COVID is still deadlier than the flu, but the gap is narrowing

Patients hospitalized with COVID-19 were more likely to die than those hospitalized with the flu during the fall and winter of 2023-2024, according to an analysis of Veterans Affairs data.

Among more than 11,000 patients hospitalized with either illness last fall and winter, 5.7% of COVID-19 patients died within 30 days of admission, compared to 4.24% of flu patients, reported Ziyad Al-Aly, MD, of the VA St. Louis Health Care System and colleagues.

After adjusting for variables, the risk of death among people hospitalized for COVID-19 was 35% higher (adjusted HR 1.35, 95% CI 1.10-1.66), the authors detailed in a letter of review. search in JAMA.

Al-Aly said Page Med today that his group was actually surprised by the results. “We largely bought into the public discourse and drank the Kool-Aid like everyone else, thinking that COVID is no longer (more deadly than the flu), even though… there was no data,” did he declare. “But the verdict is in now, because we have analyzed data from the 2023-2024 COVID season and it is clear that mortality from COVID is still higher than that from the flu.”

Additionally, the authors emphasized that the study results should be considered in light of the fact that there were nearly twice as many hospitalizations for COVID-19 as for the flu for the 2023-2024 season. , according to CDC surveillance data. In the study population, more than three times as many people were hospitalized for COVID-19 than for the flu.

However, the results revealed that the risk of mortality among patients hospitalized with COVID-19 decreased compared to the previous 2022-2023 season. In their 2023 study, using the same database and methods, Al-Aly’s group found that in the fall and winter of 2022-2023, COVID was about 60% more deadly than influenza in patients hospitalized for this illness.

“We must continue to take COVID seriously,” Al-Aly stressed. “I know we are all fed up with this pandemic and we are all suffering from pandemic fatigue, but COVID remains even more of a health threat than the flu.”

Reassuringly, there appears to be no significant difference in the risk of death among patients hospitalized with COVID-19 before and during the emergence of the JN.1 variant of SARS-CoV-2 (adjusted HR 1.07, 95% CI 0.89-1.28). , suggesting that JN.1 may not be more serious than other recent variants, they posited. The JN.1 variant became predominant from the end of December 2023.

The study examined VA electronic health record data in all 50 states. Researchers identified people admitted to hospital with a diagnosis of COVID-19 or flu between October 1, 2023 and March 27, 2024, as well as a positive test 2 days before or up to 10 days after the admission. Patients with either disease and hospitalized for another reason were excluded. The study cohort included 8,625 participants hospitalized with COVID-19 and 2,647 participants hospitalized with seasonal influenza.

After propensity score weighting, the mean age of both cohorts was approximately 74 years and 95% were male. About 19% were black and 65% were white. Around 47% were infected before the emergence of the JN.1 variant. Additionally, among patients hospitalized with COVID-19, approximately 65% ​​had received three or more injections of a COVID-19 vaccine, but approximately 15% had not received any COVID-19 vaccine. About 44% of the study population had been vaccinated against influenza.

Only about 5.3% of people with COVID-19 had been treated with an outpatient antiviral, such as nirmatrelvir-ritonavir (Paxlovid), molnupiravir (Lagevrio), or remdesivir (Veklury). On the other hand, 8% of patients hospitalized for influenza had received oseltamivir (Tamiflu) on an outpatient basis.

The authors acknowledged that the population studied by VA was older and predominantly male, so the results may not be generalizable to other populations. Additionally, the causes of death have not been investigated.