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COVID-19 has the potential to be as deadly as the 1918 flu

The Walter Reed Hospital flu ward in Washington D.C. treated patients during the 1918 flu pandemic.
The Walter Reed Hospital flu ward in Washington D.C. treated patients during the 1918 flu pandemic.
(Image: © Shutterstock)

The COVID-19 pandemic has the potential to become more deadly than the 1918 flu pandemic, a new study suggests.

Remembered as the deadliest pandemic in recent history, the 1918 influenza pandemic infected one-third of the world's population and killed at least 50 million people, 675,000 of them in the U.S., according to the Centers for Disease Control and Prevention (CDC). At the time, there were no vaccines and no antibiotics to treat secondary infections that inevitably popped up in flu patients. However, society employed measures like the ones being used today to curb the spread, such as imposing quarantines and endorsing good personal hygiene, according to the CDC. 

Over a century later, the world has found itself in the grip of another pandemic, this one caused by the coronavirus SARS-CoV-2 — and it's still not clear just how deadly it is. The virus has now infected at least 22.2 million people and has claimed at least 783,525 lives worldwide, according to the Johns Hopkins dashboard

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To compare the current pandemic with last century's, a group of researchers focused on a sliver of the world that was hard hit by both viruses. In the spring, SARS-CoV-2 hammered New York City, causing more than 19,000 known deaths — and more than 4,600 probable deaths or those that were likely caused by COVID-19 but there aren't positive laboratory tests to confirm, according to the NYC Department of Health and Mental Hygiene.

Using data from the CDC, the New York Department of Health and Mental Hygiene and the U.S. Census Bureau, the researchers compared the mortality rate in New York City during the early COVID-19 outbreak with the mortality rate during the peak of the 1918 H1N1 influenza pandemic.

The researchers specifically analyzed deaths from all causes in New York City in October and November of 1918 — the peak of the influenza pandemic in the city — and compared them with all-cause deaths in the same months since 1914. They then calculated all-cause deaths for March 11 to May 11 of this year in New York City, when the COVID-19 outbreak peaked and subsided in New York. The time periods they compared were each 61 days long.

The researchers chose to compare the early outbreak in NYC with the peak of the 1918 flu, rather than with the milder influenza wave that hit in the spring of 1918, so that "people can get context for how serious," this modern outbreak is, said lead author Dr. Jeremy Faust, an emergency physician at the Brigham and Women's Hospital in Boston and instructor at Harvard Medical School.

They found that during the peak of the 1918 influenza outbreak in New York City, a total of 31,589 all-cause deaths (this included death from any cause) occurred among the 5.5 million residents that lived there at the time. The all-cause mortality in the peak of the influenza pandemic in 1918 was 2.8 times higher than during the same months in previous years. 

In contrast, for the early 2020 COVID-19 outbreak in New York City, they found that 33,465 deaths from all causes occurred among 8.28 million residents between March 11 and May 11. The all-cause mortality in those months of 2020 were 4.15 times higher than those months between 2017 and 2019. 

That means that in the peak of the 1918 influenza pandemic in NYC about 287 per 100,000 people died a month from any cause in NYC, whereas during the early COVID-19 outbreak, about 202 per 100,000 people died a month in the city. So the all-cause mortality during the spring of 2020 was 70% of the all cause mortality during the fall of 1918. "When we do that, we see that COVID-19 really does have the potential and has already unfortunately caused per capita death rates that were in the same ballpark," Faust told Live Science. 

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But there's another way to look at the deaths related to each pandemic: comparing deaths during a pandemic to the baseline that you'd expect during a particular time. There were more "excess deaths" during the 1918 flu than the early COVID-19 outbreak. But in relative terms, the COVID-19 outbreak in the spring actually looks worse, because the numbers quadrupled from pre-pandemic times (from a baseline of around 50 deaths per 100,000 people per month), whereas in the peak of the 1918 flu, the numbers less than tripled (from a baseline of around 100 deaths per 100,000 people per month). 

"Its a bigger shock to our system, but that's a little bit unfair because we started off at a lower death rate," than there was in 1918, due to advances in hygiene, medicine, public health and safety, Faust said. Really, we don't yet know if the 1918 pandemic or the COVID-19 pandemic is more deadly, he added. Maybe what happened in New York in the spring was a "freak thing," before interventions such as masks and shutdowns took hold; or maybe the numbers will slowly creep up to match the death tolls seen in the 1918 flu until an effective vaccine is found. 

