions.
🧵
ft.com/content/e26c93…

In fairness to the article itself, the authors took significant effort to emphasise that even with the same mortality risk as Flu (we will come to the accuracy of that later) the overall risk of Covid remains high.
Here they provide an estimate of 50% increase in winter deaths:

Indeed, reading the article through, one could have made a completely different headline:

“Despite Covid’s falling mortality risk it still remains the most dangerous infection in the UK.”

Instead, the very people who need a healthy dose of reality - anti-vaxers, covid minimisers, certain politicians - find a reputable source (FT) seemingly supporting their position.

One can only imagine the headline itself had a net effect of further reducing vaccine uptake.

@FT

Delving deeper though, and reading the article properly, would perhaps do the opposite - increasing vaccine uptake.

This @FT graphic in particular provides very powerful advocacy for getting vaccinated:

The authors help disentangle whether mass-infection or vaccine is the..

..main reason for the falling mortality rate. This is a crucial distinction, particularly as the Covid Inquiry looms and the ‘herd immunity strategy’ comes under the spotlight. Without such clarification there is a danger politicians yet again pursue the same disastrous strategy.

There is a question as to whether the authors gave enough emphasis on the fact: actual individual risk of SARS2 is considerably higher than Influenza. Indeed, a quote is used:

“Is Omicron the same as flu? No. But the vaccines have made the risks to the individual very similar,”

This quote, as read, is entirely wrong.
While there is some debate amongst scientists - level of threat & level of protections needed - only a handful of rogue scientists argue the risk is anywhere near that of flu. The quote, I suspect, refers to the risk once you contract SARS2

Taking, for a moment, this premise Covid carries the same IFR* (risk of death) as Flu, the fact there is so much more SARS2 around than there ever is with Flu, the actual real-life risk - the walking about risk - is considerably higher than Flu.
*IFR - Infection Fatality Risk

So why even compare Covid with Flu?
We don’t know how much flu circulates each season. There are some small surveys, but our guesses are based on modelling studies. Estimates from 10-40% of the entire population will contract the influenza virus (the virus causing flu).

We also don’t know how many contract influenza and don’t get flu symptoms.
We have a much better idea of how much Covid there is about, and we expect at least 80% of the population will get Covid. So even if Flu and Covid have the same risk of death ONCE you get the...

....infection (a big if), because there is 2 to 8 times increased risk of getting Covid, your walking about risk is X 2 to X 8 higher than flu.

Knowing how much mild infection is around is crucial to understanding how deadly an infection is...and with Flu we simply don't know.

The second and bigger error in calculating IFR is in how you classify a Covid or Flu death. If we classify deaths the same…e.g. 'must be mentioned somewhere on the death certificate', then the IFR of 0.04% for Flu is way too high. Indeed, it is probably out by a factor of ten.

It is worth getting one's head around the numbers a bit. The data used in the article (and by many others) does not classify Covid and Flu deaths the same at all. For example, the research letter in question uses a number of 13.5 deaths per 100k people.

But only 1.7 deaths per 100k mentioned influenza ANYWHERE on the death certificate. The study then goes on to add in all respiratory related deaths during flu season, circulatory deaths, and all cause mortality, in their modelling.
References here:
doi.org/10.1136/bmj.m3…

So why the inflated figure? We now enter the ongoing debate within the scientific community over how serious the flu is. The modellers who use other deaths - circulatory, all-cause, - as flu deaths argue flu can lead on to other problems and make underlying conditions worse.

If we use deaths where influenza is mentioned on the death certificate (as many studies do), then the IFR of flu is almost 10 x less than the article quotes. And after 20 years in medicine, 1 in 20,000 dying of flu seems more plausible than the 1 in ~2,000 reported in the article

The numbers used in the article are legitimate, merely the context of the numbers IMV have been overlooked. The reality is we don’t know the IFR of flu and therefore the comparison will always be difficult.

But the reason for the comparison is clear...

...we do need to understand the risk as individuals so we can make our decisions as to whether to get vaccinated, wear a mask, go to an indoor concert, etc...

And Flu is an easier to understand comparison than IFRs and Absolute Risks.

But the comparison is difficult and risky.

We view flu as "only" a danger to the elderly, that it is mild albeit unpleasant but rarely can cause death in a healthy person.

This is not Covid! At all!

Covid remains the leading cause of death in the 45-54 yrs age category in the US, and 3rd leading cause in UK in all ages

Flu normally kills 4 per day.

Covid is currently killing around 100 per day.

This is higher than any other infectious disease.

Therefore, in absolute terms, the risk of death from Covid (as a population) is over 20 X higher than Flu.

Bottom Line:
If forced to give an estimate, currently, the risk of death from Covid is anything between 10 & 30 times more than the Flu, IMO. As numbers of infections increase that risk will also increase

The risk in the unvaccinated, non-boosted, untreated Covid is much higher!