Why I Am LESS Concerned About the Coronavirus-Episode 1

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[This is NOT the most recent blog in this series. My current thinking on this issue is better reflected by the Dan Bongino interview in Episode 4 or Episode 5 which covers the urgent need for us to begin to take steps to avoid the overload of our health systems. Meaning while the opinions expressed in this blog are still backed by data, the catch is that to have lower mortality rates we need to shut down our society due to our lack of ability to test for the coronavirus at scale as of the end of the week ending 3/13/20.].

You can’t turn on a computer screen, a TV, or look at a phone without dozens of new stories about how the deadly Coronavirus is lurking like a silent killer waiting to end millions of lives. You hear terms like “pandemic”, ICU”, and “Emergency Funding”. The shelves at COSTCO are bare. Any sane person would be scared and freaked out at this point. However, I’m neither. Why? Because if you look at the actual science emerging and read through the media hype, what you see is VERY different. Let’s dig in.


To quickly review, the Coronavirus disease is much like the flu. Its scientific name is COVID-19. ‘CO’ stands for ‘corona,’ ‘‘VI’ for ‘virus,’ and ‘D’ for disease. The “-19” indicates that it was first detected in 2019. The common name often used for this disease, called “Coronavirus” is really medical slang as that’s just a common virus type. The virus that causes the disease has been named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). Now let’s dig into why is everyone so freaked out.

The 1918 Pandemic

If you’re a virologist or epidemiologist, the “big one” happened just after World War I. This was called the 1918 Spanish Flu Pandemic. This influenza virus had a 2-3% mortality rate and killed an estimated 30 million people worldwide (1.7% of the world’s population). That number is hard to compare to today because this was before modern medicine and intensive care techniques that began in the Korean War and Vietnam. Now we have ventilators, anti-viral, drugs, and modern life support. In 1918 we didn’t even have simple things that can save lives like the widespread use of oxygen.

How Lethal Is the Regular Flu?

The average seasonal flu kills between 291,000 to 646,000 people worldwide each year (1). Before I dive into the Coronavirus you need to think about that for a second. Half a million people die from the average flu bug each winter.  The CDC recently announced that the seasonal flu has killed 20,000 people in the United States this year with 350,000 hospitalizations (5). To date, worldwide, less than 4,000 people have died of Coronavirus. That’s less than 1% of the number of people who die from the seasonal flu.

Why Then the Panic?

The panic is over the death rate per 100 patients reported out of Wuhan China, where the Coronavirus began. At one point, we heard very high numbers like 3-4% of everyone who contracted the disease or even twenty percent or more of the elderly. The average seasonal flu has much lower death rates.

How Lethal Is Coronavirus?

So just how lethal is this Coronavirus disease (COVID-19) versus the average flu? After all, if it’s a real killer of healthy young and middle-aged people you should be freaked out. If it’s really just like a bad flu bug, you should just go about your business, wash your hands frequently, and not be concerned. Hence, this is the multi-billion dollar question.

How Lethal Is the Average Seasonal Flu?

This is a really interesting one. From the paper above, mortality rates as low as 0.05% to as high as 3.5% have been reported. The fact that the high number is from southeast Asia is important (see below). The new death rate for seasonal flu worldwide, based on the most recent models, is 0.03% for people under 65 years of age and about 3% for the elderly over 75. You also need to keep in mind that most of the young who die from the seasonal flu have problems like a significant respiratory disease.

How Lethal Is COVID-19?

The most accurate data on case fatalities is from the only natural experiment that exists, the Diamond Princess cruise. Why a cruise ship? Because this is a closed environment where we can accurately measure every person who gets sick and know the real number of people who perish based on that exposure.

The cruise ship data shows a fatality rate of 0.85%. All of the people that perished were over 70, which is much more like the seasonal flu. In addition, the ability of the virus to spread was again, not that impressive as only about 20% got the virus. So while this bug is nasty, it’s NOT the middle-aged killer that the media has been making it out to be.

[3/11/20 update] Here’s some new data since this post first published:

  • The outside of Wuhan Chinese death rate reported by their CDC is 0.4% (6)
  • The South Korean death rate being reported is 0.65% (7)

Why the Huge Difference in Death Rates?

