COVID – 19 compared to H1N1 AKA Spanish Flu (which is believed started in Kansas)

There has been quite a bit of wrong information floating around comparing COVID-19 to the Spanish Flu that killed an estimated 35 million (an average of numerous sources) in 1918. Both are bad, but some people would tell you that H1N1 was much worse, and we are taking COVID-19 too seriously.

What many folks do not take into consideration is that in 1918 the world was utterly unprepared for the virus. They did not have adequate testing or sophisticated treatment procedures and did not understand the value of Non-Pharmaceutical Interventions (NPIs) like social distancing and contact tracing. It is estimated that 30% of the world’s inhabitants were infected, but the mortality rate (again an estimate) was about 2%.

COVID-19 appears to be as contagious as H1N1. Without the procedures in place, the rate of infection could approach the 30% rate of the 1918 virus. The real difference is in the mortality rate, which is currently running 7% worldwide and over 5.7% in our country. This high rate exists even though our ability to treat the virus far exceeds what was available in 1918. I can make the case that COVID-19 is much more dangerous than H1N1. One frightening aspect of the 1918 virus was that there were breakouts in both the Spring & the Fall. The latter H1N1 outbreak took twice as many lives as the initial one.

A good friend recommended that I read “The Great Influenza” by John M. Barry. I purchased it and have read parts of it. It does a great job of chronicling the 1918 event and the progress of medical practices then and how America improved medical care in the years before WW 1, mainly through the efforts of William Welch. It also chronicles the progress (or lack of it) that we have achieved in combating influenza viruses since then.

One interesting comment sited in the book from Welch was: “I think that this epidemic (the H1N1) is likely to pass away, and we are no more familiar with the control of the disease than we were in the epidemic of 1889. It is humiliating but true.”

The person that has made the most progress on the Influenza issue has been Oswald Theodore Avery Jr. (October 21, 1877 – February 20, 1955). He was a Canadian-American physician and medical researcher. The major part of his career was spent at the Rockefeller University Hospital in New York City. Avery was one of the first molecular biologists and a pioneer in immunochemistry, but he is best known for the experiment (published in 1944 with his co-workers Colin MacLeod and Maclyn McCarty) that isolated DNA as the material of which genes and chromosomes are made.

The Nobel laureate Arne Tiselius said that Avery was the most deserving scientist not to receive the Nobel Prize for his work, though he was nominated for the award throughout the 1930s, 1940s, and 1950s

Avery spent the bulk of his life researching the flu virus and is credited with establishing the importance of the immune system in combating the virus.

The book states, “Current research focuses on developing a vaccine that incites the immune system to target the stalk (common to all types of Flus).” If successful, this vaccine should work against all flu viruses that infect humans. So far, this is still a work in process.

The book makes several comments regarding NPIs. It concludes that widespread quarantine is useless; closing borders is of no benefit, and masks are of little benefit except for the infected to limit their ability to transmit the virus. To better understand the author’s rationale, you will need to read the book. It further states, “the problems presented by a pandemic are immense. But the biggest problem lies in the relationship between governments and the truth”.

There are valuable lessons we can learn from past pandemics. Probably the most important is to take early, effective action to contain transmission. This requires that a country’s leadership understand the urgency and have the political will to act responsibly. Acting in the early stages of an outbreak not only saves lives, but it will shorten the length of time that the economy is negatively impacted.

How is the USA doing so far? The answer is not so good.  With only 4.4% of the world’s population, as of April 23, the USA had over 32% of all the reported COVID-19 cases and over 26% of all reported deaths. Also, the mortality rate, while less than the world’s average, has been climbing steadily and likely has not reached its peak. One mystery is why the USA is only reporting 9% of the cases recovered? The good news is that the number of daily new cases seems to have plateaued in the last few days and hopefully, that will continue.

Date: April 23
	Location	Confirmed	Cases per	Recovered	Deaths	Death	New	Rate of	%	% of total
		Cases	1 Mil people		ratio	Cases	Increase	recovered	Daily
							Daily	Daily		new	% of
cases	Worldwide	2,709,483	348	742,855	190,872	7.0%	70,240	2.6%	27.4%	cases	deaths
32.8%	United States	890,027	2,701	82,843	50,372	5.7%	34,777	3.9%	9.3%	50%	26%
7.9%	Spain	213,024	4,523	89,250	22,157	10.4%	0	0.0%	41.9%
7.0%	Italy	189,973	3,153	57,776	25,549	13.4%	2,646	1.4%	30.4%
5.7%	Germany	153,129	1,842	95,817	5,575	3.6%	2,400	1.6%	62.6%
5.1%	UK	138,078	2,078	not reported	18,738	13.6%	4,583	3.3%	?????
4.5%	France	120,804	1,801	42,088	21,856	18.1%	1,653	1.4%	34.8%
0.9%	India	23,077	17	4,749	718	3.1%	1,684	7.3%	20.6%
	Japan	12,429	99	2,408	328	2.6%	406	3.3%	19.4%
	New Zealand	1,114	224	1,095	17	1.5%	1	0.1%	98.3%
63.8%		Items to watch	good results	poor results

The most recent professional projection on the number of deaths by August 1st is 66,000. My amateur forecast is that the amount will be at least 50% higher by July 1^st. Keep in mind that now we have 50,000 fatalities, and it is only April 24^th.5

A University of Washington model of coronavirus deaths was updated—and increased 10%—Wednesday (4/22) to include a presumed increase in nursing home deaths (according to CNN),  ultimately predicting the country will see 66,000 deaths (up by 10% from an earlier prediction) from the disease by August.

New Zealand has done an excellent job of minimizing fatalities and also has a very high rate of recovery. However, it is essential to note that most of their casualties occurred well after the peak in virus cases. Two weeks ago, they had a total of 2 fatalities compared to 17 on April 23^rd! Hopefully, our experience is not the same. If it is, we could be looking at over 150,000 deaths.