LOCAL COVID-19 CASES, DEATHS SURPASS FLU NUMBERS FOR YEAR

Complications, experts say, also more severe, and unlike with flu, no vaccine

Midway through 2020, the numbers clearly show a simple truth: COVID-19 is not the flu.

In just four months, the novel coronavirus has produced 2,362 more confirmed cases and 373 more deaths across San Diego County than influenza did during the entire 2019-20 season. And the COVID-19 curve, it is clear to see, is not a seasonal disease. Numbers are still increasing daily as the f lu largely slumbers.

There have been more than 7,000 confirmed COVID-19 cases so far in July, but only one flu case, according to county records.

An additional 625 cases were announced Saturday, bringing the local pandemic total to 23,114.

The flu season, which runs from July through June 30 of the next year, had 20,752 confirmed cases in its most recent incarnation, though that was a big year. The prior threeyear average, according to the county’s final report, was 12,110.

Of course, comparing novel coronavirus and influenza statistics comes with a whole bucket of caveats.

There is, after all, a vaccine for the

flu but none for SARSCOV-2, the pathogen that causes COVID-19. Higher infection and death rates should be expected for viruses without vaccines. And, the amount of testing under way for coronavirus has included large numbers of people without symptoms, making it more likely that positive cases will be confirmed.

More testing generally uncovers more infections that would have otherwise gone unnoticed.

So, comparing these two different diseases by case numbers alone does not tell the whole story.

But, judging by a broader range of factors than just cases, it is quite clear that COVID-19 delivers the heavier blow in terms of medical consequences felt in San Diego County and across the nation.

At 478 as of Saturday afternoon, the number of Covid-19-associated deaths is now 135 greater than the 343 recorded across the region during the 2017-18 flu season, which was the deadliest in recent memory due to a vaccine that was judged to be only about 40 percent effective that year.

Though deaths tend to get the most attention, they are far from the only place a person needs to look to understand the full scope of COVID-19’S damaging effects.

A broader understanding is possible just by taking a look at Vic Sevilla’s right foot.

The 52-year-old phlebotomist from Chula Vista who has had a 25-year career in health care at Paradise Valley Hospital in National City, found himself spending a full month on a ventilator after coronavirus ravaged his family, also infecting his mother and sister.

What started with body aches turned into sedation and insertion of a breathing tube on April 25 after pure oxygen was no longer enough to cope with the outof-control lung inflammation that is the hallmark of COVID-19.

After spending weeks in intensive care, Sevilla made it through and would likely be cited as a success. A survivor.

And that’s true. But it doesn’t mean he left this fight whole.

After returning to consciousness in the Paradise Valley ICU, he started to feel a pain in his right leg. His doctors quickly discovered a blood clot and transferred him to the critical care unit at Jacobs Medical Center in La Jolla where there was an intense discussion about having to amputate his leg above the knee. Eventually, a less-drastic approach was adopted with surgeons dissecting his lower leg to remove the clot and allow the blood vessels in the limb to recover before being sutured together again.

But the procedure was not able to prevent consequences that will stay with him for the rest of his life.

“They had to amputate about half of my foot,” Sevilla said.

So, for those who say COVID-19 is pretty much just the flu, he is, shall we say, more than a little skeptical. In two and a half decades drawing blood at Paradise Valley, there were occasionally flu patients with life-threatening illness. But amputations caused by blood clots?

“For 25 years, I haven’t heard of this kind of situation happening with the flu, but with coronavirus, it happened to me,” Sevilla said.

Many have made much since the pandemic started of the fact that the disease hits the oldest and sickest the hardest. Here, too, Sevilla begs to differ.

“I’m not diabetic, I’m not hypertensive. I work out five days a week,” he said.

Complications

Both influenza and novel coronavirus attack the respiratory system and tend to produce mild symptoms in most people who they infect. Both are capable of causing a wide range of much-moresevere complications in the minority of patients who end up sick enough to need a hospital stay.

According to a comparison prepared by the U.S. Centers for Disease Control and Prevention, both pathogens are capable of causing pneumonia, respiratory failure, sepsis, cardiac injury, multiple organ failure, severe tissue inflammation and secondary bacterial infections.

But clots in the veins and arteries that serve the lungs, heart, legs and brain are unique to coronavirus. The flu does not produce similar clotting and, at the moment, no one knows exactly why.

Time is at the top of the list for Dr. Robert Owens, a pulmonary and critical care specialist at Jacobs.

Laying in bed for a long time affects the efficient movement of blood throughout the body, and there is plenty of evidence, Owens said, that blood clots are more likely to form the longer a person spends in a hospital bed.

As a group, he added, COVID-19 patients with severe illness spend much longer in bed than flu patients do.

“A severe flu patient might be very sick for about a week and maybe on the path out of the ICU within 10 to 14 days,” Owens said. “With most of the COVID patients, we see very long stays, having to be on the ventilator for two to three weeks and in the ICU for a month, maybe more.”

Sure, there could be other factors involved that make clotting more common with corona than with influenza. But there just has not been enough time yet to study the disease in real patients and begin to draw solid conclusions.

“We do see more clots, the question is why?,” Owens said. “Is it that we need better drugs to treat the virus, or do we need to change how we’re taking care of patients in the ICU?”

It also seems, Owens added, that COVID-19 is capable of putting a bigger hurt on hospitals than the f lu can. Thinking back to the 2017-18 flu season, and to the H1N1 “swine flu” pandemic of 2009 and 2010, the physician said he can recall some flu patients needing ventilation and even being put on extra corporeal membrane oxygenation machines to take over when lungs fail.

But COVID-19, he said, has taken things to a whole different level.

“Certainly, we have seen a little bit higher census in the ICU during bad flu years,” Owens said. “Now, just here at UCSD, we have a whole 12-bed ICU that is full of COVID patients and spilling over to another ICU. Scripps and Sharp have whole hospitals down in Chula Vista that have been pretty much full of COVID patients. That is just something that has never happened with the flu, not that I’ve ever seen before.”

Burnout

A lack of seasonality is the other area where COVID-19 and the flu differ. While influenza is capable of filling up emergency departments for two, three, maybe four months in a row, COVID-19 has already had that effect and does not appear to be slowing down.

Owens said the COVID-19 grind is really beginning to show on the faces of the front-line staffers — most especially the nurses, technicians and maintenance workers who are in and out of COVID-19 rooms the most often.

“There is a lot of burnout that’s starting to happen just because this has gone on for so long now,” Owens said. “We need to acknowledge the bravery of the people who are taking this on for so long now.”

And the effects, added Dr. Eric Mcdonald, medical director of the county’s epidemiology department, are not limited to the bedside. The massive demand for COVID-19 testing has hospital, public health and commercial labs running around the clock, putting massive strain on the relatively small pool of specialists qualified to process samples after they’re collected from patients.

The flu, he noted, is like a normal baseball game with a clear beginning, middle and end. But COVID-19, he said, is beginning to feel like a Padres-rockies game he attended at Petco Park on Apr. 17, 2008. That game went 22 innings before ending with a score of 2-1 Rockies.

“With COVID, we are still on the very steep part of the learning curve. We don’t know, is this the top of the second or the bottom of the sixth?” Mcdonald said.

“With COVID, we are still on the very steep part of the learning curve.” Dr. Eric Mcdonald • medical director of the county’s epidemiology department