First, the death rates in the first part of any outbreak are always wildly inflated. Why? They are based on only the number of people who are sick and are tested for the virus while ignoring the greater number of people who contract the virus, get a little sick for a few days, and never get tested. When you add in all of those healthy people who shrugged the virus off, the death rates almost always plummet. Here are a few science-focused articles on this topic:

Second, there are other factors that could explain the differences. For example, 2/3rds of Chinese men smoke (compared to 15% of US men) (4). China also has severe air pollution compared to the US:

China is also significantly denser (4-5X the US), which facilitates viral transmission. In addition, China has many “Wet Markets” where live animals are kept in tight conditions and then slaughtered on the spot to be sold as food. You honestly couldn’t create a more perfect animal to human viral transmission model. In fact, it’s believed the coronavirus began in an animal sold in these markets called a pangolin.

What Should You Do?

If you’re healthy and under the age of 70 without any known respiratory problems or other serious health conditions, then the list below applies to you. If you’re elderly and/or have respiratory or other serious health problems like heart disease, then you’re in a higher risk category, more on that below.


  • Panic and go clear out your local grocery store shelves!
  • Buy masks unless you’re the one that has a cough
  • Cancel trips


  • Wash your hands frequently with soap for 20 seconds!
  • Use hand sanitizer when you can’t wash your hands (must be >60% alcohol)
  • Stay home if you’re sick
  • Ask for a local COVID-19 test if you think you have the flu (the symptoms of this one are a fever and a dry cough)
  • Observe strict quarantine rules if you test positive

Can Weather Help?

Check out the CDC graph below that shows that viral flu transmission goes way down after March (3). While the coronavirus isn’t the seasonal flu, transmitting it seems to obey the same rules as viral influenza.

High-Risk Individuals

Again, if you’re in a high-risk category, you may want to be more careful. For now, if you’re over 70 or have a respiratory problem that’s being actively treated (like COPD), you might want to consider limiting travel and contacts. However, even then, you have to put this in context. You need to ask yourself if you would cancel trips and stay indoors if you knew that it was a bad flu season with a bad bug or would you just go about your business and wash your hands frequently? That’s a choice only you can make.

Finally, authorities will make local recommendations for high-risk individuals based on the evolving data being collected here and elsewhere, so pay attention to those public health advisories. For example, in the US this may take the form of limiting nursing home visits. As another example, in Italy, they have recently closed down tourism to the Lombardy region. 

The upshot? After a deep dive into the best data we have, I am LESS concerned about the Coronavirus. I am, however, looking forward to some empty planes and airports!

[ We usually allow comments on this blog, but the comments on this post have not generally been constructive, so they will be suspended.]. 


(1) Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study [published correction appears in Lancet. 2018 Jan 19;:]. Lancet. 2018;391(10127):1285–1300. doi: 10.1016/S0140-6736(17)33293-2

(2) Faust J. COVID-19 Isn’t As Deadly As We Think. Slate.  https://slate.com/technology/2020/03/coronavirus-mortality-rate-lower-than-we-think.html Accessed 3/6/20.

(3) Centers for Disease Control. The Flu Season. https://www.cdc.gov/flu/about/season/flu-season.htm Accessed 3/8/20

(4) Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. 2015;386(10002):1447–1456. doi:  10.1016/S0140-6736(15)00340-2

(5) Centers for Disease Control. Weekly U.S. Influenza Surveillance Report https://www.cdc.gov/flu/weekly/index.htm Accessed 3/8/20

(6) Chinese Center for Disease Control and Prevention CCDC Weekly. The Epidemiological Characteristics of an Outbreak of 2019 Novel
Coronavirus Diseases (COVID-19) — China, 2020. Vol. 2. No. 8. http://weekly.chinacdc.cn/fileCCDCW/journal/article/ccdcw/2020/8/PDF/COVID-19.pdf

(7) Kolate G. Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How. The New York Times. https://www.nytimes.com/2020/03/09/science/coronavirus-is-very-different-from-the-spanish-flu-of-1918-heres-how.html Accessed 3/10/20

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42 thoughts on “Why I Am LESS Concerned About the Coronavirus-Episode 1

  1. DavefromLA

    This is the best article I’ve read on this topic. Thank you for the analysis, context and common sense advice! And in addition to empty airline seats, I’m enjoying stocks on sale.

  2. Jeananne Alberding

    Thank you for putting into words my feelings about all the hype. God bless!!!

  3. Becky

    Yes, a very good article. Just a few thoughts.
    What percentage of the Chinese population get the seasonal flu shot? That will affect how many get seasonal flu and how many die from it.
    Without a vaccination for COVID-19 our percentage of cases will be much higher than our seasonal flu cases.

