An Independent examination of influenza compared to the novel coronavirus

Arizona medical experts offer treatment insights


Influenza is not COVID-19 and COVID-19 is not influenza.

But both groups of viruses act in similar ways and very little is truly understood how the novel coronavirus is transmitted and why and how it unfolds within the human body of some and not others, medical professionals report to Independent Newsmedia.

According to the Arizona Department of Health Services, there are 11,736 cases and 562 deaths of the coronavirus as of May 12, 2020.

Using 2019 population estimates, Arizona’s case rate per 100,000 residents is 161.2. That rate is lower in Maricopa County — 138.6 — despite the most populous county accounting for 6,219 cases, per AZDHS.

Dr. Stephanie Jackson, senior vice president of quality and clinical value at HonorHealth, says one of the most vital pieces of information one needs to know during the global pandemic of 2020: this is not the flu.

“There are some similarities. They are both viruses, and initially, they will both cause muscle aches, fever, and typically a cough. They can both cause severe respiratory failure and death,” she said.

“The flu can be very serious but with COVID-19, the illness is about 10 times more deadly. In some people, COVID-19 triggers a very intense immune response --- causing a complement cascade within the body once it is exposed to the virus. It is kind of like calling in the Army --- the immune system response sends this big cascade, releases chemicals called cytokines, which recruit immune cells to fight the virus. It is almost a case of friendly fire where there is real damage to the body caused by the immune system trying to fight the virus.”

“The body’s immune response is wreaking havoc on all vital organs,” Dr. Jackson explained of the perplexing treatment of the virus once within the human body. “Some people don’t really have serious symptoms, but we don’t really understand why some have such severe reactions. The body is almost attacking itself.”

When Gov. Doug Ducey declared a state of emergency --- calling for at least 20% of hospital beds statewide be reserved for a possible influx of COVID-19 patients --- on the other end of that phone call was Dr. Jackson.

In all, HonorHealth, a leading Valley healthcare system serving 1.6 million people in the greater Phoenix area, has a total of 1,400 beds, which Dr. Jackson reports has a small percentage being used for coronavirus patients.

She says very early on HonorHealth was able to bring up rapid point-of-care testing to identify COVID-19 patients and quarantine those patients from others uninfected helping to curtail the surging transmission of the virus.

“With COVID-19, since it is a new virus to humans, we don’t have any acquired immunities ---whereas most of us have had the flu before,” she explained. “With COVID-19, there is no vaccine and no one has seen it before, so everyone is vulnerable.”

Dr. Jackson warns there is much misinformation and a lot of speculation about the ultimate mortality and total fatality rates, but she does describe the novel coronavirus as a potentially disastrous scenario if left unchecked.

“This is not the flu; it is worse than the flu,” she warned. “People who are constantly comparing it to the flu are really underestimating the virus. If we had as many people get COVID-19 as got the flu we would have many, many more deaths --- some people believe it could be as much as 10 times more.”

The flu vs. the coronavirus

The idea COVID-19 is the same virus that causes the flu is a deeply flawed perception of the emerging virus that is baffling medical professionals across the globe, experts say.

A typical flu season in the U.S. Lasts from October to May and would see a seasonal American death count anywhere between 25,000 to 65,000, Dr. Jackson points out, but since the U.S. COVID-19 outbreak started in mid-January of 2020 --- there have already been more deaths due to the coronavirus in just four months. As of press time that number exceeds 80,000 nationally.

Medical professionals say there is no vaccine and no tried-and-true approach to medical care for someone who has been exposed.

“With the flu, we have a long stretch of months that we have to deal with cases,” Dr. Jackson said of the annual flu seasons, which is roughly October through May. “This has come on so quickly and in a concentrated timeframe. We already have had 80,000 Americans who have died from COVID-19. Normally a flu season you will deaths ranging from 25000 to 65,000. People just don’t understand when they only compare numbers. It’s the time frame that really makes the difference.”

--- Dr. Stephanie Jackson

Dr. Brian Hess, medical director of emergency services at Abrazo Health, defines the similarities between the two viruses as those that attack the respiratory system of the human body.

“Influenza is a contagious respiratory infection caused by several flu viruses, most commonly influenza A and influenza B. COVID-19 is caused by the SARS-CoV-2 virus,” he said.

“They both cause primarily respiratory illnesses. COVID-19 spreads more easily and has a higher death rate than the flu. In addition, the odds of being hospitalized are higher with COVID-19. A more unique characteristic symptom of COVID-19 is the loss of taste and smell. It can be difficult to distinguish the symptoms of both of these diseases as they can present with similar symptoms.”

Although medical professionals cannot say how or why they do know COVID-19 is much more infectious --- by a ratio of 1 to 3.

“It can be said many different ways, but essentially it is easier to catch the COVID-19 virus than influenza. We do not know by exactly how much yet, but it is significant,” Dr. Hess explained.

