500 million infected, 50 million dead
About that 1918 flu pandemic…the CDC has some basics.
The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918.
It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States. 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.
Those stats are breathtaking.
Remember Katherine Anne Porter’s brilliant novella, Pale Horse, Pale Rider?
The thing that confuses (and frightens) me about the current epidemic is that the numbers sound about the same as 1918: I read “expert” predictions that 30% or more of the population could be infected, with a death rate around 2-3%. But at the same time I’m hearing “experts” say that this won’t be nearly as bad as 1918. That’s the part I don’t understand. How is it not comparable? The numbers are the numbers. People say things like, medicine is better now than it was, we understand containment better now than we did then, etc. But the numbers so far — here, now, taking into account advances in medicine and protocol we have in the here and now — look to be comparable to the numbers we had from the flu in 1918 taking into account the relative lack of medical and protocol knowledge they had back then.
Maybe I’m mis-reading what the experts are predicting, or maybe expert predictions are being mis-reported by the media. Perhaps what they mean is something like, left unchecked SARS-CoV-2 infection rates could be in the 30-70% range, and/or if we don’t “flatten the curve” the death rate could be as high as 2-3% or higher. Something like that maybe. And so with enough effort we can bring those figures way down. Here’s hoping.
Going by the numbers in this post, Spanish Flu’s mortality rate was about 10%, so that makes it several times worse than COVID-19. It probably also helps that most of the COVID deaths are in demographics that are easier to isolate – it’s easier to ask 70+ year olds to stay home without society grinding to a halt than 20-40-year-olds.
Isn’t it 3.3%? 33% of people caught it and 10% of them died so that’s 3.3%? Isn’t it?
Years ago, I read a book on the Flu of 1918. As I recall, the pandemic became particularly deadly for several reasons, including
– it first spread very, very rapidly among soldiers who were living in cramped quarters, and governments were slow to react.
– it killed the strong more than it killed those who were weak, because it forced the immune system into going into overdrive (cytokines storm?) and the healthier systems ended up choking those who were young and fit.
On another point…I haven’t been hearing any experts saying it won’t be as bad as the 1918. More the opposite – that it easily could be, or it could be worse.
Which…yeah…nightmare.
I meant the mortality rate of people who get the illness – 50 million out of 500 million. Estimates I read for COVID-19 have indicated that the comparable mortality rate (of those who get it) could be as high as 2-3%, although likely lower. I may have misinterpreted what Artymorty meant by “death rate” – I haven’t heard that 2-3% of the world population might die.
OB, 3.3% refers to the percentage of the world’s population that died. The Spanish flu having a mortality of 10% refers to 10% of those infected dying. Which works out to closely match your figure: 3.3% of the world is pretty much 10% of one third of the world.
My grandmother died of that flu.
Red.Tide – Oh right, duh, sorry.
Here’s the thing – in the 1918/1919 H1N1 flu pandemic, most mortality was due to secondary bacterial pneumonia. Antibiotics were not available then, so if you got pneumonia, you were pretty screwed.
With COVID-19, we don’t yet know what the primary cause of death will be. The top contenders are direct lung damage by the virus (and associated immune response), pneumonia (again), sepsis and most importantly, access to medical care.
So comparing the two pandemics is not that helpful, outside of esoteric epidemiological modeling. Looking at the raw numbers and death rates is just going to raise your anxiety and blood pressure. I’m not saying don’t be concerned, I’m just saying don’t take 1918 as your guide. I wish the media would stop comparing the two. (And certain experts, come to that).
We don’t yet know the true case fatality rate (CFR) because the ascertainment bias is so strong i.e. you have to be visibly very sick to get tested except in South Korea. In SK, interestingly, the CFR is closer to the SARS and MERS outbreaks, at 0.6%. Given their fast response and excellent intervention protocols, they’re generating the most reliable data right now. 0.6% is still an awful lot of people, given the estimated 30-70% infection rate. But it’s not World War Z just yet.
Don’t do the math. It will only make you feel worse. Focus on protecting yourself and your loved ones and monitor the situation in your area.
Ah, d’oh! I’m silly for not recognizing that 50 million out of 500 million is obviously 10% not 2-3%; my bad! But still, even if we were to say that SARS-CoV-2 is roughly one-third the equivalence of the Spanish Flu, population-percentage-wise, that’s CRAZY. That’s just… boggling. Huge. Unreal. I can’t even.
But that prediction still feels somehow not right, because look at China: the infection rate so far (which, to be fair, it’s been less than three months since this virus was detected) is high, but not 30 to 70 % of the population high. Not even remotely. There’s close to 1,400,000,000 people in China and under 100.000 identified cases… that’s, what? 1 in 17,500 people — not 1 in 3 or 1 in 2. And the death rate is in line with that. (You could argue that China is concealing its true infection rate but the death rate is presumably not so easy to massively fudge.)
Those numbers really don’t at all look like 1918, even considering that we’re still early on in the pandemic’s lifespan.
It’s very confusing, looking at the numbers. Nothing seems to add up. It’s very hard to get a solid grip on what we’re dealing with as a result. And that means it’s hard to predict what things are going to look like in the short, medium and long term.
Are we looking at maintaining social distancing practices for a few weeks, a few months, a few years, or in perpetuity? Right now it’s hard to say, because the numbers seem indecipherable. Frustrating…
Sam Harris (I know, I know, boohiss) has a couple of podcasts with actual virologists and epidemiologists that are sober and very informative (and, aside from the occasional inveighing against the Trump Administration which should not be too difficult to sit through), Sam *mostly* gets out of the way and asks pointed questions that let the guests expound upon their areas of expertise.