    1. Chris Centeno, MD Post author

      That could certainly impact Chinese death rates. The flu vaccination rate in China was 23%. https://www.ncbi.nlm.nih.gov/pubmed/30340886 For adults, ours is about double that: https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm Hence, that wouldn’t account for a 5-6 times higher death rate in China.

  4. David Roodman

    Label the US-China graph! What are the units? Otherwise this looks like pseudoscience. 8000 deaths vs 1000? China has a lot more people do this is not surprising.

    1. Chris Centeno, MD Post author

      See reference #4 where there is a link. This is median deaths per 100,000

  5. David Roodman

    So 8.25% of Chinese die each year from the flu, 110 million people?

    1. Chris Centeno, MD Post author

      David, I think you’re mixing up concepts here. There two main conditions:

      1. Primary deaths due to the flu-meaning the flu is the only known cause of death with or without comorbidities. This is the same as “excess deaths”, meaning if not for the influenza virus the person would still be alive. This is like the death rate reported on the Princess cruise. Meaning, while it happens, it’s very unlikely that someone during the average cruise would perish due to respiratory disease. Hence, any respiratory associated deaths during a SARS type outbreak would be very likely to be a death related to the outbreak.
      2. Secondary deaths due to influenza, which is is the same as “Influenza associated respiratory deaths”. These are people who may or may not have died due to respiratory disease but who also had the flu.
      Teasing these numbers out is very difficult outside of closed systems like a cruise.
      So is it hard to believe that 8% of Chinese perish every year due to having a respiratory disease and the flu and that nobody can really tease out which caused their death? Nope. The same for about 1.5% in the US. Also note in that same table 19 that the Chinese number is not considered as accurate as the US number.

  6. Bea

    I have copd with oxygen will that help when I am out

    1. Chris Centeno, MD Post author

      If you have COPD and are oxygen dependent, you are a high-risk patient and should avoid being out and about until it’s safe.

  7. David Roodman

    Chris I think you are the one who is confused and in a way that calls into question whether you should be opining on epidemiology, especially when the stakes are potentially so high. A quick Google search says the crude death rate on China is 7 per 1000, which is 700 per 100,000. Of which 8000 can be associated with the flu?? I think the numbers you cite are actually absolute totals, not rates. Please fix and flag the error(s) before you mislead more people.

    1. Chris Centeno, MD Post author

      David, you’ll need to contact the authors of that paper. Digging into this further and corroborating it versus other papers, it looks like the authors could be quoting the number of flu-related respiratory deaths. This paper discusses that 8.2% of all respiratory deaths are influenza: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30163-X/fulltext In the end though, not sure it matters since I’ve made no claim in the blog about the absolute number reported by the paper (you’re the one that brought that up), just the comparison between the two countries. So given that about 15% of US men smoke and 68% of Chinese men smoke, is it hard to believe that China would have 5-6X the influenza deaths than the US?

  8. Deborah

    Good article! I am still confused, however. I am a healthy 70 year old with no underlying health issues. The recommendations I see suggest people OVER 70 or those with health issues avoid air travel. If the planes are now not jam-packed and I disinfect my seat area/tray table, is flying domestically truly risky for me?

    1. Chris Centeno, MD Post author

      You are at higher risk due to your age. The problem is that we don’t really have good data to say exactly what that risk is at this point. Here’s an example, if you were to contract the flu, there’s only a very small chance you would perish (about 30-40 people per 100,000). We really don’t know what that real rate is for COVID-19 in a 70-year-old. The best estimate is the cruise ship model I discussed, which was 0.85% of patients 70 or older perished. A cruise would be expected to have a very high viral load (meaning it’s hard not to come in contact with lots of viruses). While we don’t know the medical histories of those patients, in general, the elderly on cruises are usually not the same active elderly biking through France. So the actual death rate in healthy 70-year-olds is likely less than 0.85%. So if you contracted COVID-19, a big if based on the fact that only 20% of the people on the cruise tested positive, then you are at more risk than a 20-year-old, but there is only a small chance of dying from the disease. That risk, however, is likely higher than dying from the flu.

  9. Kayla

    What do you think about the risk for pregnant women? There isn’t much research on how it affects an unborn child.

    1. Chris Centeno, MD Post author

      This is unknown at this point, but to date, the Chinese data showed that no child under the age of 10 has died, so this is not a disease that hits the pediatric population hard. It hits the elderly hard. Keep an eye out for information on pregnancy from the CDC.

