This week, the number of people who have died of COVID-19 in the U.S. surpassed the 675,000 said to have died in the 1918-19 influenza pandemic.
As of Wednesday morning, 675,071 people in the U.S. had died of COVID-19, according to the Centers for Disease Control; news that prompted some to proclaim COVID-19 now the deadliest pandemic in U.S. history.
But there’s a century of time, plus advances in technology, recordkeeping and medical treatment between 1918 and the COVID-19 pandemic that make the claim at least a little dubious.
The terrible W
The influenza pandemic of 1918-19 was caused by an H1N1 strain of flu virus and was first discovered in a military facility in Kansas. It was — and still often is — misleadingly referred to as the “Spanish flu” because cases were more widely reported in Spain — neutral in World War I — as opposed to other countries that censored news of the virus’ spread. The flu swept across the world in waves between 1918 and 1919.
This flu was exceptionally deadly, and compared to other flus — and notably, COVID-19 — commonly killed young people.
“The pandemic in 1918-19 had a mortality graph that epidemiologists call ‘the terrible W’ — it killed a lot of very young people — babies and very young children; it killed a lot of very old people, and then it killed a lot of people who were sort of in their late 20s,” said Susan Jones, a professor and historian at the University of Minnesota who specializes in the historical ecology of disease. The average age of death was 28.
[image_credit]Source: "1918 Influenza: the Mother of All Pandemics," by Armed Forces Institute of Pathology researchers and published in the CDC's Emerging Infectious Diseases.[/image_credit]
Comparing death rates
Just how deadly was the 1918-19 flu pandemic?
The U.S. death count of 675,000 accounted for roughly 0.64 percent of the country’s population of 103 million people at the time.
With a death toll of 675,071 so far, COVID-19 has killed about 0.2 percent of the 328.2 million people in the U.S. today.
In Minnesota, the estimated death toll of the 1918-19 pandemic was more than 10,000, which works out to roughly 0.4 percent of the state’s population at the time, compared to 8,025 deaths due to COVID-19 reported to-date, or 0.14 percent of the state’s population.
But the national death toll of 675,000 should be taken with a grain of salt, Jones said.
It’s not just that they didn’t have testing that could confirm whether or not someone who died had died of the flu a century ago, Jones said. (Actually, though, because many of the deceased were young people who succumbed to bacterial pneumonia caused by the virus — not a common way for the young to die — flu deaths were often pretty evident.)
Another issue? The 675,000 number is based on an extrapolation from incomplete data.
[image_credit]Otis Historical Archives, National Museum of Health and Medicine[/image_credit][image_caption]Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston.[/image_caption]
The person who came up with the 675,000 number took death counts from the states that reported — about 549,000, and added 25 percent to approximate a count for the missing states.
Exclusion of those states in the mortality numbers means specific populations are not well-represented in the official death count.
“Probably over half of African Americans in this country lived in the states that were not part of the mortality registry,” Jones said. Another group probably underrepresented? Indigenous people, including many living in Minnesota.
“We tend to think of mortality statistics today as being absolute numbers that we can really count on and that came from actual data collection. That’s not the case with the 675,000 number, so I guess my point is, we make these things into important numbers — we make these milestones,” Jones said. “Even if we take that number as a pretty good estimate, of course it underestimates what was happening in certain communities.”
Always struck me that the young adults were so severely affected.
There was a mild wave in the spring, followed by severe outbreak in the fall. One theory is that the first wave primed people’s immune systems, and when it can around again, a hyper immune response caused the problem
Actually, hyper immune responses are typical symptoms of respiratory infections that cause pneumonia, that was not unique to this infection. The fact that the immune systems of young people can react more aggressively when triggered is most often the explanation for the early fatalities among that demographic. The successive waves were most likely due to new emerging/different variants rather than some worldwide immune response to the same variant (i.e. priming), much the same as new variants have triggered the fourth wave of COVID.
I can’t remember the details but a while back there some researchers were digging 1918 flu victims up out of permafrost in Alaska and elsewhere to try to get hold of some virus, and I think they succeeded to some extent, but I don’t think they’ve got enough to reliably type different DNA variations.
