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President Donald Trump drew a direct comparison between the seasonal flu and the new coronavirus in his first press conference on Covid-19, saying that Americans might have more to fear from flu than the headline-making virus.

But a closer comparison of the two viruses creates a more worrisome picture of what could happen if Covid-19 virus becomes widespread in the United States, infectious disease experts say.

The new coronavirus is more infectious than the flu and appears to strike with much higher severity in certain vulnerable groups.

At the same time, there are no treatments on hand for Covid-19 as there are for the seasonal flu, experts added.

In line with pandemic flu strains

Initially, estimates on the death rate in China hovered around 2%, but a report published last week in the New England Journal of Medicine arrived at a death rate of 1.4%. And leading health experts wrote in an accompanying editorial that many mild cases have been missed, driving the death rate down closer to around 1%.

The death rate associated with a typical flu season is around 0.1%, according to the US Centers for Disease Control and Prevention.

The apparent death rate of the new coronavirus is more in line with pandemic flu strains, where a new mutation causes the flu virus to become more contagious and dangerous, experts explained.

For example, the 1918 Spanish flu pandemic, caused by the first emergence of the H1N1 flu strain, had a death rate greater than 2.5%, according to the CDC.

“Influenza doesn’t have the same mortality rate right now as Covid-19,” said Dr Aaron Glatt, an expert with the Infectious Diseases Society of America. “Both can be fatal. There’s an awful lot more flu around, but thank God it’s not as dangerous as Covid-19.”

Older folks much more at risk

There’s one important difference – Covid-19 appears to be most harmful to old people or those with underlying health problems that make them more susceptible to infection or pneumonia, Glatt added.

“No child has died of Covid-19,” Glatt said. “There have been hundreds of cases and not one child under the age of 10 has died from Covid-19.”

By comparison, 125 children in the United States have died from the flu this season, the CDC says.

One other important difference: The new coronavirus appears to be more infectious than the seasonal flu, experts said.

People carrying the new coronavirus appear to spread the infection, on average, to an additional 2.2 people, federal health officials said in a recent letter in the New England Journal of Medicine.

That’s again on par with the pandemic 1918 Spanish flu, in which each infected person, on average, passed the virus on to between two and three people, said Dr Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown in New York City.

A virus new to humans

That figure for the regular seasonal flu is around 1.3 new people infected for every person with the flu, according to a 2014 paper in BMC Infectious Diseases.

The 1957 (1.6), 1968 (1.8) and 2009 (1.5) influenza pandemics also had lower infection rates than the coronavirus, according to data from that paper.

People also shouldn’t assume that the coronavirus will fade as winter turns to spring turns to summer, as happens with the seasonal flu, said Marc Lipsitch, a professor of epidemiology with the Harvard T.H. Chan School of Public Health.

“As a virus new to humans, [the coronavirus] will face less immunity and thus transmit more readily even outside of the winter season,” Lipsitch added. “Changing seasons and school vacation may help, but are unlikely to stop transmission.

“Like pandemic flu, it might transmit widely outside of season,” Lipsitch noted.

Transmission through mucous membranes

Both the new coronavirus and the flu spread in the same way, mainly through droplet transmission, Javaid said.

“If I sneeze or I cough, small respiratory particles fly into the air about three to six feet and fall to the ground,” Javaid said. “Within those three to six feet, people can get exposed.”

When those droplets land on a surface, they can be picked up by someone’s hand touching that surface. If the person touches their eyes, nose or mouth, the virus can be transmitted thorough the mucous membranes, Javaid explained.

“We all touch our faces more than 20 times an hour. Every four or five minutes we are touching our face. I touched my face twice talking to you, already,” Javaid said.

Carriers without symptoms

In another similarity, people carrying either virus can walk around without showing any active symptoms.

As many as three out of four people carrying the seasonal flu have no symptoms, according to a 2014 British study published in The Lancet.

People infected with either virus might be contagious before symptoms develop, making it difficult to control their spread, Javaid said.

When symptoms occur, Covid-19 virus appears to be more akin to the common cold than the flu. Coronavirus symptoms include fever, cough and shortness of breath, all of which may appear between two and 14 days after exposure, the CDC says.

The flu has those symptoms as well as sore throat, muscle aches, headaches and fatigue, the CDC says.

People with the flu have one important advantage, in that antiviral drugs like Tamiflu are available to reduce the length and severity of their illness, Glatt noted.

No similar antiviral is yet available to treat Covid-19 or the virus causing it. However, a coalition of European researchers found there are as many as 31 approved antiviral drugs that could potentially be effective against Covid-19.

No vaccination available

Repurposing these drugs as a Covid-19 therapy would have “a substantially higher probability of success to market as compared with developing new virus-specific drugs and vaccines, and a significantly reduced cost and timeline to clinical availability,” the researchers wrote in the International Journal of Infectious Disease.

Glatt said he’s not optimistic that an antiviral that’s effective against the coronavirus will be found quickly.

“I doubt, although there’s a lot of effort being put into it, that we’re going to come up with an antiviral right away for the treatment of Covid-19,” Glatt said. “Who knows, but I wouldn’t count on that.”

By the same token, there’s a vaccine for the flu, but a vaccine for coronavirus won’t be available for a year at the earliest, according to Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases.

Given that, the best prevention for the coronavirus appears to be the same as for the common cold, experts said – wash your hands frequently, avoid contact with sick people, cover your cough or sneeze with your elbow to prevent hand contamination, and stay home if you’re ill.

