COVID-19 Claims More Than 675,000 US Lives, Surpassing the 1918 Flu

Brenda Goodman, MA

September 20, 2021

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COVID-19 has now killed at least 675,000 Americans, a death toll that has surpassed the estimates of the number of Americans who died during the 1918 influenza pandemic, according to data collected by Johns Hopkins University.

Although the raw numbers match, epidemiologists point out that 675,000 deaths in 1918 was a much greater proportion of the population. In 1918, the US population was 105 million, less than one third of what it is today.

So, in terms of mortality rate, the 1918 flu was probably deadlier, said Graham Mooney, PhD, an associate professor of the History of Medicine at the Johns Hopkins School of Medicine in Baltimore.  

The demographics of those deaths are different, too. While the very young and very old were impacted by the 1918 flu, it was people in the prime of their lives who were the hardest hit by that highly virulent strain.

“We still don't totally understand why. Although there are a number of theories, that was unlike the typical influenza which affected the elderly,” said Jennifer Gunn, PhD, an associate professor and medical historian at the University of Minnesota School of Medicine in Minneapolis.

Still, Mooney said that shouldn’t be a reason to dismiss today’s tragic milestone.

“It’s a big number. It’s not an insignificant number, whichever way you want to cut it. It’s 675,000 deaths that we otherwise wouldn’t have had from a disease that wasn’t in our midst 18 months ago,” he said.

The AIDS pandemic of the 1980s remains the deadliest of the 20th Century, claiming the lives of 700,000 Americans. But at our current pace of 2000 COVID deaths a day, we could quickly eclipse that death toll, too.

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Even though the 1918 epidemic is often called the "Spanish Flu", there is no universal consensus regarding where the virus originated, according to the Centers for Disease Control and Prevention.

A patient is lifted into an ambulance in St. Louis during the Spanish Flu pandemic in 1918.

 

Still, the almost incomprehensible loss harkens back to a time when medicine and technology were far less advanced than they are today.

In 1918, the US didn’t have access to a vaccine, or near real-time tools to trace the spread and communicate the threat. There was also no test to detect the virus in 1918.

“Virology was a young science,” Gunn said. “We didn’t have the ability to identify the virus. That didn’t happen for decades afterward.”

Influenza was diagnosed based on signs and symptoms. There was no national, uniform system for recording births and deaths, so the 675,000 tally was reconstructed by calculating excess deaths -- subtracting the expected number of deaths from influenza and pneumonia over those years from the total number of deaths.

There were other important differences, too. The 1918 flu killed quickly.

“It seemed to have a pretty rapid trajectory to, you know, to death over several days,” Gunn said.  Typically, COVID turns dire over a span of weeks.

And doctors didn’t have as much to offer patients in the way of supportive care.

“We didn't have the some of the treatments that we have today, like mechanical ventilators,” she said. There was a type of negative pressure ventilator, but “it was not anything you would expect to find routinely in a hospital.”

In some ways, reaching 675,000 deaths today means we’ve squandered some of the advances of our age.

“I've actually been pretty appalled,” Gunn said.

At a time in history when we have the ability to coordinate a rapid, national response, she said public policies have siloed states, letting the pandemic fester and resurge. When we most needed a strong public health system, it faced disinvestment.

Gunn said a uniform, coordinated response is something we should have done much better this time.

Similarities

There are many similarities between the two pandemics. In the spring of 1918, when the first wave of influenza hit, the US and its allies were nearing victory in Europe in World War I. Just this summer the US has ended its longest war, the conflict in Afghanistan, as COVID cases surge.

In both pandemics, hospitals and funeral homes were overrun and makeshift clinics were opened where space was available. Mask mandates were installed; schools, churches and theaters closed; and social distancing was encouraged.

Flags on the National Mall in Washington, DC representing the thousands of American lives lost to COVID-19.

 

As is the case today, different jurisdictions took different steps to fight the pandemic and some were more successful than others.

According to History.com, in 1918, Philadelphia's mayor said a popular annual parade could be held, and an estimated 200,000 people attended. In less than 2 weeks, more than 1000 local residents were dead. But in St. Louis, public gatherings were banned, schools and theaters closed, and the death toll there was one eighth of Philadelphia's.

Just as in 1918, America has at times continued to fan the flames of the epidemic by relaxing restrictions too quickly and relying on unproven treatments. Poor communication allowed younger people to feel that they wouldn't necessarily face the worst consequences of the virus, contributing to a false sense of security in the age group that was fueling the spread.

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"A lot of the mistakes that we definitely fell into in 1918, we hoped we wouldn't fall into in 2020," epidemiologist Stephen Kissler, PhD, of the Harvard T.H. Chan School of Public Health told CNN. "We did."

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