One limitation of the study is that it's not possible to directly compare how infectious and harmful the two viruses are to people and it's unknown how many deaths from SARS-CoV-2 were prevented because of modern interventions that weren't available a century ago, the authors wrote.

"All we know is that in this little slice of time that we looked at, there are certainly enough resemblances that it can't be just shrugged off," Faust said. "We've asked the question how did this compare to the worst pandemic in modern history, and we've given the first possible window into that and I think that further research will give us more answers as to whether it's not as bad, similar or worse." 

In the meantime, the take-home message is that shutting down hard-hit places, social distancing, quarantining and wearing masks are critical. "Unlike any other pandemic we've ever confronted, flattening the curve can actually do more than just slow down the death rate ... it can actually buy us time to get a vaccine," Faust said. "If you don't do these things, mayhem of historic proportions is actually possible. It's not guaranteed, but it's possible."

The findings were published Aug. 13 in the journal JAMA Network Open.

Originally published on Live Science.

  • Chem721
    An important aspect this study did not address is the age of people who died in each case. The life expectancy of Americans in 1918 was about 55 years. It is now pushing 80. (For women, it is ca. 3-5 years longer in both cases.) Of course there are differences in ethnic groups, but this single aspect of the study would seem to render the conclusions questionable at best.

    If SARS-CoV-2 was spreading in 1918 New York City, the death rate would likely have been an order of magnitude less than it is today, assuming immune competence of those "old" people (ca. 40-55) is nearly as good as it is today for this age bracket, which is not unreasonable. (Nutrition might have played a major role as well in this regard.) At any rate, failing to take this aspect into account is clearly non-trivial.
    Reply
  • Chem721
    Chem721 said:
    An important aspect this study did not address is the age of people who died in each case.


    Data from CDC supports my original post that the two diseases have little in common regarding mortality.

    Here is a direct quote from a CDC report* about mortality in the 1918-19 flu :

    "Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic."

    end quote.

    There is little doubt that no comparison can be made between the two pandemics. They are vastly different.

    * https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html
    Reply
  • ohmygoodness
    Why would you write such an irresponsibly sensational story about Covid? Don't you think we're all worried enough? I am cancelling my subscription to this site because of it. Disgusting
    Reply
  • RetEng
    Chem721 said:
    An important aspect this study did not address is the age of people who died in each case. The life expectancy of Americans in 1918 was about 55 years. It is now pushing 80. (For women, it is ca. 3-5 years longer in both cases.) Of course there are differences in ethnic groups, but this single aspect of the study would seem to render the conclusions questionable at best.

    If SARS-CoV-2 was spreading in 1918 New York City, the death rate would likely have been an order of magnitude less than it is today, assuming immune competence of those "old" people (ca. 40-55) is nearly as good as it is today for this age bracket, which is not unreasonable. (Nutrition might have played a major role as well in this regard.) At any rate, failing to take this aspect into account is clearly non-trivial.
    I take issue with your major assumption that a 55 year-old person in America in 1918 was as healthy as a 55 year-old person today. As you noted, their life expectancy was 25 years less than ours is today. There are valid medical reasons for that. Therefore a 55 year-old then would be much more susceptible to dying from COVID-19 than a 55 year-old today.
    Reply
  • RobertPolaris
    admin said:
    Mortality rates in New York City during the early COVID-19 outbreak and in the peak of the 1918 flu pandemic were "in the same ballpark."

    COVID-19 has the potential to be as deadly as the 1918 flu : Read more
    Well see, no it doesnt...it was just like I thought you are comapiring numbers (the totally wrong way to do it)and not percentages or per capita...so your comparison is bull try again next time...stop selling fear!!!
    Reply
  • Chem721
    RetEng said:
    I take issue with your major assumption that a 55 year-old person in America in 1918 was as healthy as a 55 year-old person today.

    I agree with this likely assessment that immune systems may have been less capable in 1918, and specifically noted that in post # 2 that ": (....assuming immune competence of those "old" people (ca. 40-55) is nearly as good as it is today.... " and "Nutrition might have played a major role as well in this regard.")

    However, you failed (for some reason) to note from post # 3 the CDC data from the 1918-19 flu epidemic, and repeated below :

    "Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic."

