No, the flu hasn't killed more people than coronavirus

Some people have tried to put COVID-19 into perspective by comparing it with the flu.

On April 24, North Carolina Lt. Gov. Dan Forest told a group of young Republicans that the flu had actually killed more people than the novel coronavirus.

Forest, who’s running for governor against incumbent Democrat Roy Cooper, has suggested that North Carolina’s stay-at-home order might be disproportionate to the effects of COVID-19 in his state.

In a video interview, Forest said:

"You know, we’ve still had more deaths to the flu this year than we’ve had COVID-19," Forest said, adding: "There’s been about three times more deaths for HIV/AIDS, remember that was a pandemic at one time that still has no vaccine. This one’s bad. It’s obviously worse than the normal flu year, but it hasn’t hit the extremes of other pandemics yet."

Forest also compared COVID-19 with HIV. But let’s focus on Forest’s claim about the flu, since that’s what it’s most commonly compared with.

It isn’t clear from Forest’s claim if he is talking about the United States or North Carolina. So we’ll address those stats at the both state and national level.

Is Forest right? 

No. And there are several reasons why Forest’s comparison is neither fair, nor accurate:

• He compared diseases that entered the United States at different times.

• When it comes to flu deaths across the U.S., he based his claim on an estimate — and cherry-picked the worst case scenario from that estimate.

• He overlooked data from his home state, where publicly available information showed there had been more COVID-19 deaths than flu deaths.

It’s important to note first that the flu and COVID-19 did not enter the U.S. at the same time. While the U.S. Centers for Disease Control and Prevention started tracking the flu in 2019, authorities didn’t report the first case of the novel coronavirus until Jan. 20. The first death occurred on Feb. 29.

If the diseases were in a race, the flu got several months of a head start. 

"Comparing deaths from laboratory confirmed cases of COVID that occurred between Feb. 29–April 24 to statistical model estimations of all flu deaths (detected and undetected) from October 1–April 4 is not at all equitable," said Dr. Ben King, clinical assistant professor of public health at the University of Texas Dell Medical School. 

With that said, let’s look at the numbers that are available.

As of April 25, the day after Forest made his claim, more than 50,000 people had died from COVID-19, according to the U.S. Centers for Disease Control and Prevention. The estimate has grown to 65,700 by May 4.

Some experts believe the CDC’s numbers to be low. A study released by the Washington Post and the Yale School of Public Health on April 27 found that experts missed as many as 15,000 coronavirus deaths in the first weeks after the virus arrived in the U.S.

What about flu deaths? The CDC doesn’t have up-to-date flu death numbers. Forest based his claim on the CDC’s estimate that flu deaths could be as high as 62,000, Forest spokesman Andrew Dunn told PolitiFact in an email.

A problem for Forest’s claim? That CDC estimate also predicted flu deaths could be as low as 24,000. That’s a wide range, which has recently drawn criticism.

In an April 28 Scientific American column titled, "Comparing COVID-19 Deaths to Flu Deaths Is Like Comparing Apples to Oranges," a Harvard Medical School instructor explains the CDC’s prediction methods — and argues they should change.

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Dr. Jeremy Samuel Faust, who practices emergency medicine at Brigham & Women's Hospital in Boston, noted that the CDC tries to account for unreported flu deaths "by multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms," he wrote.

Indeed, the CDC’s estimation process is "fairly elaborate," said William Schaffner, professor of infectious diseases at the Vanderbilt University Medical Center in Nashville and medical director for the National Foundation for Infectious Diseases.

The CDC estimates deaths, rather than counting raw numbers, in part because death certificates "can be mushy," Schaffner told PolitiFact in a phone interview. Deceased people can sometimes have multiple health problems, leaving the cause of death up for debate. Compounding matters, processes for determining and recording causes of death vary across the country.

