Fact Check: COVID-19 Deaths In 2020 Were NOT Mislabeled As Flu Deaths

Bad Math

Were influenza deaths mislabeled as COVID-19 deaths in 2020 to inflate the toll of the SARS-CoV-2 pandemic? No, that’s not true: Registered deaths attributed to COVID were categorized separately from influenza and pneumonia by national and international surveillance programs.

The claim originated in a tweet posted in April 2, 2022, that suggested deaths attributed to COVID were actually caused by the flu and that death statistics were mislabeled to exaggerate the actual toll of the pandemic. The claim re-emerged in an Instagram post shared on November 4, 2022. It read:

2.9 million people died of Influenza and Pneumonia in 2018

98% decline in influenza cases 2020

2.8 million “die of covid” in 2020

…it’s really not that hard figure out what they’ve done

Here is how the post appeared at the time of writing:

(Source: Instagram screenshot taken Fri Nov 4 15:19:33 UTC 2022)

It’s not clear where these statistics came from as the original poster did not credit any official sources, records or data, nor did they specify whether these statistics were said to represent U.S. or global deaths or otherwise. A search for the statistics in question by Lead Stories did not return any results.

Below is a breakdown of actual U.S. and global COVID death rates compared to deaths attributed to influenza and pneumonia, as analyzed by Lead Stories:

• U.S. statistics: In 2018, there were between 28,000 and 34,200 estimated deaths attributable to influenza. Pneumonia was the underlying cause of 47,956 deaths. In 2020 the “final, official tally of COVID-19 deaths” was 350,831.
• Global statistics: The World Health Organization (WHO) estimates that seasonal influenza causes between 290,000 and 650,000 deaths each year; however, it does not track global flu mortalities, only cases. COVID deaths in 2020 are believed to be at least 3 million, according to WHO data.

COVID was listed as a cause of death for the first time in 2020, alongside deaths attributed to influenza and pneumonia. COVID was not merely a new name for the flu, and official reports showed deaths from the two causes listed alongside one another.

Both influenza and COVID are respiratory diseases with similar symptoms, but laboratories use different molecular tests to confirm the source infection. As its name suggests, the flu is caused by influenza viruses while COVID is caused by a specific coronavirus. Health Feedback, a cohort of scientists who debunk online misinformation, writes that pneumonia is an “infection of the lower respiratory system that can be caused by many bacteria and viruses, including the influenza virus and SARS-CoV-2.”

Tracking influenza and COVID deaths in the U.S.

None of the statistics presented by health officials add up to the figures posted in the Twitter and Instagram posts.

The National Center for Health Statistics (NCHS) pointed to three annual death reports for 2018, 2019 and 2020 in an email sent to Lead Stories on November 7, 2022:

• 2018: 2,839,205 total registered U.S. deaths with 14.9 per 100,000 that listed either influenza or pneumonia as an underlying cause. This equates to a total of 59,120 deaths, making up 2.1 percent of all causes. Of these, 11,164 deaths were reported to have been caused by influenza.

• 2019: 2,854,838 total registered U.S. deaths with 12.3 per 100,000 that listed either influenza or pneumonia as an underlying cause. This equates to 49,783 deaths, making up 1.7 percent of all causes. Of these, 5,902 were reported to have been caused by influenza.
  

• 2020: 3,383,729 total registered U.S. deaths with 13 per 100,000 that listed either influenza or pneumonia as an underlying cause. This equates to 53,544 deaths attributed to influenza, making up 1.6 percent of all causes. Of these, 5,943 were reported to have been caused by influenza.

• COVID, by comparison, resulted in 85 deaths per 100,000 in 2020. This equates to 350,831 deaths, making up 10.4 percent of all causes and marking COVID as the third leading cause of death in that year. In total, 2020 saw more than a half million more deaths than in 2019.

The CDC estimated that 28,000 to 34,200 deaths in 2018 were attributable to influenza (not the lower number above) because influenza deaths are likely underreported. The CDC categorizes influenza and pneumonia deaths as the sum of deaths with an underlying cause of either condition; deaths in that category do not necessarily have both influenza and pneumonia reported, Robert Anderson, NCHS chief of the Mortality Statistics Branch, told Lead Stories in a November 9, 2022, email.

It is true that there was a sharp decline in influenza cases during the pandemic. Between September 28, 2020, and May 22, 2021, the CDC recorded that 1,675 (0.2 percent) of 818,939 respiratory cases tested in the U.S. were positive for an influenza virus.

“For comparison, during the last three seasons before the pandemic, the proportion of respiratory specimens testing positive for influenza peaked between 26.2% and 30.3%,” wrote the health agency.

Contrary to the suggestion presented in the social media post, experts largely credit this reduction in flu cases and deaths to pandemic-era preventative measures and non-pharmaceutical interventions, like wearing masks and social distancing, that resulted in declines in many respiratory virus infections, including influenza. Additionally, a record number of influenza vaccine doses (193.8 million) were distributed in the U.S. during this timeframe.

Tracking flu and COVID deaths around the world

Global COVID deaths in 2020 are believed to be at least 3 million, according to data published by WHO. Seasonal influenza is estimated to cause between 290,000 and 650,000 deaths each year. WHO does not report influenza mortality around the world, but it is true that lab-confirmed flu cases also decreased dramatically globally between July 2020 and July 2021 compared to previous years, suggesting that flu deaths were also down during this time period.

(Source: WHO screenshot taken Tues Nov 8 15:29:57 UTC 2022)

Global excess deaths, or the difference between the number of deaths that occurred and how many would be expected in the absence of the pandemic based on data from earlier years, was determined by WHO to be about 14.9 million attributable to COVID between January 1, 2020 and December 31, 2021.

Previous Lead Stories fact checks about influenza can be found here.