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Journal of Zhejiang University SCIENCE B 2021 Vol.22 No.2 P.87-98


Comparison of COVID-19 and influenza characteristics

Author(s):  Yu BAI, Xiaonan TAO

Affiliation(s):  Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China

Corresponding email(s):   taoxn2004@163.com

Key Words:  Coronavirus disease 2019 (COVID-19), Influenza, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

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Yu BAI, Xiaonan TAO. Comparison of COVID-19 and influenza characteristics[J]. Journal of Zhejiang University Science B, 2021, 22(2): 87-98.

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The emergence of coronavirus disease 2019 (COVID-19) not only poses a serious threat to the health of people worldwide but also affects the global economy. The outbreak of COVID-19 began in December 2019, at the same time as the influenza season. However, as the treatments and prognoses of COVID-19 and influenza are different, it is important to accurately differentiate these two different respiratory tract infections on the basis of their respective early-stage characteristics. We reviewed official documents and news released by the National Health Commission of the People's Republic of China, the Chinese Center for Disease Control and Prevention (China CDC), the United States CDC, and the World Health Organization (WHO), and we also searched the PubMed, Web of Science, Excerpta Medica database (Embase), China National Knowledge Infrastructure (CNKI), Wanfang, preprinted bioRxiv and medRxiv databases for documents and guidelines from earliest available date up until October 3rd, 2020. We obtained the latest information about COVID-19 and influenza and summarized and compared their biological characteristics, epidemiology, clinical manifestations, pathological mechanisms, treatments, and prognostic factors. We show that although COVID-19 and influenza are different in many ways, there are numerous similarities; thus, in addition to using nucleic acid-based polymerase chain reaction (PCR) and antibody-based approaches, clinicians and epidemiologists should distinguish between the two using their respective characteristics in early stages. We should utilize experiences from other epidemics to provide additional guidance for the treatment and prevention of COVID-19.


概要:由于新型冠状病毒型肺炎(COVID-19)和流感的治疗和预后不同,因此在使用核酸或抗体检测之前根据各自的早期特征准确区分这两种不同的呼吸道感染非常重要。为了帮助临床医生和流行病学家根据两种疾病各自的特点区分两者,我们作此综述。我们查阅了中华人民共和国国家卫生委员会、中国疾病预防控制中心、美国疾病控制中心和世界卫生组织发布的官方文件和新闻,并搜索了PubMed、Web of Science、Embase、知网、万方、预印本bioRxiv和medRxiv数据库,查找最早可用日期至2020年10月3日的文件和指南,获得了有关新冠肺炎和流感的最新信息,并对其生物学特征、流行病学、临床表现、病理机制、治疗和预后因素进行了总结和比较。虽然新冠肺炎和流感有很多不同之处,但也有很多相似之处,所以临床医生和流行病学家应该尽早区分它们,但在区分的同时也要注意两种疾病合并的可能。严重急性呼吸综合征冠状病毒2(SARS-CoV-2)和流感病毒都具有传染性高、发病率高、发病快、易变异的特点。SARS-CoV-2的传播率高于季节性流感,而季节性流感的死亡率远低于新冠肺炎。流感患者往往比新冠肺炎年轻,14岁以下的儿童相比新冠肺炎更容易患流感。与流感患者相比,新冠肺炎感染者更常见的是化学感觉障碍、皮疹的出现和生殖系统受损;新冠肺炎患者比流感患者更容易出现明显的全身性症状和干咳;流感患者发热相较于新冠肺炎患者更趋向于高热。影像表现方面,新冠肺炎患者磨玻璃样阴影多位于周边,累及下叶;流感患者阴影多呈中央型、外周型或随机型,纵隔气肿和气胸仅在流感研究中报道。病理上,流感患者的肺纤维化、血栓和出血比新冠肺炎患者更常见。流感患者的预后不良因素倾向于年轻和怀孕,但在新冠肺炎患者中这些都不是预后因素,而肥胖、具有其他合并症和老龄与死亡率的升高有关。


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[1]Ayerbe L, Risco-Risco C, Ayis S, 2020. The association of treatment with hydroxychloroquine and hospital mortality in COVID-19 patients. Intern Emerg Med, 15(8):1501-1506.

[2]Bennett JE, Dolin R, Blaser MJ, 2015. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th Ed. Elsevier, Philadelphia, USA.

