- The COVID-19 death toll in the United States has surpassed the total number of fatalities of the 1918 flu pandemic despite the medical advances of the past century.
- Experts say one reason is that the 1918 flu and COVID-19 are two different viruses that work in different ways.
- They add that the primary factor is misinformation that has spread on social media, discouraging people from getting vaccinated against COVID-19.
The 1918 flu pandemic, which ranks as one of the deadliest in modern history, has just been surpassed by COVID-19 – in the United States, at least.
That 1918 pandemic killed an estimated
The ongoing COVID-19 pandemic has killed fewer than 5 million people worldwide, about 1/10 the total of the 1918 flu.
However, more than 680,000 people have died from COVID-19 in the United States, putting it ahead of the country’s flu pandemic more than a century ago.
Put another way: 1 in 500 people in the United States have died from COVID-19, and the end of the pandemic is not yet in sight.
Daily deaths in the United States have reached 1,900 a day during the current surge fueled by the Delta variant, mainly affecting the population of 71 million unvaccinated people.
But how did we get here, and what can we learn by comparing these two public health emergencies?
The first step is not to draw too close of a comparison between these two viruses, says Andrew Noymer, PhD, MSc, an associated professor of public health at the University of California at Irvine.
“COVID-19 is not some 21st century version of the 1918 flu. In many ways, COVID-19 is less severe,” Noymer told Healthline.
“But with COVID, we are witnessing the emergence of a whole new disease, one that will be with us — in some form — for decades if not centuries,” he added. “The 1918 flu was with us for one flu season, the fall and winter of 1918–19. We are now in our second fall after our second summer of COVID, and all signs point to approaching our second winter.”
Rodney E. Rohde, PhD, MS, a chair and professor of clinical laboratory science at Texas State University, elaborated on the differences between the diseases.
“The two kill differently,” he told Healthline. “The flu killed many due to secondary bacterial pneumonia (there were no antibiotics back then), while those with COVID-19 died from an overactive immune response that resulted in multiple organ failure.”
Although there are some similarities, modern medicine is more effective at fighting COVID-19 than the medical community was at fighting H1N1 in 1918.
“Acute respiratory distress syndrome (ARDS) can develop in both cases,” Rohde explained. “As a complication from influenza, ARDS had a 100 percent fatality rate compared with a 53.4 percent mortality rate as a complication from COVID-19. So, flu was much more of a nasty virus without any checks on its virulence like we have today (monoclonal antibodies, antibiotics, vaccines, more knowledge about health treatments with steroids, placement of patients, ventilators, etc.).”
Another factor is that the U.S. population is more than three times larger than in 1918, so the death rate for COVID-19 would need to be three times higher to match the number of that earlier pandemic.
It’s also possible that more than 675,000 people died in the United States in 1918.
“That number was an extrapolated estimate by a historian, Alfred Crosby, in the late 1970s,” Susan Jones, PhD, a Distinguished McKnight University professor in the University of Minnesota College of Biological Sciences, told Healthline. “There is nothing magic or even particularly authoritative about it. Many states did not keep records of flu mortality at that time. We actually do not know how many Americans died of influenza in 1918-19 and, of course, all mortality statistics are somewhat slippery, even today.”
Also, the interconnectivity of the global community via air travel and other rapid transit means more viruses have an opportunity to blow up in today’s world.
“In 1918-19, H1N1 influenza was probably greatly assisted in becoming a global pandemic by World War I,” Jones said. “Today, we don’t even need an event of that scope. Our trade and travel networks are enough to create rapid global transmission.”
Whatever the precise numbers are, the United States is the global leader in COVID-19 deaths, despite some similar public health approaches between the two pandemics.
“The overall public messages during 1918 and 2020/21 were eerily similar in some respects: Face coverings, mass gathering cancellations, and isolation at home were employed during both,” Richard J. Webby, PhD, an influenza researcher at St. Jude Children’s Hospital in Tennessee, told Healthline.
“It is interesting to note that there were certainly differences in how U.S. states implemented these controls during 1918 with a clear association of speed and enforcement of lockdowns to pandemic impact,” he says. “These associations are a little more complicated with the COVID pandemic due to our far great interconnectivity and travel capabilities.”
With one notable exception: We have effective vaccines against COVID-19.
So why are our death rates worse?
Across the board, experts interviewed by Healthline pointed to “misinformation” as a key culprit.
“In 2020, we had a new obstacle that certainly was not around in 1918: the internet,” Jyotsna Shah, PhD, MSc, an immunologist and president of IGeneX Inc, told Healthline. “While the internet provides us easy access to updates from the CDC and WHO, it also provides easy access to less reputable sources, who may be spreading false information.”
Robert G. Webster, PhD, an infectious disease expert also at St. Jude, put it more bluntly.
“This is a war that the U.S. is losing when they have the weapons to win,” he told Healthline.
But, Webster says, different rules in different states — many of which do not adhere to the best recommendations of the scientific community such as lockdowns where necessary and masking — has led to a “disastrous situation where people are dying due to misinformation.”
“There is no simple solution for politicians and governors who are essentially killing their constituents,” Webster said. ‘When the pandemic is over, and the COVID-19 virus is under control, then it is strongly recommended that the U.S. convene a commission to make recommendations to prevent such a disaster from occurring again in the future.”