America’s False Virus Equivalence

This month marks four years since the start of the coronavirus pandemic. My colleague Katherine J. Wu recently published an article about what is driving the U.S. government to frame COVID-19 as being flu-like—and the problems with that approach. I called Katherine to discuss the false equivalence of the diseases, and how America missed out on a chance to normalize protections against respiratory illness.

First, here are four new stories from The Atlantic:

Not the Flu

Lora Kelley: To what extent is COVID-19 being treated like the flu right now?

Katherine J. Wu: In a lot of ways, this comparison has been present on public, private, and political levels since the first days of the pandemic. In 2020, some well-intentioned people were saying that, at least in some ways, you could expect COVID to behave like a lot of other respiratory viruses do.

Soon, the comparison became taboo. But in the past year and a half, the flu comparison has really been coming up again. This began to crystallize when the FDA indicated that it would start to approve COVID vaccines annually, so they could be taken once a year in the fall. That was followed by the CDC’s recommendation to give the fall vaccine to everyone six months and up, just as it does for flu shots. The White House has also explicitly tied fall COVID shots to flu-vaccination campaigns.

Drugs and tests and vaccines have slowly been commercializing. And the CDC recently dropped its time-dependent isolation policy for a symptom-based one, basically the same as the one for flu. COVID is being framed as being like any other winter respiratory illness.

Lora: What does comparing COVID to flu miss?

Katherine: One is that COVID is definitely not as seasonal as flu. Flu is generally a winter illness, whereas COVID is a year-round, erratic thing. That potentially makes it difficult to say: Oh, you’ll be good if you get this vaccine just once a year.

Also, the COVID burden is still so much larger than the flu burden. Look at how many people COVID killed and hospitalized in 2023 alone. That was our lowest year of mortality in America during the pandemic thus far, and it still dwarfed the worst flu season of the past decade.

Lora: In your article, you wrote that America has been bent on “treating COVID-19 as a run-of-the-mill disease—making it impossible to manage the illness whose devastation has defined the 2020s.” Why is that?

Katherine: I’m not a policy maker, but it seems to me that since the start of the pandemic, there has been this real desire to return to normalcy, which of course is understandable. There’s certainly been pressure and impatience from the public. But convenience can come at the expense of actually making a difference in people’s health.

There also seems to be a desire to put a stamp of success on the whole situation by fitting COVID into a “flu box.” There’s an attitude of: We have wrangled it into something that is ordinary and predictable. But I don’t think that’s really the case yet.

Lora: It’s been four years since the start of the pandemic. Why is so much still not understood about COVID and how to handle it?

Katherine: We have learned so much in the past four years. We have great vaccines, we have good treatments, and we have at-home tests.

But four years is actually not that long, when you think about the whole scientific enterprise. That’s not even close to a full human generation. Even with flu, which is better understood, there are still things we don’t fully understand about transmission.

And long COVID is this huge looming thing that distinguishes COVID from flu. There is some similarity to illnesses such as ME/CFS, but it’s so complicated, and I think there needs to be a lot more humility about the uncertainty there.

Lora: You wrote in your article that, early in the pandemic, public-health experts hoped that COVID would spur a rethinking of how we handle all respiratory illnesses. Why hasn’t that really happened?

Katherine: This is something that I’ve been thinking about a lot. In the early days of the pandemic, as we were putting on masks, avoiding large gatherings, talking about ventilation, trying to get tests to people, some began to wonder: What if we did this for other respiratory viruses?

I don’t think anybody wanted 2020’s mitigations to go on forever. That wouldn’t have been sustainable for a million reasons. But we also saw how much those changes could do. The mitigations we took for COVID ended up driving flu transmission to almost zero. An entire lineage of flu appears to have gone extinct because we were doing more to keep one another from getting sick.

Now I think about: What if we had found a middle ground that was sustainable for most people, like maybe we mask less but ventilate more? Maybe we don’t have to avoid one another as much but we’re more willing to test before we go out, and we have even more tests for other respiratory viruses. What if we kept up the things that didn’t feel like they were hampering us from interacting with one another, but just made the interactions we are having safer?

That would have required a lot of investment and innovation. Any change is going to require money but also a cultural shift. And we just didn’t really ride that momentum.

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