COVID 19 unlikely to behave like 1918 Spanish flu
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
COVID-19 is more lethal than the seasonal flu. But there are
no signs it will be as catastrophic as the worst pandemic the 1918 Spanish flu.
The 1918 flu is the quintessential pandemic, estimated to
have killed 50 million people worldwide. Although it occurred in an era before
international air travel, its movement around the globe was facilitated by
troops fighting in World War I. It went around the world four times in one year
when there were no airplanes. That’s what it means to spread like wildfire.
The 1918 flu was unusually bad for targeting healthy people,
with fatalities high in those younger than 5, between the ages of 20 and 40 and
those 65 and above. The new coronavirus, by contrast, has so far spared babies,
toddlers and young children from death. It’s estimated to be mild in about 81%
of those infected. The risk of death is substantially higher for those aged 70
and older and those with underlying medical problems.
Fatality rate for the 1918 flu was > 2.5%. In the early
months of the coronavirus outbreak, the fatality rate held steady at around 2.3%.
This week, it inched up above 3.4%.
The case fatality rate of the 1918 Spanish flu also varied
between countries, with poorer ones taking a bigger hit. In the U.S., mortality
also differed by economic status: the lower the economic level, the higher the
attack rate. People of lower
socioeconomic status are more likely to have chronic health conditions that
would make them more vulnerable to an influenza infection. Fatality rates can
also be affected by how well or how poorly public health officials respond to
outbreaks.
For instance, in the first months of the coronavirus
outbreak, Chinese authorities allowed crowds to gather in tight spaces for
Lunar New Year celebrations even though it was clear the new virus was circulating.
They also let 5 million people flee the Wuhan area just before enforcing an
unprecedented regional quarantine.
The underlying health of the population matters too. Some
experts suspect that high smoking rates among Chinese men may help explain why
some studies have reported that men who are infected are more likely than women
to die of COVID-19.
Back in 1918, those who were infected did not have the
benefit of the medicines available today. Antibiotics hadn’t yet been invented,
and that was a problem because most of the people with the flu died of
secondary bacterial infections.
At this time, there’s no evidence that secondary bacterial
infections are a major complication of the new coronavirus.
The overall clinical consequences of the new coronavirus may
ultimately be more like a severe seasonal flu, or one of the flu pandemics the
world saw in 1957 and 1968.
Each of those flu pandemics resulted in about 1 million
deaths worldwide, and about 100,000 deaths in the U.S.
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