Comparing Covid-19 to the ‘Spanish Flu’ Just Shows How Badly We Screwed This One Up

Comparing Covid-19 to the ‘Spanish Flu’ Just Shows How Badly We Screwed This One Up
American flags at a COVID Memorial Project installation of 20,000 flags are shown on the National Mall as the United States crossed the 200,000 lives lost in the pandemic September 22, 2020 in Washington, DC. (Photo: Win McNamee, Getty Images)

As of this week, covid-19 is officially the deadliest pandemic ever recorded in the U.S., trumping the 1918-19 pandemic influenza. It’s understandable for people to make the comparison between the two horrific diseases, but there are many reasons why they’re not so analogous, some of which only highlight the dismal response that the U.S. has had to our current crisis.

Pound for pound, for instance, the 1918 to 1919 flu pandemic (sometimes and erroneously nicknamed the Spanish flu) was substantially more fatal than covid-19. Yes, it’s estimated to have killed 675,000 Americans. But the country’s population then was one-third the size it is now. Mortality records weren’t as precise during the early 20th century either, so this well-cited figure may be an underestimate of the flu’s true toll.

It was also more of an equal opportunity killer when it came to age, with many more of its victims being under 40 relative to covid-19. Worldwide, the flu is thought to have killed somewhere around 50 million, a far starker number than the 4.5 million deaths reported for covid-19 currently.

There are also major epidemics that occurred among Native American populations (spread through contact with European colonists) living in what’s now considered the U.S. that might have surpassed the death count of both pandemics on a local level, killing millions before they ended.

That said, our official toll of the covid-19 pandemic is off the mark. According to the Centres for Disease Control and Prevention, only 1 out of 1.3 covid deaths have been officially reported, based on their estimates. When taking other estimates into account, that means somewhere around 800,000 to over a million Americans have probably died from covid-19 by now. Globally, the undercounting problem may even be worse, especially in countries with poorer healthcare systems. In India alone, it’s thought that millions more people have died of covid-19 than official counts indicate, and as many as 18 million people worldwide may have died as of September.

We’ve also had advantages that people during the 1910s didn’t. Modern medicines like antibiotics have likely saved many people from secondary infections that would have been untreatable back then, while a cheap steroid called dexamethasone used for severe cases may have saved another million lives and counting. Hospitals are also a safer place in general, thanks to better sanitation. And the advent of vaccines since last year may have saved upwards of 140,000 Americans already (a vaccine for flu was still decades away in 1918). All of this might mean that covid-19 would have been even more of a nightmare a century ago than now.

On the other hand, you could argue that modern travel greatly aided the spread of covid-19 in a way that wouldn’t have been possible if it showed up in 1918. And the 1918 flu didn’t spread as widely throughout the world as covid-19 has now. But the mass transport of soldiers during World War I did play a substantial role in the flu pandemic’s spread, so a hypothetical covid-1918 still could have sickened many globally.

There are more nitpicks you could make about this comparison between the 1918 flu and covid-19 and why it doesn’t work. But perhaps the most damning flaw comes down to our collective response to both, as other experts have pointed out.

The 1918 flu hit the world in three to four waves, with the second wave that began in the fall being the first to actually spread widely and cause massive outbreaks throughout the U.S. These outbreaks took people by surprise, and the pandemic reached its deadliest peak then, possibly due to a mutation between the first and second wave. Subsequent outbreaks months later weren’t as potent, though there was some luck involved there, since the flu may have mutated again by then to become less virulent.

As for covid-19, with a few exceptions in some places, it wasn’t the first spring peak that was the hardest-hitting in the U.S., nor the summer peak, but the third one that came last fall and winter — long after the pandemic had been established as a clear threat and before any major important variants like Delta emerged. The spread of covid-19 between those peaks was never truly contained either, despite having far more scientific knowledge and technological resources like mass testing at our disposal.

President Trump instead downplayed the severity of the pandemic at every turn, even after he was hospitalized by it, and by the fall of 2020, some administration officials actively surrendered to the virus, claiming that nothing could be done to control it. Many states never enforced the same level of preventive measures they had enacted earlier in the year, while many people ignored public health advice by travelling and socialising during the winter holidays (that’s not to say there wasn’t pandemic fatigue back in 1918 either).

The Biden administration isn’t exactly passing with flying colours, either. Even with the wide availability of vaccines since early this year, the U.S. is now in the middle of yet another deadly resurgence. And by the end of December, it’s possible that more Americans will have died of covid-19 in 2021 than did in 2020 — an abject failure that was by no means inevitable. The wealthy U.S. looks even worse when you compare how it managed covid-19 to the rest of the world, with an official death rate in the bottom 25 out of 200 or so countries and territories. Worldwide, the pandemic will rage on into 2022, thanks largely to flagging vaccination rates across the globe, particularly in poorer countries whose concerns have been shoved aside by countries like the U.S.

Covid-19 may not be as bad a disease as the worst flu pandemic ever recorded in human history. But our performance against it may very well be worse than how the world and the U.S. did against a pandemic a century earlier, despite all our tools available to fight it.