[3]Bloch EM, Shoham S, Casadevall A, et al., 2020. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest, 130(6):2757-2765.

[4]Bonmarin I, Belchior E, Bergounioux J, et al., 2015. Intensive care unit surveillance of influenza infection in France: the 2009/10 pandemic and the three subsequent seasons. Euro Surveill, 20(46):30066.

[5]Brun-Buisson C, Richard JCM, Mercat A, et al., 2011. Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med, 183(9):1200-1206.

[6]Cao B, Li XW, Mao Y, et al., 2009. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med, 361(26):2507-2517.

[7]Carlson SJ, Scanlan C, Marshall HS, et al., 2019. Attitudes about and access to influenza vaccination experienced by parents of children hospitalised for influenza in Australia. Vaccine, 37(40):5994-6001.

[8]Centers of Disease Control and Prevention, 2020. Weekly U.S. Influenza Surveillance Report. https://www.cdc.gov/flu/weekly/index.htm

[9]Chan KW, Wong VT, Tang SCW, 2019. COVID-19: an update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese-Western medicine for the management of 2019 novel coronavirus disease. Am J Chin Med, 48(3):737-762.

[10]Chen NS, Zhou M, Dong X, et al., 2020. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 395(10223):507-513.

[11]Committee on Infectious Diseases, 2014. Recommendations for prevention and control of influenza in children, 2014‒2015. Pediatrics, 134(5):e1503-e1519.

[12]Cowling BJ, Jin LM, Lau EHY, et al., 2013. Comparative epidemiology of human infections with avian influenza A H7N9 and H5N1 viruses in China: a population-based study of laboratory-confirmed cases. Lancet, 382(9887):129-137.

[13]Cox NJ, Subbarao K, 1999. Influenza. Lancet, 354(9186):1277-1282.

[14]Doxey M, Chrzaszcz L, Dominguez A, et al., 2019. A forgotten danger: burden of influenza mortality among American Indians and Alaska natives, 1999-2016. J Public Health Manag Pract, 25(Suppl 5):S7-S10.

[15]Drosten C, Günther S, Preiser W, et al., 2003. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med, 348(20):1967-1976.

[16]Fan CB, Li K, Ding YH, et al., 2020. ACE2 expression in kidney and testis may cause kidney and testis damage after 2019-nCoV infection. medRxiv, preprint.

[17]GBD 2017 Influenza Collaborators, 2019. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017. Lancet Respir Med, 7(1):69-89.

[18]Geleris J, Sun YF, Platt J, 2020. Observational study of hydroxychloroquine in hospitalized patients with COVID-19. N Engl J Med, 382(25):2411-2418.

[19]Grant WB, Lahore H, McDonnell SL, et al., 2020. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients, 12(4):988.

[20]Grein J, Ohmagari N, Shin D, et al., 2020. Compassionate use of remdesivir for patients with severe COVID-19. N Engl J Med, 382(24):2327-2336.

[21]Guan WJ, Ni ZY, Hu Y, et al., 2020. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 382(18):1708-1720.

[22]Han QZ, Wen XM, Wang L, et al., 2020. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal, 34(5):e23191.

[23]Harper SA, Bradley JS, Englund JA, et al., 2009. Seasonal influenza in adults and children-diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 48(8):1003-1032.

[24]Hill A, Gillings S, Berriman A, et al., 2019. Quantifying the spatial risk of avian influenza introduction into British poultry by wild birds. Sci Rep, 9:19973.

[25]Huang CL, Wang YM, Li XW, et al., 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 395(10223):497-506.

[26]Isenor JE, O'Reilly BA, Bowles SK, 2018. Evaluation of the impact of immunization policies, including the addition of pharmacists as immunizers, on influenza vaccination coverage in Nova Scotia, Canada: 2006 to 2016. BMC Public Health, 18:787.

[27]Iuliano AD, Roguski KM, Chang HH, et al., 2018. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet, 391(10127):1285-1300.

[28]Jaillon S, Berthenet K, Garlanda C, 2019. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol, 56(3):308-321.

[29]Jia XH, Liu B, Bao LL, et al., 2018. Delayed oseltamivir plus sirolimus treatment attenuates H1N1 virus-induced severe lung injury correlated with repressed NLRP3 inflammasome activation and inflammatory cell infiltration. PLoS Pathog, 14(11):e1007428.

