Is covid "just like the flu"...if you're vaccinated?
April 23, 2021 7:15 AM   Subscribe

A family member (in their 60's) said the other day "I'm vaccinated, so if I do catch covid it'll be more like the flu, and less like a potential serious illness with hospitalization risks." Struggling to figure out whether this is an accurate statement?

The context was this family member's personal individual risks involved with indoor dining.  The line of thinking for them was "I'm not afraid to dine indoors at all, because I'm vaccinated, and while I understand it doesn't make me immune, it will more likely make covid 'more like the flu' should I happen to contract it. I don't want the flu as much as anyone else, but I never insisted on dining outdoors in the cold back when the flu would be going around."

I understand the vaccine drastically reduces the risk of developing serious symptoms, and I imagine this is what they've heard in order to come to the conclusion that they did with regards to their own risk tolerance - I'm more interested in the accuracy of the statement they were making.

Is one's personal, statistical health risks as a vaccinated person contracting covid more in line with that of contracting the flu, than pre-covid vaccination? Is there any validity to this line of thinking?

(Note: Focusing on personal health risks, not risk of transmission to others.)
posted by windbox to Health & Fitness (36 answers total) 2 users marked this as a favorite
 
Best answer: the hospitalization rate plummets for those infected with covid after vaccination: https://www.pbs.org/newshour/show/what-are-my-chances-of-hospitalization-even-after-being-fully-vaccinated
posted by noloveforned at 7:21 AM on April 23, 2021 [16 favorites]


Best answer: Yes, there is validity in that line of reasoning.

I'd just like to note, that right now, there's a lot of misinformation based on fear, around vaccines and immunity. Phrases like "We don't know how well vaccines work" and "We don't know if you can still transmit" and "We don't know if immunity lasts for a long time" are all articles that have circulated, without much expert opinion.

In reality, we know a LOT of that info, it's all come out in the last few months. Including the above - vaccines are very effective. Even when there is a breakthrough case, it is much less severe. So far, immunity has not worn off from first trials, 9 months ago, though a new publication has not been released on that topic. And, transmission is greatly reduced by those vaccinated.

So please, tell your 60 year old relative to dine all they want. The chances of them catching it in the first place are very low. (If distanced dining had a 10% odds before vaccination IF SOMEONE WITH COVID WAS THERE, and 5% of population have it, then it's a .5%, but if they are vaccinated, a further 0.025% chance... and again, it's not as deadly).
posted by bbqturtle at 7:29 AM on April 23, 2021 [34 favorites]


As I understand it, yes. With the caveat, "as far as we know". It is still early days with the data but it does seem like those who by chance do get covid after the vaccine get ill on par as most people who catch the flu. What we don't know is how long this lasts, whether we will need boosters, etc.
posted by stormygrey at 7:31 AM on April 23, 2021


My understanding is that if we're focusing strictly on their own personal risks, then yes, that is the most likely outcome for them. Not a guaranteed outcome - there is no absolute guarantee that they won't be one of the rare people for whom the vaccine is less effective, that they won't be one of the first people to run into a new bad variant that the vaccine doesn't work well against, etc. - but their calculus re: their own risk seems to be more or less in line with the always-moving target of "what we know today."

Of course they are not actually making their choice in a vacuum where no one else's risks and needs should be considered, but on that aspect of it, I think they're up to date with the most recent science I've seen.
posted by Stacey at 7:36 AM on April 23, 2021 [4 favorites]


Generally, vaccine is supposed to stop you from getting sick altogether.

But in some cases, where the vaccine is not fully effective, basically not enough antibodies or not enough time, and so on, there can be sometimes what's called "breakthrough infections", where the body gets sick anyway. However, since the immune system had a bit of "heads up", the symptoms are usually MUCH LESS severe than a full COVID episode.

Which results in "much less hospitalization" statistics as cited earlier by @noloveforned
posted by kschang at 7:45 AM on April 23, 2021


You don't mention this person's health history. For people with certain types of conditions that make them immunocompromised, the vaccine may not work well at all. So if this person is say, a cancer survivor, being vaccinated might not make a difference. NYT article.
posted by FencingGal at 7:45 AM on April 23, 2021 [10 favorites]


I checked, the the CDC has data on breakthrough infections (that is to say, people who got COVID after getting the vaccine.) The data is as of April 13th. 75 million Americans had been fully vaccinated, and there were 5,814 reports of breakthrough infections. Of those, 29% were asymptomatic, 7% were hospitalized, and 1% died. (Of the people who died, 12% may have died of a cause unrelated to COVID.)