    This is clearly very different from the current pandemic, where older people are most at risk,, and it seems unlikely to be due to poor nutrition, but cannot be ruled out. No further replies to such commentary will be made.
    Reply
  • yaringa3
    Chem721 said:
    An important aspect this study did not address is the age of people who died in each case. The life expectancy of Americans in 1918 was about 55 years. It is now pushing 80. (For women, it is ca. 3-5 years longer in both cases.) Of course there are differences in ethnic groups, but this single aspect of the study would seem to render the conclusions questionable at best.

    If SARS-CoV-2 was spreading in 1918 New York City, the death rate would likely have been an order of magnitude less than it is today, assuming immune competence of those "old" people (ca. 40-55) is nearly as good as it is today for this age bracket, which is not unreasonable. (Nutrition might have played a major role as well in this regard.) At any rate, failing to take this aspect into account is clearly non-trivial.




    The 1918 pandemic is considered unusual in so far as the mortality for older individuals was relatively low (stressing the world "relative"). It has been assumed that the older population had been exposed to an earlier cross-reactive strain of flu that the younger generation hadn't seen. The same is true for the h1n1 flu pandemic of 2009 - where those born before 1957 were somewhat protected, most likely because they had been exposed to a h1n1 variant that had been circulating prior to appearance of the asian flu in the late '50s.
    Reply
  • Bridman
    According to Arthur Firstenberg in his book "The Invisible Rainbow" the U.S. Military tried in vain to infect healthy volunteers with 'Spanish Flu'.
    Their methods included coughing in the faces of the volunteers (by the 'infected victims') & material was transferred directly from those suffering from this 'Flu' to the volunteers (nose to nose, throat to throat) more than once & 20 c.c. of blood from 5 sick donors were mixed and injected into each volunteer.
    "None of them took sick in any way"
    Mucous material from the upper respiratory tract was taken from the sick, filtered through Mandler filters and injected into 10 volunteers ; none took sick. The conclusion - it was not infectious/contagious.

    Face masks, quarantine & social distancing were widespread but apparently of no use.

    Indeed, the disease spread impossibly fast - more rapidly than persons could travel.

    As I understand it , The 4 Koch postulates have not been satisfied with respect to Covid-19; has anyone actually shown /proven that Covid-19 is infectious? The Covid-19 'virus' has not apparently been isolated/purified.
    Reply
  • Chem721
    Bridman said:
    has anyone actually shown /proven that Covid-19 is infectious?


    The whole reason for employing trackers is to trace those who were in contact with COVID-19 positive people who may be spreading the disease. It is highly unlikely they would be spending such an effort on that alone if it were not infectious, to say nothing of the billions being spent on vaccine research and trials. Make no mistake here, it is very infectious. Read on.

    Recent reports from mink farms in the Netherlands indicate the virus can be transmitted from humans to mink and back to humans again.* Reports indicate 100s of thousands of mink have been culled because they were infected with the virus. Lab data indicate that ferrets** are also serious targets, so likely are all members of the weasel family. There is no doubt about the infectiousness of this virus.

    I am amazed about the story with the Army trying to give the flu infection to "volunteers". One is compelled to wonder about their age, where they were born and raised etc. And how many were exposed? But definitely their age, and number tested. If they were 18-19 year olds, they were some of the least prone to symptoms. It was not, however, what one would call a scientific test, but it certainly sounds like serious challenges.

    It is also important to appreciate that many of the people exposed to the flu pandemic were "survivors" of many viral infections through the years leading up to 1918. It has been shown in numerous cases were many populations that have been exposed to a variety of viruses do much better than those who shelter from them. It is likely that getting infected by minor viruses "exercises" the immune systems and preps it for nasty cases like this, and many that are much worse.


    * https://www.washingtonpost.com/science/2020/06/19/humans-may-have-caught-coronavirus-mink-thats-wake-up-call-study-infections-animals-researchers-say/

    ** https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30089-6/fulltext
    Reply
  • Chem721
    Chris763 said:
    After over 60 years of approving this drug, NOW they decide it's dangerous?

    Aspirin is an approved drug, but you don't give it to hemophiliacs - people with bleeding disorders.

    Drugs are approved for specific conditions, and may not be appropriate for others.

    That is why "off-label" use can be troublesome, like with hydroxychloroquine treating COVID-19 . It is not a useful treatment and can cause major problems, which was proven in real use.
    Reply