[30]Kalarikkal SM, Jaishankar GB, 2020. Influenza vaccine. In: Abai B, Abu-Ghosh A, Acharya AB, et al . (Eds. ), StatPearls . StatPearls Publishing, Treasure Island (FL).

[31]Kalil AC, Thomas PG, 2019. Influenza virus-related critical illness: pathophysiology and epidemiology. Crit Care, 23:258.

[32]Krammer F, Smith GJD, Fouchier RAM, et al., 2018. Influenza. Nat Rev Dis Primers, 4:3.

[33]Lakdawala SS, Jayaraman A, Halpin RA, et al., 2015. The soft palate is an important site of adaptation for transmissible influenza viruses. Nature, 526(7571):122-125.

[34]Lam S, Lombardi A, Ouanounou A, 2020. COVID-19: a review of the proposed pharmacological treatments. Eur J Pharmacol, 886:173451.

[35]Lampejo T, 2020. Influenza and antiviral resistance: an overview. Eur J Clin Microbiol Infect Dis, 39(7):1201-1208.

[36]Li HX, Zhao Y, Zhou L, et al., 2020. Cutaneous, skin histopathological manifestations and relationship to COVID-19 infection patients. Dermatol Ther, 33(6):e14157.

[37]Li Q, Guan XH, Wu P, et al., 2020. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, 382(13):1199-1207.

[38]Li RF, Hou YL, Huang JC, et al., 2020. Lianhuaqingwen exerts anti-viral and anti-inflammatory activity against novel coronavirus (SARS-CoV-2). Pharmacol Res, 156:104761.

[39]Li ZT, Li L, Zhao S, et al., 2018. Re-understanding anti-influenza strategy: attach equal importance to antiviral and anti-inflammatory therapies. J Thorac Dis, 10(S19): S2248-S2259.

[40]Lian N, Xie H, Lin S, et al., 2020. Umifenovir treatment is not associated with improved outcomes in patients with coronavirus disease 2019: a retrospective study. Clin Microbiol Infect, 26(7):917-921.

[41]Liu J, Zhang S, Wu ZX, et al., 2020. Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study. Ann Intensive Care, 10:99.

[42]Liu Y, Gayle AA, Wilder-Smith A, et al., 2020. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med, 27(2 ): taaa021.

[43]Long SS, Pickering LK, Prober CG, 2012. Principles and Practice of Pediatric Infectious Diseases, 4th Ed. Elsevier, Edinburgh, USA.

[44]Ma L, Xie W, Li DY, et al., 2020. Effect of SARS-CoV-2 infection upon male gonadal function: a single center-based study. medRxiv, preprint.

[45]Moa AM, Muscatello DJ, Turner RM, et al., 2020. Estimated hospitalisations attributable to seasonal and pandemic influenza in Australia: 2001-2013. PLoS ONE, 15(4):e0230705.

[46]Munster VJ, Koopmans M, van Doremalen N, et al., 2020. Novel coronavirus emerging in China-key questions for impact assessment. N Engl J Med, 382(8):692-694.

[47]Nicholls JM, Bourne AJ, Chen HL, et al., 2007. Sialic acid receptor detection in the human respiratory tract: evidence for widespread distribution of potential binding sites for human and avian influenza viruses. Respir Res, 25(8):73.

[48]Nicholson KG, 1992. Clinical features of influenza. Semin Respir Infect, 7(1):26-37.

[49]Onigbinde SO, Ojo AS, Fleary L, et al., 2020. Chest computed tomography findings in COVID-19 and influenza: a narrative review. BioMed Res Int, 2020:6928368.

[50]Oroojalian F, Haghbin A, Baradara B, et al., 2020. Novel insights into the treatment of SARS-CoV-2 infection: an overview of current clinical trials. Int J Biol Macromol, 165:18-43.

[51]Qu JX, Gu L, Pu ZH, et al., 2015. Viral etiology of community-acquired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity. BMC Infect Dis, 15:89.

[52]Rowe E, Ng PY, Chandra T, et al., 2014. Seasonal human influenza: treatment options. Curr Treat Options Infect Dis, 6(3):227-244.

[53]Shi Y, Wang G, Cai XP, et al., 2020. An overview of COVID-19. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 21(5):343-360.

[54]Sihler KC, Park PK, 2011. Extracorporeal membrane oxygenation in the context of the 2009 H1N1 influenza A pandemic. Surg Infect, 12(2):151-158.