“Influenza has a season and tends to circulate in the winter months. A vaccine exists and is updated every year. As most are aware we have no vaccine for COVID-19. Unfortunately, both have higher death and complication rates in vulnerable populations, but these populations appear to vary for each disease. Both infections more likely cause severe manifestations in those with chronic medical conditions. Influenza can be dangerous for the young and old whereas COVID-19 appears to be far more deadly for the elderly than the young.”

Every day the topography of the battlefield at the front lines of the war against the coronavirus get more defined, Dr. Hess contends.

“It is probably clear that we don’t have all of the answers, but we are learning more and more every day,” he said. “Comparing and completely contrasting influenza is difficult to do as COVID-19 is a new disease process for the world. The above differences unfortunately required the current response. The virus transmission known as a basic transmission number (R0) for COVID-19 is generally thought to be two to three, meaning that for every one person with the disease it will spread to three to three people. The flu has is estimated R0 of 1.3.”

--- Dr. Brian Hess

Another sharp detail Dr. Hess provides is a stark contrast between influenza and the COVID-19 death rate.

“The death rate for influenza is about 0.1%,” he said. “The death rate for COVID-19 appears to be six to 30 or more times that. Essentially COVID-19 is more significantly transmissible and deadly than our seasonal flu infections. This translates into a far greater risk of loss of life, morbidity and potential for community health resources to be overwhelmed.”

Protecting the public,
understanding the vulnerable

Both the HonorHealth and Abrazo Health networks have not touched dedicated capacity thresholds for COVID-19 patients but remain steadfast to the assertion they are ready for the worst.

But hundreds of thousands of people worldwide have recovered keeping medical professionals cautiously optimistic the worst is behind them.

“When we first became aware of the pandemic our focus certainly shifted to the management of this new disease,” Dr. Hess said of initial reactions to the novel coronavirus.

“With the measures that have been put in place, Abrazo has significant capacity to manage the COVID-19 pandemic, both in this sense of managing those with this disease and the many others that affect our community. Hospital and physician leaders have continued to communicate daily to ensure that we will be well prepared to meet the community’s needs now and in the future. The number of patients presenting to emergency departments around the Phoenix metro area have decreased and we want to ensure that people are not delaying necessary medical care.”

--- Dr. Brian Hess

But Dr. Hess also outlines that some are resistant to seek routine medical care.

“We hear stories from patients that they didn’t want to bother us or that they didn’t feel that they were sick enough or that they were worried of being exposed to other patients,” he pointed out.

“As this comparison to influenza inherently points out there are other diseases out there that affect our patients including heart disease and stroke and we want to get the word out to our patients not to delay presenting. We have a process in place at every Abrazo hospital to keep you safe as you are receiving care for your emergency.”

Dr. Jackson echoes a similar sentiment regarding proper quarantine practices keeping all safe in HonorHealth facilities.

“There is so much misinformation out there about what to do and very limited evidence,” she said. “One of the things we did very early on is to make sure we have enough personal protection equipment or PPE. That was very important because of the supply chain disruptions taking place. We put in a lot of policies and protocols for screening employees. We were one of the very first places in Arizona to get rapid testing. That allows us to keep COVID-19 patients in a separate area within the hospital right away so they don’t expose other patients – that helps us keep everyone safe.”

One thing discovered in recent weeks is that sunlight --- more specifically ultraviolet waves --- is effective in killing the novel coronavirus.

“We had a large UV robot fleet, which uses pulsed UV-C light to kill viruses and bacteria on surfaces,” she said. “Since COVID-19, we have been using those robots to clean the waiting areas at our respiratory urgent cares, emergency rooms and COVID-19 patient rooms, to make sure our hospital remains virus-free.”

The most vulnerable for contracting the COVID-19 virus? Medical professionals say everyone is susceptible but those with certain underlying conditions are at more of a threat to not recover.

“Everyone over 65 years of age are at increased risk,” Dr. Jackson pointed out. “Arizona is proud of being a place where people want to retire, and we want to protect those retirement-age individuals.”

But Dr. Jackson confides she does not think Arizona is any more or less unhealthy than any other state.

“We have some advantages in that we don’t tend to live in high rise apartment buildings and most homes are spread out. There are certain pockets in the U.S. and Arizona where people are unhealthier than others. Demographic areas that have higher rates of poverty typically have higher rates of obesity hypertension and diabetes, placing them at higher risk. There is also speculation about certain blood types handling the virus better than others.”

Dr. Jackson points out that most of the research surrounding COVID-19 have too few data points to draw meaningful conclusions from.

Dr. Hess agrees.

“It is difficult to quantify, but in general vulnerable populations include those with poor access to care, the elderly, and those with chronic medical conditions,” he said. “Research can focus in on a number of factors to help identify these at-risk populations.”