July 17, 2020
As Americans struggle to understand the risks of COVID-19 relative to other infectious diseases, a common benchmark is influenza, commonly known as the flu. So what is the relative risk of dying from COVID-19 vs. the flu? The answer: it depends on your age, and also your assumptions about how deadly COVID-19 will turn out to be.
However, based on mid-range assumptions, it appears that those under 25 have a significantly lower risk of dying from COVID-19 vs. the flu, while those over 35 are at significantly greater risk. Those over 75, in particular, are at the greatest risk of dying from COVID-19.
COVID-19 disproportionately affects the elderly
The risk of dying from COVID-19 is impossible to answer definitively at this time, because we do not yet know how widely the novel coronavirus will spread, and exactly how lethal infection from SARS-CoV-2 is. Many patients recover from the infection without showing any symptoms.
What we do know is that death from COVID-19 disproportionately affects the elderly.
Based on data from the Centers for Disease Control and Prevention, as of May 13, those older than 85 are 314 times more likely to die of COVID-19 than those aged 25–34; those under 15, by contrast, are 43 times less likely to die of the disease than those aged 25–34.
Comparing risk of death from COVID-19 vs. influenza by age
Assessing the relative risk of death from COVID-19 and influenza involves a fair amount of educated guesswork, because we do not know how lethal COVID-19 will ultimately be.
As of July 17, one widely-cited but often-criticized epidemiological model, that of the Institute for Health Metrics and Evaluation at the University of Washington, estimates that the U.S. will experience 202,717 deaths from COVID-19 by October 1, with a 95% confidence interval of 183,814 to 230,480.
For the purposes of this exercise, we assumed that the U.S. COVID-19 death toll ultimately reaches 200,000.
The second challenge we have is that the lethality of influenza varies from year to year, depending on the exact strain of influenza and many other variables, such as the weather. In addition, some people die of pneumonia that is presumed to be caused by influenza, while in other cases, pneumonia is not associated with influenza.
For this analysis, we averaged the death tolls from influenza and pneumonia from 2007 to 2017 from the CDC’s National Center for Health Statistics. On average, in those 11 years, 172 people per million U.S. residents died of influenza or pneumonia, or roughly 60,000 per year.
Based on that analysis, what is striking is that those under the age of 25 are at significantly lower risk of death from COVID-19 than of the flu. Under our assumptions, for example, school-aged children between 5 and 14 have a 1 in 200,000 chance of dying of influenza, but a 1 in 1.8 million chance of dying of COVID-19.
For toddlers, the relative risk is even more pronounced. We estimate that Americans between ages 1–4 are 20 times more likely to die of influenza than of COVID-19.
A story of 3 age brackets: Under 55, over 75, and those in between
It is clear from these analyses that death from COVID-19 is low for those under 55, and especially those under 25. By contrast, it is relatively high for those over 75. This evidence should lead us to consider ways to reopen pre-K and K-12 schools and also postsecondary institutions like colleges. It should also lead us to do everything we can to protect the elderly, especially those in nursing homes.
Those between 55 and 75 years of age are somewhere in between. In aggregate, those in this age range are roughly 4 times as likely to die of COVID-19 than influenza.
However, the absolute risk of death from COVID-19 scales up in this bracket by age. At a death toll of 150,000, about 1 in 2,300 individuals aged 55–64 will die of COVID-19; among those aged 65–74, about one in 1,000 will.
According to our projections, if 150,000 Americans in total die of COVID-19, approximately 2,700 35–44-year olds would be in that category. For context, in 2016, 2,851 individuals in that age range died of liver disease; 3,369 died of homicide; 7,030 died in suicides; 10,477 died of heart disease; 10,903 died of malignant cancers; and 20,975 died of unintentional injuries such as car accidents.
A worst-case scenario is possible
As noted above, assessing the relative risk of dying from COVID-19 vs. other diseases requires us to estimate the ultimate death toll from COVID-19, and one should adjust the relative risk numbers calculated above for alternate scenarios. For example, if 300,000 Americans die of COVID-19 in 2020, instead of 200,000, one would need to divide the relative risk numbers listed above by 50%.
Having said that, there is growing evidence that complete economic lockdowns cause more harm than good, and that it is possible to prudently reopen the economy today. Reopening is especially important to lower-income Americans, whose economic prospects have been most durably and significantly harmed by shelter-in-place orders.
As we reopen the economy, we should pay special attention to those older than 50 with risk factors such as cardiovascular disease, high blood pressure, diabetes, obesity, kidney failure, and immunodeficiency. These individuals should take special care to engage in frequent hand-washing and physical distancing. But our caution should include an understanding that while the risks of COVID-19 are serious, they appear to be in the range of other lethal diseases that are all too common in the United States and other industrialized countries.
">