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Making sense of COVID-19's risk now


It's a strange moment in the pandemic. Mask mandates and other restrictions have all but disappeared. Vaccines and boosters mean lots of people are protected against severe illness, and yet hundreds of people are still dying from COVID-19 every day. So we're left to figure out for ourselves how risky that night out at the movies is or that trip abroad.

CARLA SCUZZARELLA: You know, it's kind of on the back burner for a lot of - it was on the back burner for us.

SUMMERS: Carla and Frank Scuzzarella of Saugus, Mass., had put off their European vacation since 2020, but this summer they were both double-boosted. It felt safe, so they went - Spain, Portugal, Morocco, London.

SCUZZARELLA: And we had a wonderful, wonderful three weeks. I'm grateful for that time. And I have lots of great memories and good pictures from that. But, you know, we are home for four days, and he's in the emergency room.

SUMMERS: Frank went to the hospital on August 6, and he quickly got worse.

SCUZZARELLA: Kind of unbelievable how quickly it established itself in him. And, you know, within a week he had small blood clots in both lungs from the COVID. You know, it was terrible.

SUMMERS: Frank was on a daily steroid to manage his rheumatoid arthritis, and that put him at higher risk for a severe case. And he died just last week on Labor Day. He was 64 years old. Now Carla is adjusting to life without the man who coached their son's hockey and Little League teams, who was getting ready to welcome their second grandchild, the man who she'd been with since they were 17 years old.

SCUZZARELLA: I've been thinking a lot about what we still wanted to do, and now I got to figure out, you know, how to be by myself without him. It's been a long time.

SUMMERS: Carla says she wants people to know that COVID is not a joke. For the people who can't fight it off, it's not just a cold. But she also understands that people want to live their lives.

SCUZZARELLA: You can't say it's gone. And I know everybody - you know, we don't have to necessarily wear masks. We don't have to stay six feet apart. You have to live your life. And that's the way we looked at it when we planned to go on our trip this summer - that we felt safe and we have to live our lives still. But you just - you can't totally let your guard down yet.

SUMMERS: Even among scientists, there is debate about how risky COVID is right now and what precautions most people should be taking. And the way this question is often framed is as a comparison. At this point, is COVID more or less dangerous than the seasonal flu? The flu, after all, is a disease we're familiar with and a risk that most of us are comfortable dealing with each fall and winter. NPR health correspondent Rob Stein has been digging into this debate. Hey, Rob.


SUMMERS: All right. So we have spent years now living in fear of COVID because it was seen as so much more dangerous than the flu. So how could COVID have become no more menacing than the flu?

STEIN: That's the big debate right now. Many experts say it's way too soon to declare COVID a threat on par with the flu. But some infectious disease experts are ready to go that far, like Dr. Monica Gandhi at the University of California San Francisco.

MONICA GANDHI: We have all been questioning, when does COVID look like influenza in terms of deaths? And, yes, we are there. We are essentially at a low case fatality rate where COVID has reached influenza. So live your life in a way that you used to live with endemic seasonal flu.

STEIN: Gandhi says that's because people have built up strong immunity from getting vaccinated or infected or both and because omicron doesn't appear to have made people as sick as earlier versions of the virus. So she says unless some nastier variant suddenly emerges, COVID's menace has diminished considerably.

SUMMERS: OK. But that is a controversial perspective, right?

STEIN: Yeah, absolutely, absolutely. Others argue that we may hopefully be heading in that direction, but we're not there yet - not even close. I talked about this with White House adviser Dr. Anthony Fauci.

ANTHONY FAUCI: I'm sorry. I just disagree. COVID is a much more serious public health issue than is influenza. The severity of one compared to the other is really quite stark. And the potential to kill of one versus the other is really quite stark. Never, ever, ever would flu kill 1,031,000 people in two and a half years.

STEIN: Making COVID the third leading cause of death in the U.S. And Dr. Fauci points out that COVID is still killing hundreds of people every day, which translated into more than 125,000 deaths a year. A very bad flu season kills, you know, maybe 50,000 people.

SUMMERS: OK. That is a pretty large difference, Rob. So what do people who say that the COVID risk has waned say about that?

STEIN: You know, they agree that omicron is so contagious that it's still making lots of people sick, some really sick. So, you know, lots of people are still getting seriously ill and even dying. But it's become rare for most young, otherwise healthy people to get so sick they end up in a hospital or die, especially if they're vaccinated and boosted. And Dr. Shira Doron at Tufts University argues that many hospitalizations being blamed on COVID are really people hospitalized with COVID, not because of COVID.

SHIRA DORON: We are now seeing consistently more than 70% of our COVID hospitalizations are in that category. If you're counting them all as hospitalizations and then those people die and you count them all as COVID deaths, you are pretty dramatically over-counting.

STEIN: Which she says means the daily death count is probably really much closer to what happens during a typical flu season. And many experts say so many non-fatal infections aren't being reported because of home testing. It's masking that the risk of dying from COVID has probably dropped to about the same as the flu.

SUMMERS: And, Rob, what do we know about who is still dying from COVID?

STEIN: Yeah. Most of those ending up in the hospital or dying are those who are older, especially the age 75 and older, who have other health problems, especially those who aren't vaccinated or boosted. I talked about this with Heather Scobie at the Centers for Disease Control and Prevention.

HEATHER SCOBIE: People that are 65 to 74 years have 60 times the risk of dying than people that are 18 to 29. And people that are 85 years and older have 330 times the risk compared to people that are 18 to 29.

STEIN: So it's super-important that they get vaccinated and boosted and get treated quickly if they do get sick.

SUMMERS: And, Rob, we've been talking a lot about deaths from COVID, but something that I know a lot of people are concerned about is long COVID.

STEIN: Right, absolutely. You know, Dr. Fauci and others say that's another way COVID remains a far greater risk than the flu. While people can end up with lingering health problems from the flu and other viral infections, the risk from COVID is estimated to be much greater. But, you know, some doctors say the estimated risk for long COVID comes from people who got seriously ill early on in the pandemic. And if you count for that, the risk of long-term health problems may not be much greater from COVID than from other viral infections. But, you know, that, too, remains a subject of great debate.

SUMMERS: That's NPR health correspondent Rob Stein. Thank you so much.

STEIN: You're welcome - nice to be here.

(SOUNDBITE OF GARY NUMAN'S "TROIS GYMNOPEDIES") Transcript provided by NPR, Copyright NPR.

Rob Stein is a correspondent and senior editor on NPR's science desk.