This stuff is complicated, Here’s one example of a journal article that can give you some insight into this complexity. Basically they authors suggest that the different “waves” of the 1918 flu were actually different flu variants. For instance the first wave may have actually been the last wave of a previous pandemic.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310443/
I do this for living, thanks
It’s very possible that the 1918/19 flu will remain the most devastating pandemic in American history on a per capita basis. But given the limited tools and a whole lot of other complicating factors (e.g., WWI), it was understandable. After all, look at the infant mortality–it was already a medical and social challenge to keep babies and toddlers alive without a pandemic. Age-adjusted death rate in 1914 (which was a low point ahead of the 1918/19 flu pandemic) was about 2100, while in 2018, it was about 723 (https://www.cdc.gov/nchs/data-visualization/mortality-trends/index.htm), so about 3x what it is today for every day illness in the absence of a pandemic. We’ve come a LONG way medically, so you would expect the mortality rate to be lower in this pandemic due to the increased general health of the population. Also, the complications of the 1918/19 flu include a very obvious one — bacterial pneumonia. It’s easy to identify those people who died of a very specific flu complication; one that we can easily deal with now (with antibiotics). To the extent that COVID-19 patients develop bacterial pneumonia after the initial viral illness, we can and do treat that (unless they don’t have access to healthcare). But COVID-19 has some odd complications. There are excess deaths in a number of different categories, but NOT respiratory illness. This suggests that the 675k dead as a result of COVID-19 is undercounted. And might not ever be counted, depending on the politics of certain offices. And, despite having HUGE medical advantages, including a very effective vaccine, drugs that can reduce an overactive immune response (steroids are very effective treatment for some patients), mechanical solutions (respirators), and even clean and effective hospitals, people are STILL dying of COVID-19. It’s hard to say how many people ultimately will die of COVID-19, but it’s pretty pathetic that we have lost 0.2% of the ENTIRE US population SO FAR. If our goal is to achieve the same death rate as the 1918/19 flu pandemic, we have time.
Fortunately most covid fatalities now are among the slow-to-learn or oppositional defiant. Some say Darwin is culling the weak from society. My concerns are for overworked healthcare workers (I respect those who’ve quit because of preventable strain, and wonder if they’ll return after we lose some to stress, etc when this settles down – which it will/should/?? unless we get a variant that trumps Delta) and for the cost this is putting on society and economy. Normal people won’t fly or go to restaurants (or work in the public sector) until covid dies down – we’re losing a LOT of businesses because of the unvaccinated.
Yeah, it’s the “most” part that bothers me. I have friends/family with suppressed immune systems (transplant recipient, cancer survivors, and those being treated for autoimmune disorders) that, although they have been vaccinated, might not actually be well protected from those who are actively participating in spreading it. In addition, every single person with little or no immunity to this is a potential incubator for a new variant. While the vaccines we have right now appear to be pretty effective against the current strains, especially if the vaccine was administered some time after an infection, that’s not a guarantee that future strains might bypass that immunity. While those strains might not be as deadly, it is also possible they’ll be more deadly. If SARS-COV-2 (the virus that causes COVID-19) is to become endemic, like the flu (which, as a reminder, still kills a significant number of people each year), it’s going to take a few more rounds of variants before our immune systems have a pretty generic recognition. Assuming that immunity is long term.
All true, especially about underreporting – they say it’s likely the same in India with covid (could be 10x more cases/deaths).
Main points are that people would have welcomed vaccines back then, when so many in US don’t now. Other is the US seems to have a LOT of brainwashed “Branch Covidians” who’ll do experimental drugs/treatments, but not vaccines that have been given to 3.4B people (at least one shot) and 2.5B fully vaccinated worldwide (someone said his 46-year old RN sister died because there wasn’t enough data after giving vaccines to millions of people.. he/she was off by a factor of 1000). Some of them say they’d rather die than get “the shot” and that’s exactly what they’re doing.
I also sense we have a LOT more miserable, borderline suicidal people in the US nowadays, which turns the US pandemic into a psychological issue.
Speculation will likely continue on, but what I do know is that my grandmother was 28 when the Kettle River fire happened and when the survivors crowded into one building the flu swept through. She died leaving three orphans as their father had already died in a railroad accident. They were both Finnish immigrants.