COVID-19 is closer to the flu than it was in 2020, but it hasn’t caught up yet. Even in the 2023-2024 season, with widespread immunity from vaccines and prior infections, COVID still hospitalizes and kills people at higher rates than seasonal influenza. The gap has narrowed considerably, though, and the way public health agencies treat COVID is starting to look more flu-like every year.
How Death Rates Still Differ
The clearest way to compare the two is to look at what happens when people end up in the hospital. During the fall and winter of 2023-2024, a JAMA study tracked over 11,000 hospitalized patients and found that 5.7% of those admitted for COVID died within 30 days, compared to 3.04% of those admitted for influenza. That means hospitalized COVID patients were still roughly twice as likely to die as hospitalized flu patients, even four years into the pandemic.
That gap used to be much wider. In the first year of the pandemic, before vaccines, COVID’s in-hospital death rate was several times higher than that. The fact that it’s dropped to roughly double the flu reflects real progress from population immunity, better treatments, and viral evolution toward less lethal variants. But “half as deadly as it used to be” is not the same as “just the flu.”
COVID Still Sends More People to the Hospital
Beyond what happens inside hospitals, COVID is also more likely to put you there in the first place. During the 2022-2023 season, COVID hospitalizations ran about 4.6 times higher than flu hospitalizations overall: 350 per 100,000 people compared to 77 per 100,000 for the flu over a six-month period. ICU admissions showed the same ratio.
The gap varies by age in a way that might surprise you. For young children (ages 0 to 5), COVID hospitalizations were only about 1.3 times higher than flu hospitalizations, making the two viruses roughly comparable in that age group. But for working-age adults between 18 and 49, COVID hospitalizations were 5.6 times higher than flu. Adults over 65 saw a fivefold difference as well. In other words, COVID hits the adult population harder relative to flu than it hits children.
Long-Term Symptoms Are More Common After COVID
One of the biggest remaining differences between the two viruses is what happens in the weeks and months after you recover. Both COVID and the flu can cause lingering symptoms. A large UK study found that about 22% of people in the most severe symptom group experienced prolonged problems after either type of infection. But the specific symptoms were worse after COVID.
People recovering from COVID were nearly 20 times more likely to have lasting problems with taste and smell compared to those recovering from other respiratory infections. They also had higher rates of memory problems, unusual heart racing, hair loss, and excessive sweating. The flu can leave you feeling run down for weeks, but COVID’s signature long-term effects, particularly the cognitive and sensory symptoms, remain distinctive.
Anyone who has had COVID can develop long-lasting symptoms, even if their initial illness was mild or produced no symptoms at all. Long COVID can persist for weeks, months, or years. The flu doesn’t have a well-established equivalent at that scale.
COVID Carries Extra Complication Risks
Both viruses can cause pneumonia, respiratory failure, sepsis, heart injury, and inflammation of the heart, brain, or muscle tissue. Both can worsen existing conditions like diabetes, heart disease, or lung disease. But COVID carries additional risks the flu doesn’t. It causes blood clots in the veins and arteries of the lungs, heart, legs, and brain at rates not seen with influenza. It can also trigger multisystem inflammatory syndrome in children and adults, a rare but serious condition where multiple organs become inflamed at once.
On the other hand, secondary bacterial infections (like bacterial pneumonia developing on top of the viral illness) are more common with the flu than with COVID.
The Viruses Spread and Mutate Differently
COVID is more contagious than the flu. Early estimates of the basic reproduction number (how many people one infected person spreads it to in a fully susceptible population) put COVID’s median at about 1.82 compared to the flu’s median of 1.54. That difference sounds small, but it compounds rapidly across chains of transmission and helps explain why COVID spreads through communities faster.
Interestingly, the flu virus actually mutates about 24 times faster than SARS-CoV-2 in lab settings. COVID’s replication machinery has a built-in proofreading function that catches most copying errors, something the flu virus lacks. In real-world evolution, the flu’s key surface genes change about five times faster per year than COVID’s spike protein gene. Despite this, COVID has still produced a steady stream of immune-evading variants, partly because so many people are infected at once, giving the virus enormous opportunities to stumble onto advantageous mutations even at a lower error rate.
Is COVID Becoming Seasonal?
COVID is showing early signs of settling into a seasonal rhythm, but it’s not there yet. A four-year analysis of transmission patterns in Ecuador found consistent dual seasonal peaks emerging over time, a pattern that parallels how the flu behaves in tropical and subtropical regions. In temperate climates like most of the United States, COVID has increasingly concentrated in fall and winter waves, similar to flu season.
But the pattern remains less predictable than influenza. Summer surges still happen, driven by new variants rather than purely by weather and human behavior. Researchers describe this as a “gradual shift toward endemicity” that is not yet complete. The flu has had centuries to settle into reliable seasonal cycles. COVID is still finding its rhythm, and new variants can disrupt emerging patterns in ways that flu variants rarely do anymore.
How Public Health Agencies Treat It Now
Officially, health authorities have started treating COVID more like the flu in practical terms. The CDC now refers to COVID as endemic and recommends updated COVID vaccines on a schedule that mirrors flu shots: one updated dose each fall for everyone six months and older. Both vaccines can be given at the same visit, and September and October are the target months for both.
One notable shift came in 2025, when the CDC moved COVID vaccination to an “individual-based decision-making” model, where you and your healthcare provider weigh the personal benefits together rather than following a blanket recommendation. This is a step away from the urgent, universal push of the pandemic years and reflects the reality that most people now have substantial baseline immunity. Vaccination is still covered through Medicare, Medicaid, insurance plans, and the Vaccines for Children Program.
The Bottom Line on the Comparison
COVID is behaving more like the flu than it did in 2020 or 2021. Seasonal patterns are emerging, vaccines are updated annually, and most healthy people recover without hospitalization. But the numbers tell a consistent story: COVID still kills hospitalized patients at roughly double the rate of the flu, sends far more adults to the hospital per capita, and causes more frequent and distinctive long-term complications. Calling it “just the flu” understates the remaining differences. Calling it “nothing like the flu” ignores how much has changed. The most accurate framing is that COVID is a more serious respiratory illness that is slowly, unevenly converging toward flu-like patterns, but hasn’t arrived there yet.