Influenza and Coronavirus lethality rates

As we are trying to fight the Coronavirus outbreak, it may be helpful to review some statistics and data. Part of the reason for reviewing the statistics is the memés that are being found all over social media, and especially on one of the news networks, that appear to say that the COVID-19 efforts are nothing more than hysteria. It should be noted that currently, the President is taking the spread of COVID-19 seriously, although as I write this he is blaming the Obama administration for his lack of adequate response. In other words, by blaming the Obama administration, he is acknowledging that the current response is not adequate. It should be noted that in the Spring of 2018 the current administration dismissed or pushed out various officials whose job was to prepare for a pandemic.

Blame-games aside, what are the statistics collected so far? Well, outside of the 1918 Spanish flu pandemic, influenza has had only two prior events that were somewhat pandemic-like. The death rate during those two events was only 0.1%, which is a negligible number. The yearly influenza death rate worldwide is normally around the same 0.1%. The CDC predicts that about 12,000 people a year will die from the flu, although in bad flu years (outside of the 1918 Spanish flu pandemic) it can climb to 60,000 as it did in 2017-2018 with 45 million infected. The death rate from the flu has dropped dramatically since the 1930s due to health efforts. In the 1930s, flu deaths were roughly 400 per 100,000 infected, while by the 1980s the rate was closer to 100 per 100,000 infected.

Most of the memés about flu in the USA that one sees are either wrong or deliberately pick the figures from one of the higher flu years. However, the memés are correct in that flu deaths per year are still more than COVID-19 currently. The memes also imply that no one cares. While it is true that many people do not care, it is not true that the medical community does not care. Every year there are campaigns to try to get people to receive the flu vaccine. Nevertheless, because of the low death rate by the flu, a very significant proportion of the population refuses to get the flu vaccine and thus contributes to the death rate. And, yes, I do realize that the yearly flu vaccine is never 100% effective. However, the point is that the medical establishment does not ignore the flu, we do.

So, are people upset because this is a media-impulsed event? Well, not unless you buy into conspiracy theories which would have to include major world leaders, to now include President Trump. The reason these leaders are so upset is that the death rate for COVID-19 is significantly higher than for regular influenza. What is the death rate for COVID-19? Currently, it is around 1-3%. However, the death rate among the elderly starts approaching 7%. As we see with what is currently happening in Italy, when COVID-19 gets loose, it can rampage. Northern Italy went from almost no deaths to over 1,000 deaths, as of the numbers 18 hours ago.

This death rate is why there has been such a strong emphasis on containment. Here is the irony. If containment is successful, there will be a few cases. It is only if containment is not successful that we would begin to see the same massive number of cases as with the 1918 Spanish flu pandemic. One of the memés on the Internet points out that there are 45 million cases of flu a year in the USA. This is actually an exaggeration, but if you apply the 3% death rate, we would experience 1.4 million deaths that year. It is this type of mathematical calculation that scares health authorities.

This does not mean that medical authorities take regular yearly flu deaths lightly. But, it does mean that yearly flu deaths have been lowered to such a low percentage that it is unlikely that we could lower it much more. Sadly, given people’s resistance to yearly flu shots and given the costs to the economy to further lower the spread of the yearly flu waves, there is not much more than can be done. The same is not true of COVID-19. Between 1 to 2 million deaths not to mention the overload to the health system from those infected, would be destructive to this country.

So, what is the purpose of an epidemiological approach? Well, look at the chart at the beginning of this post. There are two purposes. First, can the infection be stopped in its tracks? Second, if it cannot be stopped, can the effects of the infection be ameliorated so that the impact on the country and the health system is a slow and semi-controlled impact?

So, let’s look at some numbers. First, guess what? The 1918 Spanish flu had a 1-3% death rate just like COVID-19. It took place during a World War, which meant a rapid spread because of the highly mobile populations due to war. One-third of the world was infected and between 20 to 50 million died. This took place prior to modern healthcare, yet still after the development of early forms of infection control. This pandemic is what all wish to avoid. This is why the travel controls, the canceling of events, etc. COVID-19 has the same apparent epidemiological profile as the 1918 Spanish flu. Notice that even with strict control measures, spraying antiseptics in the streets, etc., China has racked up over 3,000 deaths so far.

Here is the ultimate irony. When world health leaders are effective, no pandemic takes place. For instance, Ebola spread was able to be halted due to the coordinated efforts of world health authorities. But, because no pandemic takes place, it is all too easy to claim that no pandemic would ever have taken place. So, if world health authorities take no action, a pandemic could easily take place. But, if world health authorities are successful, they are mocked by the uninformed and uneducated for having raised a false alarm. This reminds me of the problem that “spy” agencies have. If they are successful, no one hears about what they have done for either a long time or often never.

We are in the midst of stopping the spread of a virus that could be as bad as the 1918 Spanish flu. So far its death rate and its rapidity of diffusion appear to be similar to that of the 1918 Spanish flu. The difference is that there is a health network in place now that was not present back then. So, if we are successful, you will see few deaths. Please take these efforts seriously and do not mock them.