[55]Suphanchaimat R, Doung-Ngern P, Ploddi K, et al., 2020. Cost effectiveness and budget impact analyses of influenza vaccination for prisoners in Thailand: an application of system dynamic modelling. Int J Environ Res Public Health, 17(4):1247.

[56]Tan Q, Duan LM, Ma YL, et al., 2020. Is oseltamivir suitable for fighting against COVID-19: in silico assessment, in vitro and retrospective study. Bioorg Chem, 104:104257.

[57]Tan WJ, Zhao X, Ma XJ, et al., 2020. A novel coronavirus genome identified in a cluster of pneumonia cases—Wuhan, China 2019‒2020. China CDC Weekly, 2(4):61-62.

[58]Tang X, Du RH, Wang R, et al., 2020. Comparison of hospitalized patients with ARDS caused by COVID-19 and H1N1. Chest, 158(1):195-205.

[59]Tersalvi G, Veronese G, Winterton D, 2020. Emerging evidence of myocardial injury in COVID-19: a path through the smoke. Theranostics, 10(21):9888-9889.

[60]The RECOVERY Collaborative Group, 2020. Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med, online.

[61]Tian SF, Hu WD, Niu L, et al., 2020. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol, 15(5):700-704.

[62]Tolksdorf K, Buda S, Schuler E, et al., 2020. Influenza-associated pneumonia as reference to assess seriousness of coronavirus disease (COVID-19). Euro Surveill, 25(11):2000258.

[63]Verity R, Okell LC, Dorigatti I, et al., 2020. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis, 20(6):669-677.

[64]Wang BL, Li RB, Lu Z, et al., 2020. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging, 12(7):6049-6057.

[65]Wang CH, Chung FT, Lin SM, et al., 2014. Adjuvant treatment with a mammalian target of rapamycin inhibitor, sirolimus, and steroids improves outcomes in patients with severe H1N1 pneumonia and acute respiratory failure. Crit Care Med, 42(2):313-321.

[66]Wang DW, Hu B, Hu C, et al., 2020. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 323(11):1061-1069.

[67]Wang YX, Wang YY, Chen Y, et al., 2020. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol, 92(6):568-576.

[68]Webster RG, Monto AS, Braciale TJ, et al., 2013. Textbook of Influenza, 2nd Ed. Wiley-Blackwell, Chichester, West Sussex, UK.

[69]World Health Organization, 2014. Influenza (seasonal). https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)

[70]Wu Z, McGoogan JM, 2020. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13):1239-1242.

[71]Xie MX, Chen Q, 2020. Insight into 2019 novel coronavirus—an updated interim review and lessons from SARS-CoV and MERS-CoV. Int J Infect Dis, 94:119-124.

[72]Xu XT, Chen P, Wang JF, et al., 2020. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci, 63(3):457-460.

[73]Xu Z, Shi L, Wang YJ, et al., 2020. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 8(4):420-422.

[74]Yan CH, Faraji F, Prajapati DP, et al., 2020. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol, 10(7):806-813.

[75]Yang XB, Yu Y, Xu JQ, et al., 2020. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 8(5):475-481.

[76]Yang Y, Sugimoto JD, Halloran ME, et al., 2009. The transmissibility and control of pandemic influenza A (H1N1) virus. Science, 326(5953):729-733.

[77]Yin YD, Wunderink RG, 2018. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology, 23(2):130-137.

[78]Yousefi B, Valizadeh S, Ghaffari H, et al., 2020. A global treatments for coronaviruses including COVID-19. J Cell Physiol, 235(12):9133-9142.

[79]Zaki AM, van Boheemen S, Bestebroer TM, et al., 2012. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med, 367(19):1814-1820.

[80]Zeng Z, Huang XR, Lu PX, et al., 2015. Imaging manifestations and pathological analysis of severe pneumonia caused by human infected avian influenza (H7N9). Radiol Infect Dis, 1(2):64-69.

[81]Zhang JJ, Litvinova M, Wang W, et al., 2020. Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study. Lancet Infect Dis, 20(7):793-802.

[82]Zhu N, Zhang DY, Wang WL, et al., 2020. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 382(8):727-733.

[83]Zhu Z, Lu ZH, Xu TM, et al., 2020. Arbidol monotherapy is superior to lopinavir/ritonavir in treating COVID-19. J Infect, 81(1):e21-e23.

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