Are you saying all of those complications are not possible in a flu pandemic?
No no, I mentioned in my response to Pogue that a lot of them are
Bear in mind I'm referring to seasonal and not pandemic flu. I don't take seasonal flu lightly, first thing I tell my patients in GP surgery is to get their flu jab.
My first job was in respiratory medicine as a junior (albeit in the summer) but I have worked in A&E and resus in the winter and my acute medical rotation was in a second tier NIV-equipped ward which saw complicated flu patients
Certainly we do see pneumonias, myopathies, myocardial involvement, encephalitis, GBS, sepsis, worsening of chronic diseases with flu in addition to delirium in the elderly. But my point is the incidences of those complications and like I said covid is new so we're still awaiting data but the breath of complications are more vast
I don't know how prevalent coagulopathies are for example in the instance of severe flu, nor the degree of acute kidney injuries or ARDS which are features of COVID.
By every metric from what I've seen in my line of work covid patients even the non-ITU ones have been sicker. The white outs on their chest Xrays are more, the lactates, trops and d-dimers are higher, electrolytes more deranged, eGFRs and blood pressures are lower, oxygen sats are lower, pH's more acidotic, the older's one arrest more, the younger ones arrest too or reach peri-arrest very easily and often. And they need to be on tubes for longer, harder to wean off, get intubated more often, inotrope needs are higher, get way more secretions and require more intense chest physio. And I'm using as a comparison the sick, young, few comorbidities complicated flu vs complicated covid for comparison as best as I can from memory and experience.
But of course we have to wait for the formal data.
I think certainly the R0 for covid might be higher but flu has a shorter median incubation period (the time from infection to appearance of symptoms) and a
shorter serial interval (the time between successive cases) than COVID which means flu in theory can spread faster. Mortality I think for covid generally is higher and I don't know whether the seasonal flu we see year after year is something that is a less deadly strain and that we are getting more immune to it and as a result most are not as ill
Incidentally my wife works as a dermatologist, covid presents in all weird and wonderful dermatological manifestations but she has just biopsied a potential toxic epidermal necrolysis (TEN) patient secondary to covid. TEN is a rare but very serious condition and one of the few true derm emergencies. I don't think I've seen case reports of TEN secondary to covid in literature yet but yet another one to add to how shitty covid is.
So I just think prognostic implications on a population wide basis if our strategy is gradual herd immunity (or if that just seen as an inevitable clincal end point) that we take into consideration prevalence and extent of complications beyond case fatality rate.