The novel means new in novel coronavirus 2019, so data stacked against that of the flu appears a little skewed.

As of Thursday, the Centers for Disease Control and Prevention said the United States has more than 1.36 million cases of the coronavirus and has amassed 82,246 deaths. These cases and deaths are tabulated since the virus arrived in the nation in January.

Comparatively, the CDC has estimated that between 39 million to 56 million U.S. citizens will contract some form of influenza for the 2019-20 flu season, which began in October.

The estimates are based on the Influenza Burden Estimates Model, which uses a formula to predict the annual impact of the flu season.

The model also showed estimates of between 18 million to 26 million people will visit a health care provider for the flu, 410,000 to 740,000 will need to be hospitalized; and 24,000 to 62,000 people will die from the virus.

So, while the overall number of COVID-19 cases don't come close to that of the flu, the novel coronavirus has killed more people than the flu in a shorter amount of time.

Dr. Elliot Smith, chief clinical officer and vice president of the Butler Health System Ambulatory Network, said there is one important note to remember when looking at this data.

“There seems to be a much higher asymptomatic carry rate than the flu,” Smith said. “We don't understand what that number looks like for COVID. If it's 50 times more than the number we know, then the death rate is going to follow substantially.”

Smith said this type of data discrepancy comes with a new disease. Health agencies worldwide had to start from scratch, developing testing and data tables to track COVID-19, whereas the CDC has been tracking the flu for almost a decade and knows relatively what to expect each year.

[naviga:h3]County comparison[/naviga:h3]

According to figures last updated March 28, the state Department of Health reported 1,290 cases of flu in Butler County this flu season, broken down into 659 cases of influenza A and 631 cases of influenza B. These were all confirmed cases through testing.

As of Thursday, the Department of Health had 59,636 positive cases of COVID-19 in the state and 199 in Butler County. Data collection for COVID-19 began in February.

As Gov. Tom Wolf's stay-at-home orders began in March, the county and state both have seen a plateau in COVID-19 cases, but they also saw an earlier end to the flu season, which usually goes until May.

“The flu data that is on the website is considered the preliminary final data for the 2019-2020 flu season,” said Nate Wardle, state department press secretary. “The flu is no longer circulating and has not been since March 28, and so the data has not been updated since then.”

Smith said the response to COVID-19 likely discouraged patients from seeking treatment for the flu, which then reduced the number of patient visits.

“People wanted to know if they had COVID, and they didn't necessarily care if they had the flu,” Smith said. “Our flu testing dropped off rather precipitously, and if you're not testing for it you don't find it.”

[naviga:h3]In harm's way[/naviga:h3]

COVID-19 has been especially dangerous to the elderly and people whose immune systems are compromised.

“Our nursing homes in Butler County are doing a tremendous job. They are taking wonderful care of our residents,” said Beth Herold, the director and nurse for the Butler County Area Agency on Aging. “They communicate with us, and we communicate back with them.”

Herold said the key difference in how nursing homes prepare for the flu and the coronavirus is the number of procedures in place. She said it's not unusual for a nursing home to lock down when dealing with the flu, but procedures have been defined by years of experience in dealing with the same enemy.

“When we have flu outbreaks in nursing homes, they will quarantine and limit,” Herold said. “They implement some of the same tactics, but not in such a broad scale.”

When the coronavirus struck, long-term care facilities closed themselves off from visitors and isolated all of their residents.

As of Thursday, the state Department of Health reported there were six facilities in Butler County that had cases at some point in the pandemic. Countywide, there were 13 cases among residents and 10 cases among employees. Two people associated with these facilities have died from the virus.

Herold said the coronavirus attacks the elderly aggressively, and they are more vulnerable to catching and succumbing to the disease. This is due to the lack of understanding of a new virus.

“There's a game plan for that. There's a vaccine for the flu. There's a tool for the flu,” Herold said. “We don't have any tools for COVID right now.”

Impact on children

While the coronavirus appears to be worse than the flu for the elderly, it has been commonly referred to as mild in children.

Dr. Christania Morganti, a pediatric specialist with BHS, said she has seen no positive cases in children, but through her network of colleagues she has found that in most cases, children experience mild symptoms.

Morganti said the flu poses a much greater risk at this time for children, especially infants. While a condition called multisystem inflammatory syndrome is being examined for its connection to COVID-19, the condition is very rare. She said the flu is widespread every year and known to bring complications for children, especially infants.

“Ultimately, being a parent, you have to be a little more afraid of the flu, especially if they're younger than 2, especially with this virus,” Morganti said.

Influenza-associated deaths in children under the age of 18 became nationally reportable in 2004, according to the CDC.

Since then, the number of pediatric flu deaths reported to the CDC each year has ranged from 37 in the 2011-12 season to 185 in the 2017-18 season. The agency says the number of flu deaths in children is thought to be higher than what is reported because not all flu deaths in children are detected and reported.

According to the state Department of Health, there have been no reported deaths in children from COVID-19, and there has yet to be a case in Pennsylvania of the new and rare autoimmune syndrome that can show up four to six weeks after a child has recovered from the virus.

Morganti said while the COVID-19 pandemic has unfolded with dire circumstances, social mitigation practices might have saved a number of children.

“Thankfully, I think the isolation helped get rid of the flu (this year,)” she said.

[naviga:h3]Deadly difference[/naviga:h3]

Smith said the two illnesses appear similar. Both are transmitted through the air and have a similar list of symptoms in the early onset.

“There is a great deal of overlap in symptoms,” Smith said.

But there is a core difference. The coronavirus can kill on its own. The flu needs a complementary infection to kill.

“People who see the ventilators on the flu are seeing superimposed infection; they get an infection on top of the flu,” Smith said. “This (corona)virus itself is what causes respiratory failure, unlike the flu, which is a bacteria infection on top of the virus.”

He said this core difference has been the driver of the precautions taken at every level. He said it's important for people to remember that the coronavirus is a real threat.

“This is a severe virus. I wouldn't put it in the same category as the flu other than how it's spread,” Smith said. “People can get much sicker directly from this virus than the flu virus in general.”