Early in the pandemic, there was an article written by an MD calling out the high estimates of flu mortality:
[I]n four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu. I could only remember one tragic pediatric case.
Based on the CDC numbers though, I should have seen many, many more. In 2018, over 46,000 Americans died from opioid overdoses. Over 36,500 died in traffic accidents. Nearly 40,000 died from gun violence. I see those deaths all the time. Was I alone in noticing this discrepancy?
I decided to call colleagues around the country who work in other emergency departments and in intensive care units to ask a simple question: how many patients could they remember dying from the flu? Most of the physicians I surveyed couldn’t remember a single one over their careers. Some said they recalled a few. All of them seemed to be having the same light bulb moment I had already experienced: For too long, we have blindly accepted a statistic that does not match our clinical experience.
Effectively, this doctor was asking “who should we believe, statistics or our own lying eyes?” They incorrectly chose to believe their own lying eyes. In fact, they probably see people dying of flu all the time, but fail to recognize it as a flu death.
For any individual case, it can be literally impossible to know whether it’s a flu death or not: someone has the flu in April and a heart attack in May. Is it a flu death? Literally impossible to know. Only aggregate numbers does it even make sense to ask the question of excess deaths.
Cases like someone dying of a bacterial pneumonia caught while suffering from flu are perhaps easier to attribute to the flu, but different countries count those differently.