You've got to wonder how many asymptomatic cases weren't reported because people had no idea they had COVID, and that's a transmission concern. And for that reason, I don't think I would eat indoors in a restaurant right now, even if I were fully vaccinated. But honestly, those numbers look pretty darn good to me, and I think this is a matter of people's personal risk calculations.

Having said that, the flu is not a joke, and "no worse than the flu" would not be terribly reassuring to me!
posted by ArbitraryAndCapricious at 7:52 AM on April 23, 2021 [5 favorites]


It's a little tough to get a true comparison because we know when flu season is, and we have a vaccine to start giving people each year BEFORE flu season, whereas this year obviously the COVID vaccine has been rolling out gradually in the midst of a big wave and they're constantly collecting new data about how well it's working. But:

The CDC recently released that of the 77 million vaccinated people, there have been 5800 breakthrough cases, 396 hospitalizations, and 74 deaths.

To me, that seems pretty good when compared to the average person's likelihood of getting a life-threatening flu.
posted by lampoil at 7:58 AM on April 23, 2021 [1 favorite]


There's different data for different vaccines. I'm in Chile, got Sinovac, and the latest numbers say my chances of dying are 20% of what they would have been without the vaccine, and my chances of going to the ICU are 17%. So not nothing, but less of a worry.
posted by signal at 8:02 AM on April 23, 2021


The flu doesn’t have the same track record as COVID for leaving some patients with only mild to moderate (or even asymptomatic) cases with long term, life altering health issues afterwards, and we still don’t have enough data to know if those who are vaccinated and end up with asymptomatic to moderate breakthrough infections are or aren’t less likely to develop long haul COVID issues, so there’s that.
posted by blue suede stockings at 8:30 AM on April 23, 2021 [9 favorites]


I mean, the flu is definitely "a potential serious illness with hospitalization risk" (pre-covid, major cause of ICU admissions in the winter months, and a noticeable spike in death for >65 and immunocompromised people during flu season), but all evidence seems like to suggest dramatic reduction in covid severity after covid vaccination.

That said, it's not cause for a free-for-all, particularly with uncertainty around variants. There is a covid risk calculator floating around (I think I first saw it here) to help with risk stratification.
posted by basalganglia at 8:34 AM on April 23, 2021 [4 favorites]


There is a covid risk calculator floating around (I think I first saw it here) to help with risk stratification

Microcovid.org — now with the ability to input your vaccination status
posted by blue suede stockings at 8:51 AM on April 23, 2021 [5 favorites]


Response by poster: To clarify, it's not that the flu isn't also serious especially if one is older or immunocompromised. But we all agree that pre-covid, we had a baseline set of personal/societal risk tolerance for every day activities, even with a bad flu outbreak going around. That is to say - very few people (in the US at least) would wear masks, socially distance, refuse to go to crowded bars/restaurants or to family/friends houses. This person's line of reasoning was that because they were vaccinated, they felt comfortable returning to their baseline lifestyle/behaviors, provided they were around others who shared that risk tolerance (vaccinated or not).

For more context around our conversation - we have a pretty big (20+ people) family reunion of sorts planned for the summer and I imagine the majority of people's sentiment will be aligned with this person's ("meh! why should we have to social distance, we're vaccinated!"). I'm excited by the prospect of seeing family again and I genuinely hope their sentiment with regard to risk is correct provided it's rooted in accurate data. Just want to make sure we aren't getting ahead of ourselves!
posted by windbox at 8:55 AM on April 23, 2021 [5 favorites]


It’s a tricky question to answer because the virus seems to affect different people differently. I got Covid as an unvaccinated person back in December/January, and my experience was that it was significantly *less* worse than the flu. I was a little sleepy, but I didn’t miss any work, and my wife and I were able to take care of our small children(/infection vectors) without any help. On the other hand, vaccinated people have died. There’s probably a reason why my response was so different than theirs, but I don’t know what it is. And even though I’ve subsequently started the vaccination process (first dose down), I’m not going to be reckless, because there’s the chance that a second infection might be totally different than the first.