People who have chronic illnesses should make sure their disease is under control, to prevent their infection risk, Javaid said. For example, people who have diabetes should make sure their diabetes is under control.

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Someone is classified as obese when their body mass index (someone’s weight-to-height ratio) is more than 30.

And while the body mass index has been criticised by medical experts in recent years as not being an accurate portrayal of someone’s total health, an unhealthy weight can, however, take its toll on your health as it increases your risk for chronic diseases such as hypertension and diabetes type 2. 

Unfortunately, losing weight isn’t as easy as it sounds. We are inundated by so many fad diets and weight-loss products that it’s easy to become confused. We also want to see quick results and tend to reach for anything that offers the promise of quick weight loss. 

However, it’s not only a healthy weight that is key to optimum health. Your lifestyle as a whole needs a complete overhaul.

Here are some pointers to help you choose the best lifestyle for you:  

1. You should be able to maintain your regimen

Unless you have chosen a diet or eating plan that you can follow indefinitely, you are likely to return to your bad old ways when you’ve reached your goal with the new diet. Before you know it, you will be back at your old weight. 

What you really want is to start a diet that isn’t really a diet at all, but rather a lifestyle change. Weight loss is very exciting and motivating, but once you get to weight maintenance, the novelty has worn off and it may become a challenge to stick to the changes you made.

Your new weight is only viewed as “permanent” once you have managed to keep it off for an entire year. The National Weight Control Registry is a long-term study which currently observes over 10 000 people who have lost a significant amount of weight and managed to keep it off. This is what they did to maintain their weight:

• 78% eat breakfast every day.
• 75% weigh themselves at least once a week.
• 62% watch less than ten hours of TV per week.
• 90% exercise, on average, about one hour per day.

2. Eat to fight disease, not feed it

A “healthy diet” needs to adhere to a number of principles. The most important is that most of your food should be minimally processed (eaten as it is found in nature) and be predominantly plant based.

Here are some more practical suggestions to promote good health:

• Mix up your meals. Eat a variety of foods and not just “the same old” on repeat. Different foods contain different vitamins, minerals and anti-oxidants and therefore variety is essential in order to obtain a range of nutrients.
• Move it! Be physically active for at least 30 minutes per day.
• Make starchy foods the basis of most meals. There is a catch here – portions should be kept small (half a cup to one cup) and these options should be unprocessed, whole grain and high in fibre.
• Eat plenty of plants. Aim for at least five portions of vegetables and fruits per day, giving preference to vegetables. You will benefit from the satiety value they provide, their fibre content as well as the wide range of nutrients they contain. Strive for variety.
• Incorporate at least one meat-free meal per week into your routine. Eat beans, chickpeas, soy and lentils regularly.
• Chicken, all types of fish, low fat dairy, lean meat or eggs can be eaten daily – but, control the portions of your proteins – two to three matchbox-sized portions will suffice for most adults.
• Include healthy fats in your diet. Give preference to heart-healthy monounsaturated fats such as olives, olive oil, canola oil, nuts and avocado. 
• Drink six to eight glasses of water daily. If you want to have a “tipple”, be sensible about how much. A recommended guideline is no more than one unit of alcohol for women per day, and no more than two for men.
• Skip the salt (or at least use it sparingly).
• Try and quit sugar. If you can’t, use small amounts and not between meals.

3. Eat a diet that’s within your budget

It’s important to be able to maintain your diet, not only from a mental perspective, but also an economic one.

We tend to think that a healthy diet should consist of expensive superfoods. A healthy lifestyle can (and should), however, be cost-effective.

To save on your food budget, try focusing less on grass-fed, organic and “free from” foods (free from gluten/wheat/lactose etc.), and rather include minimally processed whole foods that are seasonal, that can be bought in bulk (and shared). You can also start a vegetable garden.   

Small changes in your shopping list can have a significant effect on the weight of your wallet. Take for example swapping your fillet of salmon, for a few pilchards (the omega-3 content is similar). The cost per portion will drop from R40 to R3.50. 

A similarly easy swap with very little impact on health outcome is swapping your olive oil (R150/L) for canola oil (R22/L).

4. Don’t turn into a hermit

Is your diet one that can only be followed if you dedicate all your time to preparing intricate meals? Is socialising difficult because of all your restrictions? 

Although you may be able to follow a complicated and restrictive for a short period of time, eventually your need to socialise and be with others will take over and adherence to your diet will wane.

Find a way of eating that doesn’t just suit you, but also your family, and allows you the flexibility to eat with others.

5. Don’t choose an unsafe and unsustainable fad diet

If the new diet you have decided to embark on has one or more of the following characteristics, you may be chasing a fad diet which is both unsafe and unsustainable:

• It offers an easy magic solution without having to make many lifestyle changes.
• It promises rapid weight loss of more than 1kg a week.
• It promises foods with “fat burning” properties (such as the grapefruit diet).
• It promotes the avoidance or severe restriction of major food groups.
• It promotes eating mainly one type of food (such as cabbage soup or eggs).
• It eliminates major food groups.
• It recommends eating foods in particular combinations according to your blood type.
• It recommends detoxing or juicing.
• It offers no supporting evidence.
• It recommends eating non-food items such as cotton wool (there are some bizarre diets out there).
• The same diet is recommended for everyone without accounting for specific needs such as age, gender, body size and activity levels.

If you need help on your journey to a healthier weight and lifestyle, our nutritional experts at Nutrition Solutions are there to help you. Ask them a question here, or visit their website. 

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Jade Seeliger

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