COVID-19 is Deadlier Than the Flu for Children

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It is natural for people to compare COVID-19 to other contagious diseases, namely influenza. Journalists and politicians often compare the two diseases, particularly in children. Many who make this comparison claim the impact of the two diseases is similar, and thus the reaction to COVID-19, at least for children, has been overwrought. Even some doctors make this comparison. Dr. Monica Gandhi, for example, tweeted this March:

Currently, California reports that 28 children have died of COVID-19. I wonder if she will update her tweet.

There are two ways to compare the diseases: which is more dangerous for those who contract it and which is more harmful overall, the latter being the more important of the two metrics. It may be true that children younger than 5 years have a slightly lower risk of dying if they catch COVID-19 than if they catch the flu. However, as COVID-19 is much more contagious, its total harms for children exceed that of the flu, a very simple point that often eludes those who compare these diseases.

Comparisons between the flu and COVID-19 are confounded by the fact that much of normal life was suspended the past year and masks were ubiquitous. These measures lowered the transmission of both diseases. Therefore, the most meaningful comparison between the two diseases is the past year. The numbers couldn’t be clearer. According to the CDC, 490 children under age 17 years have died of COVID-19 in the US. This number was derived from an analysis of 83% of the total number of COVID-19 deaths, so the actual number of pediatric deaths is certainly a bit higher than this.

In contrast, the CDC reported that just one child died of the flu during the 2020-2021 flu season.  Those who compare the two diseases curiously omit this fact.  Even in previous years, the flu killed less children than COVID-19. According to the CDC:

Since 2004-2005, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 to 199 deaths. (During the 2009 H1N1 pandemic, 358 pediatric flu-related deaths were reported to CDC from April 2009 to September 2010.)

The CDC would later increase the estimate of deaths to 1,090 during the H1N1 pandemic.  Aside from this pandemic strain, not once since the CDC started tracking pediatric flu deaths in 2004-2005 has the flu killed more children in a year than COVID-19.  This is true even taking into account incomplete reporting of the flu.  The CDC said in the deadliest flu season, 2018-2019, that “statistical modeling suggests approximately 434 deaths may have occurred” even though only 199 deaths were reported.  Of course, there is no guarantee that the CDC has tallied every pediatric death from COVID-19.

While the number of children killed by the flu would certainly be higher without the flu vaccine, promoting flu vaccination is unfortunately not the goal of people who compare it to COVID-19. This highlights an interesting fact – most people who compare these diseases ignore their most crucial similarities. Both diseases can kill hundreds of children per year. Both diseases can send tens of thousands children to the hospital, some needing ICU-level care. Both diseases can be largely prevented with a tragically underused vaccine.

Acknowledging that COVID-19 is deadlier than the flu for children does not mean that policy recommendations automatically follow. In contrast, denial of this reality limits our ability to honestly discuss the trade-offs of various policies. As such, those who write about children and COVID-19 have an obligation to present facts, rather than specious comparisons. A disease that killed 500 children the past year is much worse than a disease that killed one child. Writers who suggests otherwise are woefully misinformed. So are their readers.

Science-Based Medicine