Faust, who wrote the column, argued that the number of actual flu deaths could be much lower than the CDC’s estimate. As the Washington Post pointed out on May 2, the number of actual deaths directly contributed to the flu has been less than 10,000 each of the past two seasons.

In the past, Faust said it was justifiable to err on the side of substantially overestimating flu deaths "in order to encourage vaccination and good hygiene." But now, "the CDC’s reporting about flu deaths is dangerously misleading the public and even public officials about the comparison between these two viruses."

Without a clear idea of how many flu deaths might be tallied for the 2019-20 season, we turned to past totals and estimates.

The CDC preliminary estimates show that 34,000 people likely died from the flu in the 2018-2019 season and that 61,000 died over the 2017-18 season.

Finalized CDC data shows that 38,000 died between 2016-17 and 23,000 died between 2015-16. That’s an average of about 39,000 flu deaths over the last four seasons, (assuming death estimates from the last two seasons turn out to be accurate.)

The 2017-18 season stands out as one of the highest in history, according to Reuters. Flu deaths only topped 60,000 on three other occasions. About 100,000 Americans died of the flu in 1967, about 116,000 died in 1957, and nearly 675,000 died from the 1918 flu.

We asked Schaffner if it’s possible to predict flu deaths and flu severity based on reports from prior years. It’s difficult, he said.

"There’s a saying: If you’ve seen one flu season, you’ve seen one flu season," Schaffner said, emphasizing that each season can be different and unpredictable. 

The CDC hasn’t offered a prediction of how many Americans might die from COVID-19 over the course of this year’s season.

Modeling from the University of Washington’s Institute for Health Metrics and Evaluation has offered death counts in the range of 48,000 to 123,000. On April 24, the day of Forest’s claim, Politico reported that the institute was predicting about 67,000 deaths. On May 4, the institute’s model predicted 134,000 deaths by Aug. 4. 

Information on flu deaths is limited. But Lisa Maragakis, senior director of infection prevention at Johns Hopkins, recently wrote that coronavirus deaths are "thought to be higher than that of most strains of the flu."

Angela Rasmussen, a virologist at Columbia University, agreed. In an email, she said, "SARS-CoV-2 is at least as deadly as the highest flu estimate, and over the year will undoubtedly be more so."

What if the flu does turn out to kill 62,000 over the course of the season? That would still make it less deadly than the coronavirus on a per-day basis, CNN reported on May 1.

If 62,000 people died from the flu between Oct. 1 and April 4, that would mean the U.S. had an average of about 331 flu deaths a day, CNN reported. By contrast, CNN estimated that an average of 739 people died per day from coronavirus between February and the end of April, according to data from Johns Hopkins University.

While flu deaths across the U.S. have yet to be determined, flu data is more definitive in Forest’s home state. And it further proves him wrong.

Mandy Cohen, North Carolina’s health secretary, announced on April 20 that COVID-19 deaths had surpassed flu deaths in less than a month.

Cohen said in a press conference that 179 people died between March 24, when North Carolina recorded its first coronavirus death, and April 20. By contrast, WUNC reported, 167 people had died over the course of the flu season, which started in September.

By April 25, a day after Forest made his claim, the NC Department of Health and Human Services, had reported 177 flu deaths and more than 300 coronavirus deaths. By May 3, there had been 183 flu deaths and 430 coronavirus deaths. 

On April 24, Forest said: "We’ve still had more deaths to the flu this year than we’ve had COVID-19."

Forest phrased his claim in a way that makes it seem like health experts were keeping and publicizing an ongoing log of flu deaths across America. That’s not the case.

The CDC predicts that the number of flu deaths will be anywhere between 24,000 and 62,000. Forest cherry-picked the highest number possible, and then compared it to the CDC’s running tally of coronavirus deaths. That’s unfair because he compared an estimate to an actual number, and because the diseases entered the U.S. at different times.

Forest’s claim isn’t true for his home state either. In fact, Forest never proved that there have been more flu deaths than coronavirus deaths as of April 24. We rate his claim False.