San Francisco Chronicle - (Sunday)
COVID may become common, but not like flu
Health officials are saying it, friends are saying it: COVID-19 seems on track to become as common and familiar to us as influenza. But experts stress that there are still limitations to this comparison — COVID is still, and may always be, no ordinary flu.
“It is time to accept that the presence of SARS-CoV-2, the virus that causes COVID-19, is the new normal,” leaders at the U.S. Food and Drug Administration wrote in a paper published Monday in the Journal of the American Medical Association. “It will likely circulate globally for the foreseeable future, taking its place alongside other common respiratory viruses such as influenza.”
At the beginning of the pandemic, experts noted, drawing comparisons between COVID-19 and the flu was highly politicized — a way to minimize a new disease that would go on to kill nearly a million people in the U.S. alone. But now, with vaccines and treatments more widely available, comparing the two is more appropriate.
“Today, for a vaccinated and boosted person, the chances of a severe outcome are comparable to the flu,” said Dr. Bob Wachter, the chair of medicine at UCSF. He noted that Paxlovid, the antiviral pill used to treat COVID-19, even further reduces the chance of death.
In the Bay Area, for example, where the vast majority of people are vaccinated, all types of severe outcomes from COVID-19, including both hospitalization and death, are far lower than they were in winter 2020 through 2021, despite a surge in cases.
For many, the experience of having COVID will likely be similar to being sick with the flu — the Centers for Disease Control and Prevention notes that the two can be difficult to tell apart on symptoms alone.
But there are still key differences between the two infectious diseases that limit just how much we can learn from the yearly flu.
While the disease manifestation might be similar in the two, the underlying viruses are still very different, Dr. Jorge Salinas, an assistant professor of infectious disease at Stanford, said — and the virus that causes COVID-19 is still not very well understood.
He compared the viruses interacting with our immune system to a soccer match: Getting the flu is like playing a team you know well. While surprises and upsets can occur, we generally know what to expect.
But getting COVID is something different entirely.
“COVID is a very sneaky team. We don’t know that much about it, and they may not play by the rules of the game,” he said.
Experts also noted COVID is far more infectious than the flu, which means that it puts more people at risk of severe disease and death by way of infecting far more people.
“There’s never been a flu season when you would look around and know so many people that had it,” Wachter added.
COVID also brings the potential for long-term effects, including neurological complications, heart disease and diabetes, something that the flu does not have on a large scale, experts said.
“I don’t want to be an alarmist, but there are certain viral diseases that don’t manifest until 10 to 20 years later,” Salinas said. “I am positive that we don’t know yet what the full scale of short, mid- and long-term manifestations are of COVID-19.”
Finally, COVID is still too new and unpredictable to compare to the seasonal flu, which comes and goes over the winter, experts said. While COVID has shown signs of being worse during the winter, like the flu, that is largely a product of behaviors like spending more time indoors.
“I think that there is going to be and there is already some seasonality, some variation with seasons, but I haven’t seen yet that transmission has gone down to very negligible levels in warmer months,” Salinas said.
Experts noted that COVID surges continue to happen at any point throughout the year, and with new, more infectious variants repeatedly popping up, there’s no way to predict what happens next.
“The surges have been too frequent so far to say that it will be just like flu season,” Myoung Cha, president of home-based care and chief strategy officer at Carbon Health, previously told The Chronicle.
“Counting on us having six or eight months each year of essentially freedom from COVID — I think that’s wishful thinking,” Wachter said.
But one takeaway that the flu may give us is a yearly vaccine, as the FDA noted.
Salinas noted that with the flu vaccine, experts try to predict the most common strain several months ahead of flu season before mass producing a vaccine for it, with some years producing better results than others, a pattern he thinks is conceivable for COVID as the virus continues to evolve.
But Wachter said that COVID’s lack of seasonality will make it more challenging to produce a yearly vaccine that significantly slows transmission for an entire year, making continued efforts of better, easier-to-administer vaccines and treatments even more important.
Beyond rejiggering the vaccine every season, he said, “we’re going to have to come up with different therapy or combination therapies.”
But all of this does not mean we have to live in fear of COVID forever, Salinas said. If you get vaccinated and boosted, try to limit time in crowded indoor spaces and wear masks when transmission is high, and try to gather mostly in well-ventilated places or outdoors, you can limit the spread of the disease.
“You can still socialize, you can still do a lot of things, but you can still prevent many COVID infections,” he said. “You’re not going to be able to prevent all of them, but it is possible to continue with your life and at the same time, reduce your risk of getting this infection.”
“There are certain viral diseases that don’t manifest until 10 to 20 years later.”
Dr. Jorge Salinas, assistant professor of infectious disease at Stanford University