  10. Jeremiah P.

    Articles like this give false assurance. There’s no mention of the death rate in Italy, the fact that the virus is aerosolized (unlike the flu), it lives on surfaces longer than flu, it’s communicable when pre-symptomatic, and consequently has an R-value a lot higher than flu. Even under the best circumstances it’ll be 5x-10x more deadly than flu here in the US. So, yeah, if you’re in the smoke free and totally healthy population, maybe you fall in the 80% “safe” category but I bet you know friends and loved ones who fall into the other 20% of people who will have complications when hospitals are under stress. Compound all this with the fact that many people do not have adequate health insurance and avoid seeing a doctor until they’re very sick (unlike China, Japan, South Korea and Italy).

    1. Chris Centeno, MD Post author

      The flu spreads primarily through aerosolization, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372341/ as does coronavirus. The mean age of people dying in Italy is >81 years based on information today from the Italian health ministry, see https://www.bbc.com/news/world-europe-51799956. The death rate for the flu in that age group varies from 1-40% depending on medical comorbidities, see https://www.nature.com/articles/s41598-018-27694-6 Your 80/20% number is incorrect. Outside of Wuhan, the death rate in China was 0.4%, see http://weekly.chinacdc.cn/fileCCDCW/journal/article/ccdcw/2020/8/PDF/COVID-19.pdf As far an emergency medical care, every state has laws that require all patients who come into the ED in medical distress to be treated.

  11. K'Lann Hamende

    How do you think this affects pregnant women? I am currently in my 2nd trimester. I’m trying to decide if I should go on a trip to South Carolina involving airports next week. Thanks. Your article has been very helpful.

    1. Chris Centeno, MD Post author

      This is unknown at this point, but to date, the Chinese data showed that no child under the age of 10 has died, so this is not a disease that hits the pediatric population hard. It hits the elderly hard. Keep an eye out for information on pregnancy from the CDC.

  12. Brad

    Okay, so you’re not concerned because you’re relatively young and healthy. After all, it is all about you – Right? Since the flu has only a 1-4 day incubation period (2 being the average), you’d know fairly soon if you were exposed. With the Covid-19 virus, the incubation period is up to 14 days; as far as is known. So if you work on your premise of this only being a bad flu – how many people would you infect before potentially getting sick?

    1. Chris Centeno, MD Post author

      The incubation period for coronavirus is longer. This is why I have advised everyone who is sick to stay home and if you have a fever and dry cough to get tested. If you test positive, then you should strictly obey quarantine rules.

  13. Audrey Clonch

    Thanks for the article, feel a bit better flying back to UK this evening from Baltimore. (Live in LA and very much on fence all weekend trying to decide on canceling plans and going home-like most are doing)…
    My question is what about the permanent lung damage it’s said to be causing? Do we risk-at best-being on oxygen permanently after contracting this beast? Is this also more common in smokers, copd/emphysema patients and those in poor air quality cities?

    1. Chris Centeno, MD Post author

      As the blog states, severe cases are mostly in the elderly. As far as permanent lung damage, the virus is only about 6 months old, so that would be unknown at this point.

  14. Joe

    Good sane article and the numbers match up with the CDC. I have a trip to Paris planed in May and like you would go because the crowds would be way less, but if the Louvre and all the other major attractions are closed, why go?

    1. Chris Centeno, MD Post author

      Viral transmission drops off a cliff as temperatures warm and is very low in May through the summer. I have a trip to Europe in late May with my family and we’re still going.

  15. Bill

    What you’re forgetting is this is a new virus compared and Thai strain of the virus is a few months old and is spreading expressly fast.
    What we know about the flu and how to treat it is much different than a new virus.

    Yes, don’t panic and be smart.

    No, don’t encourage people to think this isn’t important.

    1. Chris Centeno, MD Post author

      I have encouraged no one to think this is not important, please see my recommendations for high-risk people contained in the blog. The good news here is that the Chinese learned quite a bit about how to treat COVID-19 and the US will benefit greatly from that knowledge.

  16. Jo-Ann

    I agree with some of your points, that being said, if countries were not putting up travel advisories
    this virus would spread rapidly. until they really know what they are dealing with, I’ll take the required precautions.
    It really is not in our control, You may be sitting on a plane by yourself and not going anywhere.
    Only one person has to get sick on a plane, or bus and then the whole group is quarantined, not my idea of a holiday!

    1. Chris Centeno, MD Post author

      I haven’t seen any evidence of testing passengers on a plane and that resulting in a quarantine of the passengers. If you have evidence of that, please post. I think you may be thinking of the place they chartered to get Americans out of Wuhan or the planes coming in from certain countries with high rates of community spread.