You can answer this question for the average person, but that’s little help if the specific person is someone who reacts unusually badly.

And of course, just thinking in terms of their infection is only considering part of the question. Transmission to others has always been the bigger question, and that doesn’t seem to have any correlation to symptoms. So when I had Covid, I sometimes say it didn’t really affect my life. That’s true in some ways - the symptoms didn’t change anything - but untrue in others, because I ended whatever meager public interaction I had been having (grocery shopping, etc.) at that time until I could no longer transmit. We cancelled Christmas dinner. I would encourage your relative to keep this in mind.
posted by kevinbelt at 9:01 AM on April 23, 2021 [1 favorite]


To echo basalganglia's point, the phrase "more like the flu, and less like a potential serious illness with hospitalization risks" is in itself inaccurate. The very premise is faulty.

To echo FencingGal, we can't really ballpark how dangerous a flulike illness might be to your relative, because we don't know their medical history.

I bring up both these points in light of your update, because I know a lot of sixtysomethings who tend to underestimate their susceptibility to severe illness/injury/death.

Case count rolling averages/trends in your area are important, too -- and when that big family reunion rolls around, you'll have to weigh in case counts where everyone else is living, and what means of transport they're using, and whether another highly-virulent new variant is more prevalent by then. (Speaking of which, this is why it SHOULD matter, even to total solipsists, whether they're exposing others. Mutation over time could theoretically mean "what goes around comes around.")
posted by armeowda at 9:07 AM on April 23, 2021 [4 favorites]


The flu is also a lot more likely to kill you at 60 than 30.

The data we have is still inconclusive but there's definitely older, vaccinated people getting covid and in some cases dying from it.

Because the vaccines are so new, we also have little information about what the long term effects of post-vaccination infections will be, whereas we know what they are for the flu.
posted by Candleman at 9:11 AM on April 23, 2021 [2 favorites]


One thing to consider is that a lot of the people who've had long covid didn't have what's counted as "severe" cases requiring hospitalization. I'm personally pretty wary even of light covid, relative to the flu. (on preview, what blue suede stockings said)
posted by trig at 9:13 AM on April 23, 2021 [5 favorites]


I am in my seventies, older than your relative. I got my second dose of Moderna in February. In March some dear friends came through town on their first trip since the beginning of this. They both work in health care and are also both vaccinated. The three of us went to lunch at an upscale restaurant with high ceilings and socially distanced tables. The staff were all fully masked. The three of us are probably healthier than a lot of people our age. We know and trust each other very well, we know we've all been super-careful even after we were fully vaccinated. I know plenty of people I wouldn't trust that way and I know plenty of restaurants that might not be as diligent.

If your relative is eating out in similar circumstances it's probably ok. But if your relative is sharing a table with people who aren't vaccinated and/or don't believe in masks or vaccines at a restaurant that is not making serious efforts to put distance between tables, then your relative is foolish.
posted by mareli at 9:51 AM on April 23, 2021 [5 favorites]


Response by poster: I want to make sure I'm really clear here: the general line of reasoning in dispute that I'm seeking clarification on is that these statistics around hospitalization and death among the vaccinated for covid are now similar to that of the flu. And consensus still seems very mixed here! Seeing "sure, your older family can dine all they want!" vs "no, don't, 60-somethings underestimate their health/it is still very foolish to take certain risks after being vaccinated!"

I'm struggling to reconcile these two very different sentiments and having trouble confirming whether there is any statistical validity in my family's personal risk sentiment.

For the purposes of staying on track, things I am *not* seeking clarification on: Whether breakthrough cases or hospitalizations post-vaccination exist or not, whether different people will react differently, whether it's possible for older people to be hospitalized/die from the flu/covid, whether mild cases of covid means there is danger of transmitting a more severe case to someone else. I don't mean to thread sit, just want to be clear that all of that is not what's in dispute here.
posted by windbox at 10:12 AM on April 23, 2021


Microcovid.org — now with the ability to input your vaccination status

I wouldn't trust this one little bit. It's a toy model put together by a bunch of non-experts. They've read a lot, though.
posted by mr_roboto at 10:13 AM on April 23, 2021 [6 favorites]


A Tiny Number of People Will Be Hospitalized Despite Being Vaccinated. We Have to Learn Why. (ProPublica, April 14, 2021) Experts say we should investigate “breakthrough infections” to look out for variants and understand who’s vulnerable. In many cases, that’s not happening.