If you’re interested in the mathematics of exponential growth and why we want to “flatten the curve”, there’s also a video from 3Blue1Brown, here: https://www.youtube.com/watch?v=Kas0tIxDvrg
Surely it’s not China as a whole which we should be looking at, but Wuhan?
The Great Chicago Fire of 1871 was by legend started when Mrs O’Leary’s cow kicked over a lantern in a barn.The COVID-19 epidemic of 2020 likely began when a single bat was cooked and eaten in Wuhan, China. The cooking would probably have destroyed the virus particles, but the cook in preparing the bat probably got virons all over his/her hands, went on to contaminate other ingredients, and serve them up to other family members..
The worst part of the story is that early on, medically trained people were onto it, but were silenced by the local low-level Chinese bureaucracy, desperate to hush it up and control public information: a crucial part of the whole modern Chines Communist Party system of population control.
The rest will be history.
.
https://en.wikipedia.org/wiki/Great_Chicago_Fire
The “Spanish flu” was called that because Spain wasn’t participating in the Great War, and so there was no censorship there. It most likely didn’t originate in Spain, and these days the name “Spanish flu” is losing favor.
Nobody listens to me. Sigh.
Stop. Doing. The. Math.
If you’re not an epidemiologist, your math is wrong. Sorry, but that’s the truth. And ignore the Chinese numbers, they’re probably wildly wrong. If you must look abroad, use South Korea as your guide.
Anxiety and stress, coupled with consequent poor quality sleep are not going to help your immune system.
I understand that the uncertainty, the disastrous response of the US government and frightening statistics are combining to create a high-stress environment. But you’re not helping yourselves.
If you have questions – send them my way. I’m a genetic epidemiologist, not an infectious disease epidemiologist but a lot of the statistical modeling is the same and I have lots of friends in the infectious disease field who can give me the answers if I don’t know them.
I read that 1918’s unusuasl deadliness among the young was enhanced by a long gap since a similar flu strain had appeared. People under (I think) 30, had no prior exposure to any related strain.
Claire,
Thanks for the reality check. I’ve been guilty of doing the math, but I’m trying to break myself of the habit.
Sorry; maybe I shouldn’t have posted this one. I’m just interested in the history and as usual shared what interests me. Didn’t mean to boost stress levels.
Ophelia – I wasn’t meaning to attack you. I’m actually glad you posted it. It gives me a chance to stand on my soapbox. :-)
Seriously though, I am trying to spread information as best I can on various social platforms if I see people getting too focused on these historical precedents.
The history of pandemic disease is very interesting. My personal fascination is with the Black Death in the 14th century because it is believed to have caused the fall of the feudal system – quite a feat if you think about it. But it’s easy to fall into the trap of comparing them to the current crisis.
If you are interested in the history of disease and effects on human populations, I recommend Guns, Germs, and Steel by Jared Diamond. It’s excellent and it focuses a lot on non-European societies which is rare in history books published in the West. It’s a mighty tome however, an ebook or audiobook is easier on the hands :-). If you’re stuck at home, social distancing and can’t telework, it is worth investing some time in.
One of the things that worry me (perhaps a petty concern when considering the alternatives, but still) is that the pandemic ends up “fizzling out” (or is perceived as fizzling out – correctly or not), thus providing ammunition to the usual suspects who get to frame the response to the pandemic as yet another “ridiculous overreaction” to a “hyped up scare”, “mass-panic”, “hysteria”, “doomsday prophecy”, etc. invented by “doomsayers” and exploited for political purposes by the anti-trumpists.
Bjarte – It’s always a possibility. See Y2K for a similar example. Millions of person-hours spent fixing all the problems and everyone complained it was a damp squib when planes didn’t fall out of the sky or banks lose all the money.
However, it’s going to be hard to do this here. COVID-19 is going to have considerable effects on the healthcare system and federal and local governance. There will be an uneven spread of the virus – Montana might do better than New York, simply because of population density. However, more populated states with significant rural populations may be hit hard because of the lack of medical facilities. Many rural hospitals are on the brink of closing.
More complete healthcare coverage for the entire population might become more palatable to the US electorate, especially if competent governors like Andrew Cuomo and Jay Inslee are seen to be managing the problem better than Rick Scott or Greg Abbot. Who knows, the public might decide how they feel based on when they get their Starbucks and Chick-Fil-A again.
If Democrats are smart, they can talk about how M4A or some kind of public option buy-in for Obamacare might be better going forward. I think Biden can talk competently about this, given his experience with the ACA. He just needs to sharpen his message.
Thinking back to history lessons (several decades ago…where does the time go?) I seem to recall that as well as there being no antibiotics a major factor in the high mortality rate in 1918/19 was that it came on the back of the war, when much of the population of Europe had suffered four years of food shortages and malnutrition, mass dislocation of vast swathes of the population, increased poverty and all the other effects of total war on both those doing the fighting and those struggling to survive at home.
Add to that the large family units, cramped living conditions and over-crowding in towns and cities that was the norm for all but the wealthy at the time, along with the sheer amount of military personel returning to their own countries all around the world and displaced civilians returning to their homes from all points of the compass – usually on foot and passing through many towns and cities en-route – and it’s hardly surprising that people were both bound to come into contact with plenty of infected people and pass the infection to plenty more, and had very little strength left to cope with the effects of the flu once infected.
Claire – no, I didn’t take it as an attack – a justified corrective, more like.
I have read Guns Germs & Steel and have it out for re-reading now. I also like McNeil’s Plagues & People (which Diamond cites as a predecessor in his notes). The other evening I read some of Pepys’s diary during the plague period.