  17. Joann Carroll

    This has reassure me that if something doesn’t change I will be seeing my daughter and grandkids on the 26th. The only thing I have is high blood pressure and cholesterol problems. I think I have my anxiety under control.

  18. Odii G

    While this article is insightful, frankly, I am surprised coming from an MD. A couple of concerns: 1) While it is NOT the flu and its mortality concerns are really not as high as influenza, it is disconcerting that this virus has the ability to impact groupings, gatherings, or cruise ships this quickly and specifically. While the flu can do the same, it does not spread or “attack” cruise ships aggressively with likely imminent threat to life (for those in that particular age group). There is no vaccine at the moment and it is not likely to be seen for a year. But for comparison, let’s say there is a stomach virus discovered at the one of these cruise ships (which has happened). It can be deadly say for elderly even children. There is no vaccine. It can be treatable. But local quarantine is still advised. Now take that situation times global. Should there be more concern at that level? I think so.
    2) I think we should know it is not a matter of getting and surviving the virus. It is a matter of continued transmission of it maybe onto someone who is not able to survive. Until there is a better “grip” on this virus, then I still think it is NOT advisable to taking it lightly.

    1. Chris Centeno, MD Post author

      20,000 people last year died of the flu in the US with 350,000 hospitalizations and about 500,000 died worldwide due to the flu. That compares to under 4,000 coronavirus deaths. The flu is plenty lethal to the elderly with death rates of 1-40% depending on medical comorbidities, see https://www.nature.com/articles/s41598-018-27694-6. As far as cruise ships, flu outbreaks impacting the elderly on cruise ships are common, you just don’t hear about them splashed on the news: see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869710/ Nobody is advising that anyone take coronavirus lightly, we should all take it seriously, but the level of panic that is being spread is not a net positive, but a net negative.

  19. Mindy

    You have the name of the virus and the name of the disease backwards. Virus = SARS-CoV-2
    Disease = COVID-19. Check the CDC webpage.

    1. Chris Centeno, MD Post author

      That’s what I have in the blog, please read again…

  20. fiona sartoretto verna

    Dear Chris, until 1 week ago I thought exactly like you but Corona is 20 times more infective than a normal flu this means that death rate can increase exponential, overall in countries where there’re no enough intensive care room. This is what’ s happening in Italy, this is why in China they built an hospital in 10 days, this is why is better no travel. or stay in mass in contact with a lot of people.
    This kind of pleumonia needs icu!! what about if there no anymore in hospitals? Death rate increase from 2% UP now we are at 5.7% and are not all bad conditions and old people, there re also young health people ( 38 and up!).

    1. Chris Centeno, MD Post author

      Fiona, the Italian health minister just released that the average age of death due to SARS-COV-2 virus (COVID-19) was >81 years, see https://www.bbc.com/news/world-europe-51799956

  21. Eric Nystrom

    Chris, thank you for the insightful discussion and pertinent information shared regarding the Corona Virus.

    This is to the people who are all but attacking you due to this post. Please do everyone, including Chris, a favor and don’t begin by attacking his research and assumptions. If you have a disagreement, state the disagreement and ask for clarification.

    He has been very open, pleasant and honest about what he has found and communicated through this article. It is unfair to treat him with anything less than professional courtesy. If his conclusions are not the same as yours, you are more than welcome to state that and then you can go write your own article somewhere. Hopefully if you do that, people will not attack you for trying to provide information.

    Thank you for helping keep the discussion civil.

    1. Chris Centeno, MD Post author

      Thanks, Eric. I think that, regrettably, this topic has become political. My investigation into this was because I was getting bombarded by patients and my own extended family with questions, so I began to look at all of the information and I drew a conclusion that I have shared with my patients, family, and my readers.

  22. Russ

    I would like to see more discussion about the wet markets being closed down, especially when endangered animals like the pangolin are involved. The pangolin is the most trafficed animal in Africa.

    There is no need nor benefit eating pangolins or other endangered species. Same with Rhino horn.

  23. Lou

    I am an 89 year old female. I have kidney disease which is under control…now in the normal range. My BP is also now under control. Everything else is normal. I have seasonal allergies. My only concern is I live in an Independent Living place with approximately 300 residents. I usually escape colds and the flu. Is there anything I should/could do to avoid contracting this illness?

    1. Chris Centeno, MD Post author

      Lou, you are in a high-risk category, so I would listen to the latest CDC guidelines about restrictions on travel.

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