SARS-CoV-2 Variant Classifications and Definitions (CDC.gov)

(TL:DR Keep an eye on variant outbreak news; hold your family reunion outside. Party-supply stores have shade canopy, outdoor fan, table and chair rentals.)
posted by Iris Gambol at 10:13 AM on April 23, 2021 [1 favorite]


Sorry, seeing your update -- the upshot is, no, your family member's statement was NOT accurate.
posted by Iris Gambol at 10:16 AM on April 23, 2021 [1 favorite]


Best answer: I want to make sure I'm really clear here: the general line of reasoning in dispute that I'm seeking clarification on is that these statistics around hospitalization and death among the vaccinated for covid are now similar to that of the flu.

One way to make this comparison is in how vaccination changes the risks of serious complications for COVID vs. the flu. For instance, in patients who contract A/(H1N1) influenza, those who have been vaccinated are 36% less likely to die than those who have been not been vaccinated. ICU admission rates go down by 19% and the need for ventilation decreases by 34%. [source]

For the COVID vaccines in use in the US, as described above, there have been 5800 cases and 74 deaths. So the death rate in people who have contracted the disease is 1.3%. The total numbers for the US are 32 million cases and 570,000 deaths, for a death rate of 1.8%. That's a decrease of 28%. Same order of magnitude as the flu vaccine, not quite as good. Consider however that asymptomatic cases of COVID seem to be much more common that asymptomatic cases of influenza, so that 5800 may be a significant undercount, which would decrease the COVID death rate.

That's just one way of looking at it though, and probably not the most important way, because COVID vaccines radically decrease case incidence.

The case rate for the cohort of 77 million vaccinated people in the US is 0.0075%. The total US case rate over the pandemic has been about .1%. So that's decrease of 93% (very similar to the clinical trial result). Flu vaccine effectiveness on the other hand is anywhere between 40-60%. [source] So the COVID vaccine is much more effective than the flu vaccine in this respect.

Somebody check my calculations, please.
posted by mr_roboto at 10:40 AM on April 23, 2021 [6 favorites]


Best answer: And one more quick comparison--hospitalization rate for the vaccinated COVID population is 396 out of 77 million, so 0.0005%. Flu hospitalization rate in the entire US population varies A LOT year-by-year; in recent years it's between 0.04% and 0.25% of the entire US population (including vaccinated and unvaccinated individuals). [source] So hospitalization rate seems to be much, much greater for influenza overall than for COVID with vaccination.

Again, these are quick calculations I just made, they should probably be double-checked.
posted by mr_roboto at 10:54 AM on April 23, 2021 [3 favorites]


Best answer: And one more caveat--the COVID hospitalization rates are for a population that has been practicing a significant degree of social distancing and mask wearing. The influenza data are pre-2020, so that's without distancing or masks.
posted by mr_roboto at 10:55 AM on April 23, 2021 [2 favorites]


I hate to keep bringing this up, but covid sickness and death is not evenly distributed by race and socio-economic class.

CDC data

And this is just the generic data across all ages and income classes. Take income into account, the differences are even greater.

The ratio of noticeable sickness, hospitalization, and death vary dramatically, and your risk calculation should take this into account.

Is your relative Asian or upper middle class white? Are they going to an expensive steak house in a generally upper middle class area? Then statistically, their risk of even getting sick if they were unvaccinated and in a crowd is very different vs going to fast food in a heavily Hispanic area.
posted by The_Vegetables at 11:47 AM on April 23, 2021 [6 favorites]


The Flu causes death in .9% of those 65 and older that catch the flu. https://www.cdc.gov/flu/about/burden/2017-2018.htm

Vaccinated covid is a very hard number to crack, but because the old people got vaccinated first, most of the vaccinated covid rates are those 60+.

Of breakthrough infections, 5,800 breakthrough infections, with 396 requiring hospitalization and 74 deaths. That's a death rate of 1.2%. https://www.medpagetoday.com/special-reports/exclusives/92071 source.

