Don’t Compare Covid-19 to the 1918 Spanish Flu
If we're honest with ourselves, almost however you look at it, they had it worse back then.
“COVID-19 Is Now the Deadliest Pandemic in American History,” wrote Time. “Covid Is Officially America’s Deadliest Pandemic As U.S. Fatalities Surpass 1918 Flu Estimates,” said CNBC. “Coronavirus Death Toll In U.S. Eclipses 1918 Influenza Pandemic Estimates,” was ABC News. And there’s lots more where those came from, trying desperately to compare our lot to those who suffered through a nightmare that we can’t begin to imagine.
A lot of us have been enjoying the Covid pandemic just a bit too much. That includes social and political engineers, the clickbait media, and lots and lots of bored people. It’s boredom that’s the root of all evil, according to a Danish philosopher. We’ve probably proved that in the past 19 months.
But this comparison to the A/H1N1 1918 to 1919 pandemic isn’t fun, funny, or fair, although it is frequent (I wrote “No More Crying ‘Spanish Flu’” for Forbes all the way back in 2010, responding to hysteria over what was already proving to be a mild flu season). Any comparison of Covid-19 to so-called “Spanish flu” (no reason to think it began in Spain) is just grotesque.
For one, populations have grown a bit since the old influenza. In 1918 there were about 103 million Americans; today it’s over thrice that at about 332 million. So the estimated 675,000 flu victims back then would be equal to 2.2 million deaths today. Taking a step away from statistics, that means that back then, unless you lived under the proverbial rock, you knew someone who died of the Spanish flu and probably several someones. I know numerous Americans who were diagnosed with Covid-19, but they’re all fine. That includes a 91-year-old friend.
For another, the U.S. isn’t the world and, as someone once said, “Any man’s death diminishes me.” With alleged Covid deaths, for every dead American there are 6.61 people dead worldwide. But using the most common estimates for Spanish flu—675,000 American and 50 million worldwide—more than 100 million citizens of the earth perished for every American. The worldwide death toll for Spanish flu adjusted for population growth would be 214 million, compared to 4.55 million Covid deaths. (Some researchers put the Spanish worldwide toll as high as 100 million.)
Yet another massive difference is that while the flu estimates are just that, the Covid figures are far sketchier yet. That’s because of the “died of” versus “died with” conundrum. Data from the U.S. and elsewhere show almost nobody in the Covid tally did not have at least one pre-existing condition (comorbidity) that could have actually been the proximate cause of death—sometimes more than ten. One Italian study found that 85 percent had at least two. (It’s true that Spanish flu or any other type also doesn’t usually kill directly, rather usually giving rise to fatal bacterial infections. But those infections were not pre-existing.)
Given that there are major financial incentives under Medicare favoring a Covid diagnosis or even to say it’s possible someone has it, and doctors are susceptible to powerful cognitive biases to “see” that which is in the news and put that on the first line of the death certificate, we just don’t know how reliable those CDC data are. But the flu estimate, again while just an estimate, is those who died of flu. Not people who just happened to die in nursing homes or in the most extreme instances were victims of, say, homicide or alcohol poisoning, but somehow still listed as Covid fatalities.
Then there’s the issue of who the victims are. Despite the inevitable “Covid doesn’t discriminate” shibboleths, we all know otherwise. As with HIV, the first “democratized” disease, Covid is amazingly discriminatory.
Nobody should say your grandfather’s Covid-related death isn’t awful just because he was 98. But in recognition that everyone must eventually die of something, society has long considered younger deaths as worse. Not for nothing does everyone from health professionals to sociologists to economists use “Years of Potential Life Lost (YPLL)” to measure the impact of deaths. You also see it in expressions such as “A parent shouldn’t have to bury a child.” Yet, until very recently in history, that was the norm. Name someone famous who lived in the 19th century. Abraham Lincoln? Three of his four children died before adulthood.
One remarkable shared aspect of both Covid and Spanish Flu is highly distinctive age mortality patterns, albeit completely different. Typically the flu, including the three official pandemics since Spanish flu, strikes hardest at the elderly and the very young. Spanish flu, conversely, spiked for the very young but was hardest on those in the prime of life, ages 25 to 40. They accounted for an amazing 40 percent of all deaths. One theory is many died of something called a “cytokine storm” that is most likely to afflict those with the strongest immune systems. Something else that may have spared the elderly was exposure to a similar viral strain three decades earlier. In any case, the elderly were the least likely to die of the Spanish flu.
Covid-19? Americans over age 85 are 570 times likelier to die than those age 18 to 29. Naturally, younger people are also far less likely to be sickened and hospitalized.
Consider the much-followed story of the supercarrier USS Theodore Roosevelt, whose commander was relieved for allegedly violating military protocol in emailing a letter to numerous parties about his concerns for his crew. While the Roosevelt is huge, its 4,770 sailors are still packed together. Only a handful work on deck. In total, 1,271 crew members tested positive for the novel coronavirus. Of those positives, 76.9 percent were asymptomatic at testing and only 55 percent developed any symptoms. Ultimately, just one Roosevelt death was connected to Covid. When someone doesn’t know they’re “sick” until a blood test is performed, as opposed to knowing there is illness and typing it, it’s problematic indeed.
Indeed, the impact of Covid is so great on the old and infirm and so mild on the young and healthy that it’s possible that had Covid appeared in 1918 we wouldn’t even know anything special was happening. There were no viral tests, “natural causes” was allowed on death certificates, and there was no Medicare bounty for applying a Covid label.
A horrific difference between Covid and Spanish flu: The speed with which people sickened and died back then was incredible. “The Spanish flu strain killed its victims with a swiftness never seen before,” relates National Geographic.
In the United States stories abounded of people waking up sick and dying on their way to work. The symptoms were gruesome: Sufferers would develop a fever and become short of breath. Lack of oxygen meant their faces appeared tinged with blue. Hemorrhages filled the lungs with blood and caused catastrophic vomiting and nosebleeds, with victims drowning in their own fluids.
There were stories of people in apparent good health boarding a trolley car at one end of the line, only to arrive a corpse at the other.
If you think hysteria has been high over Covid, no arguments here. But for understandable reasons, even sans social media, fear was worse then, too. An internal American Red Cross report concluded, “A fear and panic of the influenza, akin to the terror of the Middle Ages regarding the Black Plague, [has] been prevalent in many parts of the country.” There were no effective treatments for any viral disease, including such simple ones as intubation and I.V. fluids; instead, bloodletting and exposure to poisonous chlorine gas were among treatments tried for Spanish flu.
One more thing to put this pandemic and the last year and a half in perspective. Americans in 1918 were already dealing with one of the greatest horrors the world has ever known. The very healthiest young men from all over the planet were being fed into a meat grinder called the First World War, the main purpose of which proved to be setting the stage for a second.
Shame, shame on us for comparing our lot to theirs.
Michael Fumento (www.fumento.com) is an attorney, author, and journalist who has written on pandemic hysteria for over 35 years.
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