The coronavirus death toll is approaching the 1918 flu pandemic — with some key caveats

The Washington Post
By Aaron Blake

The United States just hit a grim milestone when it comes to the toll of the coronavirus, with now 1 in 500 Americans having died. But for some, an even-grimmer milestone is fast-approaching: When the death toll exceeds the 1918 influenza pandemic.

We’re currently on-pace to surpass the 675,000 deaths that have been attributed to the last comparable pandemic in the coming days. The Washington Post’s tracker shows more than 668,000 deaths so far, with a still-increasing seven-day average of nearly 1,800 deaths per day. That means we’re likely to hit that number by early next week.

“The number of reported deaths from Covid in the US will surpass the toll of the 1918 flu pandemic this month,” Tom Frieden, the former director of the Centers for Disease Control and Prevention, wrote on Twitter. “We cannot become hardened to the continuing, and largely preventable, tragedy.”

This is certainly a milestone — particularly given early comparisons by covid-doubters, including former president Donald Trump, who frequently compared the virus to the regular flu: “Many people every year … die from the Flu,” Trump said in October 2020, adding that “we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!”

But this moment also requires context.

The first obvious point is that our nation’s population is much larger now — by more than three times: The U.S. population in 1918 was just over 100 million, compared to nearly 330 million today. So while the 1918 death toll accounted for about 1 in 150 Americans, we’re currently at 1 in 500.

Another is that it’s possible we’ve already surpassed 1918 in terms of raw numbers. The 675,000 estimate from back then involves some extrapolation. Essentially, the official mortality statistics only included a little more than 30 of the then-48 states, plus some cities in the other states.

As historian Alfred W. Crosby explained in his book, “America’s Forgotten Pandemic: The Influenza of 1918″:

The United States Bureau of Census Mortality Statistics is the most important source of exact figures on the pandemic’s deaths and death rates in America, but even these are incomplete. In 1918, for instance, the area from which the Census Bureau received transcriptions of all death certificates, that is to say, the Registration Area, contained only 77.8 percent of the total estimated population of the nation.

The official death toll of 549,000 was thus extended based upon those percentages to 675,000.

But Virginia Tech historian E. Thomas Ewing suggests simply assuming a constant number of deaths in the un-surveyed areas might not be strictly accurate, in that the available statistics under-sampled Black Americans and oversampled urban areas. Precisely whether this might have led to an undercount or overcount isn’t clear.

Another key difference Ewing cites is in the relatively rapid escalation and decline of the influenza pandemic. That pandemic is generally understood to have lasted around a year in the United States, with the worst month coming in October 1918, right after the start, when as many as 200,000 died of the flu and pneumonia. This was followed by five months of heavy but declining deaths, and then a relatively similar number of deaths to before the pandemic.

By contrast, the worst of the first wave of the coronavirus came about three months after the problem was recognized, in April 2020, and the worst wave to date came about a full year later, last winter.

Ewing also suggests this is a black mark against the official response to the coronavirus.

“The fact that deaths surged at the end of 2020, nine months after the pandemic reached the United States, with the highest daily death tolls in early January 2021, is perhaps the most discouraging comparison to the historical record,” Ewing concludes. “We ignored the lessons of 1918, and then we disregarded warnings issued in the first months of this pandemic. We will never know how many lives could have been saved if we had taken this threat more seriously.”

The last major point we’ll touch on is the difference in deadliness between today and a century ago. We’ve seen similar numbers of raw deaths, but fewer deaths per capita, fewer cases per capita (so far) and fewer deaths per case. While the 1918 flu pandemic is believed to have infected 1 in 5 to 1 in 4 Americans and killed 2.5 to 3 percent of those who contracted it, we’re currently at about 1 in 8 Americans having confirmed cases of the coronavirus, with a 1.6 percent case-fatality rate.

The question from there is whether that reflects upon the relative deadliness of the virus, the advances in health care and mitigation over the past 100 years, or some combination of both (and which is more responsible). The rapid production of vaccines, in particular, is something that would have been largely unfathomable a century ago. (The first flu vaccine would not even be developed until 1942.) It seems evident that without vaccines, we would be in a much-deadlier situation right now, particularly given the rise of the delta variant.

The biggest difference for now is in the staying power of the virus. By the time we reached 1 in 500 people who had died of the flu pandemic in 1918, the pandemic was already on a downward trajectory, and there would never be another wave. Today, we’re seeing a wave reaching 1,800 daily deaths for the third time.

All of which suggests, even if the virus hasn’t yet approached the per capita deadliness of the 1918 pandemic, it’s possible it might one day, albeit thanks to a slower burn and quite possibly a greater ultimate infection rate.

It might yet be more akin to the flu. Just not the flu those like Trump suggested.

Aaron Blake is senior political reporter, writing for The Fix. A Minnesota native, he has also written about politics for the Minneapolis Star Tribune and The Hill newspaper