So, yes, I would say, if someone 60+ catches covid, it's "just about as bad as the flu". I assume strong error bars on both the .9% and the 1.2% numbers making them equivalent.

Now, that if is also much less likely then they actually catch the flu, because we have a working vaccine. So, I wouldn't recommend any precaution for vaccinated people that they weren't already taking for the flu pre-covid.

Or, maybe take a few more precautions, because, now that we all know more about how viruses work, maybe we should be wearing masks (for the normal flu) in busses and other germ infested areas.
posted by bbqturtle at 2:01 PM on April 23, 2021 [3 favorites]


Chiming in with Mr. Roboto on microcovid.org - I admire the desire these folks have to read journal articles and make a rubric for their group house, but I haven’t seen it discussed by anyone in public health or medicine. If people who think about the risks of disease at both population and individual levels for a living are not talking about it, I am much less inclined to take it seriously.
posted by rrrrrrrrrt at 10:44 PM on April 23, 2021


Vaccination of one person is not a magic bullet, none of them will inoculate you against covid. Ignoring hospitalisations and just focussing on catching the disease at all, if the vaccine is 90% effective you are 90% less likely to catch it all other things being equal.

So if you jump on a plane and travel to a location where covid rates are 10 times higher, guess what you are right back at the same risk profile you had before the vaccination.
Similarly if you don't have a vaccination and somehow manage to travel to an area where covid rates are 10 times lower, thats the same effect as if you had been vaccinated.

To even attempt to estimate the risks, you need to know what the covid rates are in your area, and who else in the group has been vaccinated.
posted by Lanark at 10:12 AM on April 24, 2021


So not dying from covid is certainly a good thing. However, getting covid, even a mild form, can have all sorts of long term nasty effects.

From this NYT article: In the study, published Thursday in the journal Nature, researchers looked at medical records of more than 73,000 people across the United States whose coronavirus infections did not require hospitalization. Between one and six months after becoming infected, those patients had a significantly greater risk of death — 60 percent higher — than people who had not been infected with the virus.

...What’s more, some of the patients’ post-Covid medical issues — like diabetes, kidney disease and some heart problems — could become chronic conditions that would require treatment for the rest of their lives.
posted by oceano at 12:46 PM on April 24, 2021 [1 favorite]


Vaccination of one person is not a magic bullet, none of them will inoculate you against covid.

Yes, they do inoculate you against covid. They produce an immune response that often eliminates infection entirely, and reduces its severity in most people otherwise.

So if you jump on a plane and travel to a location where covid rates are 10 times higher, guess what you are right back at the same risk profile you had before the vaccination.


No, you aren't, because even if you manage to catch it, you're still likely to have a significantly milder infection. Vaccinations largely prevent catching it at all in most people, and reduce the seriousness of the infection when it is caught.
posted by ch1x0r at 3:01 PM on April 24, 2021 [3 favorites]


As game-changing as the Pfizer vaccine (and Moderna's equally effective mRNA-1273 vaccine) may be in affording protection against the COVID-19 illness, the results do not reflect complete "sterilizing immunity."
posted by Lanark at 3:46 PM on April 24, 2021


Microcovid wasn't created by doctors or epidemiologists, but it was discussed by Bob Wachter here.
posted by airmail at 8:20 PM on April 24, 2021 [1 favorite]


As game-changing as the Pfizer vaccine (and Moderna's equally effective mRNA-1273 vaccine) may be in affording protection against the COVID-19 illness, the results do not reflect complete "sterilizing immunity."

That was in December. This is from Friday. The Pfizer vaccine is 85% effective against COVID infection, including asymptotic infections.
posted by mr_roboto at 10:48 PM on April 26, 2021 [2 favorites]


Sterilising immunity means that the immune system is able to completely prevent a virus from replicating in your body. You can have a vaccine which is 85% effective or even 100% effective, but if it has not reached Sterilising immunity then you could still pass on the virus to another person, and if that person is unvaccinated they could get ill.
This is why it's important for vaccinated people to still take some precautions to protect others who haven't yet had the vaccine.
posted by Lanark at 6:56 AM on April 27, 2021


Right. That’s what the SIREN study cited above shows. Sterilizing immunity.
posted by mr_roboto at 8:18 PM on April 27, 2021 [1 favorite]


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