Comparing the Risk of Death from COVID-19 vs. Influenza by Age

(Due to high demand, this article is regularly updated. The analyses discussed below are based on CDC data as of January 27, 2021.)

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 15 have a significantly lower risk of dying from COVID-19 vs. the flu, while adults are at significantly greater risk. Those over 75, in particular, are at the greatest risk of dying from COVID-19. This is why a growing number of states are making vaccines available to all elderly individuals, regardless of race or ethnicity or health status.

COVID-19 disproportionately affects the elderly

The risk of dying from COVID-19 is difficult to establish quantitatively, as different strains of the virus, different population behavior, and different policy interventions make it difficult to establish absolute risk.

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 January 27, 2021, those older than 85 have been 119 times more likely to die of COVID-19 than those aged 25–34; those under 15, by contrast, are 73 times less likely to die of the disease than those aged 25–34.

The risk of death from COVID-19 is far higher in the elderly than in younger Americans. According to data from the Centers for Disease Control and Prevention, those older than 65 are far more likely to die of COVID-19 than those aged 25 to 54. Note that not all COVID-19 deaths reported elsewhere are counted by CDC, and that not all CDC-counted deaths were caused by COVID-19; some of these individuals died from other causes, but tested positive for SARS-CoV-2 antibodies. (Graphic: A. Roy / FREOPP)

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 as to the ultimate death count related to COVID-19 in the United States.

As of February 1, 2021, the COVID-19 Forecast Hub—a compilation of various epidemiological estimates—projects that the U.S. will reach approximately 550,000 deaths from COVID-19 by March 1, 2021. We use that estimate in our comparison of COVID-19 and influenza mortality risks.

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 15 are at significantly lower risk of death from COVID-19 than of the flu. Under our assumptions, for example, children under the age of 15 have a 1 in 155,535 chance of dying of influenza, but a 1 in 1.2 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 3.4 times more likely to die of influenza than of COVID-19.

Comparing the relative risk of death from COVID-19 vs. influenza or pneumonia. Estimating relative risk is highly dependent upon the ultimate lethality of COVID-19, which is unknown at this time. Nonetheless, a clear pattern emerges from what we know, in which those under aged 15 are at the lowest risk of death from COVID-19, relative to influenza or pneumonia. (Source: National Center for Health Statistics; CDC; A. Roy / FREOPP)

A story of 3 age brackets: Under 55, over 75, and those in between

It is clear from these analyses that the absolute risk of 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 550,000, about 1 in 660 individuals aged 55–64 will die of COVID-19; among those aged 65–74, about one in 269 will.

According to our projections, if 550,000 Americans in total die of COVID-19, approximately 9,396 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.

Of note is the fact that we are seeing a surge in teen suicides during the COVID-19 pandemic. The closure of schools, and the move to entirely online interactions, has been harmful to all Americans, especially children. A study in the journal Pediatrics estimates that suicide attempts were up as much as 86% in 2020 relative to 2019 in 11- to 21-year-olds in Texas. If growth in suicide attempts roughly equals growth in suicides, this would amount to nearly 5,000 additional deaths in that age group from suicide rather than the virus. By contrast, we estimate that 867 Americans will die of COVID-19 between the ages of 10–24.

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.

As we administer vaccines to non-elderly individuals, 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. As they wait for vaccines, 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.