COVID-19 in Context: An Unbiased USA Perspective
Photo by Alexas Fotos
The World We Knew / The World We Never Knew / The COVID-19 Pandemic / Into the Future
THE WORLD WE KNEW
Once upon a time, when we would talk about the cold-and-flu season coming up, we didn’t waste much time discussing the differences between the two bugs; they both hit us around the same time of year, and they were both unpleasant illnesses that caused a slew of familiar symptoms that lasted a week or two. Many of us would go get our yearly flu vaccines, but none of us were truly concerned about winding up dead.
Influenza
In fact, so few people pass away during flu season that almost nobody in a developed country has lost a loved one to the illness. Every year, as new flu-causing viruses come around, the scientific community quickly and methodically isolates the most dangerous strains, whips up a new cocktail of dead virus, and tries to get it out to as many people as possible. Usually, they get it right. Most of us think nothing of it, and this is what we’ve grown accustomed to seeing, year after year.
We don’t think of the flu as a deadly virus. And while it is sometimes fatal, the truth is that on average, influenza claims up to 646,000 lives around the world each year, which is well under 0.01% of today’s world population, or less than 10 in every 100,000 people. (The percentage is even lower in the US).
>>> Based on deaths by population, the seasonal flu death rate for the US and the world is less than 0.01%.
Deaths are typically highest among the very young, very old, the immunocompromised, and those with limited access to healthcare, meaning that the average healthy child or adult with access to soap, water, and vaccines has an incredibly low risk of dying from the flu. The case fatality rate (CFR) of influenza, the whole family of viruses that causes the seasonal flu, is < 0.1% in the US, which is fairly characteristic of developed countries where we have the technology and resources to minimize the death toll. This is, quite simply, the number reported by our very own Center for Disease Control (CDC); The “real-world-outcome” CFR (my words) for a country or region can be much higher (even as high as > 0.1%) due to complicating factors like sanitation and access to healthcare, according to a comprehensive 2014 study aimed at reexamining and clarifying the case fatality risk of the seasonal flu, and recognizing its variability around the world.
>>> Among those with confirmed cases, the “known” seasonal flu death rate is also < 0.01%.
It’s just a coincidence that the CFR and deaths by population can both be described with the same statistic. The fact is that, year after year, this is the very safe reality in which we lived. The flu didn't scare us. We washed our hands. We counted our blessings. We knew nothing, firsthand, of the terrors that a flu virus had once visited on the world.
Human Coronaviruses
Corona is a family of viruses with a characteristic corona-like or crown-like set of spikes that attacks both animals and humans. Some of these viruses have proven to be harmless; others, quite deadly. Actually, "common" coronaviruses cause 15%-30% of all common colds each year, and of course, we know that catching one of these is almost never deadly.
>>> Four out of the seven known human coronaviruses do nothing more than cause the common cold.
The remaining three viruses you might know by name; each one has made the headlines at some point in the past 20 years, and each one is essentially unrelated to the other six; they're all very distant relatives. Just like most pandemic-causing pathogens, each of these has occurred as the result of the habit of all viruses to transmute into new and unique strains as they replicate.
In 2003, Severe Acute Respiratory Syndrome (SARS) was discovered, an illness caused by SARS-associated coronavirus (SARS-CoV). This pathogen originally appeared and caused an outbreak in Asia; it caused over 8,000 cases and 755 deaths worldwide. SARS-CoV was contained successfully through basic healthcare measures like quarantining of the sick, and essentially disappeared; however, many healthcare experts became vigilant knowing the likelihood of a similar, worse event. Fourteen years later, scientists were able to isolate the bat population where the disease originated.
>>> The SARS outbreak from 2002-2004 in Asia was caused by a deadly coronavirus that was contained fairly quickly; it wasn't extremely contagious.
In 2012, Middle East Respiratory Syndrome (MERS) was discovered, an illness caused by MERS-CoV. It has caused two outbreaks so far, in Saudi Arabia and South Korea, and it has only reached the point of about 2,600 cases and 900 deaths over all this time, worldwide. The two prominent theories as to its origins are bats and camels.
>>> The MERS outbreaks of 2014-2015 in the Middle East were caused by another deadly coronavirus that we've been able to contain very well.
Until now, none of these coronaviruses had ever successfully “crossed the line” and caused an ongoing public health crisis. If either of these COVID-19 predecessors had gotten out of hand, they might have caused the same international panic, but the fact of the matter is that they didn’t. There was the common cold, and there was a couple of briefly dangerous mutated animal viruses, and that was the whole story. Until now.
Infographic by Visual Capitalist
The World We Knew / The World We Never Knew / The COVID-19 Pandemic / Into the Future
THE WORLD WE NEVER KNEW
Two things stand out very clearly when we look at the US: first of all, we had a relatively tame experience of the Spanish Flu; secondly, we have had an even more muted experience of pandemics and endemic diseases over the 100 years since then. We didn't live through the 1918 pandemic, and we didn't live through the vast majority of premature death happening all over the world in the last century.
The Spanish Flu
Different strains of influenza have caused several pandemics since the 1500’s, including the “Spanish” H1N1 Flu of 1918, which got its name due to the efforts of Spanish reporters at the time, who came through with unbiased, groundbreaking news on an international crisis that was suppressed by other war-driven countries. It was one of the most infectious and deadly pandemics in human history, and came on the heels of one of the deadliest wars in world history. At the tail end of World War I (WWI), the World Health Organization (WHO) did not exist, and neither did the science, resources, nor collaboration between countries necessary to collect data on a worldwide pandemic. That’s why there is such a range in possible deaths attributed to the “mother of all pandemics.”
That famous virus claimed 50-100 million lives between 1918 and 1919, or more than 2.5 - 5% of the world population at that time, which would be 2,500 - 5,000 out of every 100,000 people. In the US alone, the virus killed 675,000 people, which was 0.66% of the US population at the time, or 660 in every 100,000 people. Though it was still a time of shocking loss and mass hysteria, this places the US death rate at 3.8 to 7.6 times lower than the worldwide death rate, which may explain why the US participated in suppressing reports of the virus’ impact at the time.
>>> Based on deaths by population, the Spanish Flu was 4-7 times less deadly in the US than worldwide.
The Spanish Flu had an estimated case fatality rate (CFR) of > 2.5% in the US, based on a comprehensive 2006 study which nods to advances in forensic science. This number makes that original strain of H1N1 (a type of Influenza A) at least 250 times more deadly than the seasonal flu — which is due, in no small part, to vaccines and hygiene practices which we use to minimize the death toll each year and to prevent another influenza virus from ravaging our nations. The numbers would not be quite so far apart, otherwise.
>>> Among those with confirmed cases, the Spanish Flu death rate was estimated to be over 250 times more deadly than the seasonal flu in the US and worldwide.
The Spanish Flu killed children and adults of all ages within days, sometimes hours, and was exceptionally contagious. Although the pandemic may have lasted for at least a year, the death toll essentially occurred over a single flu season, from September of 1918 to April of 1919; an official crisis period of 8 months. None of us were alive for that terrifying experience, and so our expectations of the flu in modern life are very mellow. Of course, that’s partly because we do everything we can to prevent another 1918, from promoting sanitation practices to creating new vaccines each year to combat the latest strains - we've just lost touch with the gravity of these practices, 100 years later.
Pandemics of the Last Century
From mid-1919 to mid-2019, the US simply didn’t lose more than about 0.07% of its population, or 70 in every 100,000 people, to any one pandemic (specifically, the Asian Flu of 1957), a mere 10% of the impact