It has been interesting and rather disheartening reading a number of idiotic articles in the NZ Herald in recent days calling for a change in the way that we handle outbreaks of covid-19 in NZ. Implicit in the articles was that the risks that covid-19 poses to the population of NZ over time are less than the economic damage.
So far I haven’t seen anything that convinces me that this is the case.
One basic precept that is common to these dialogues is that covid-19 is no worse than a bad flu season. That is complete crap written by lazy fools who haven’t bothered to look at its epidemiology in any depth. Nor apparently can they are bothered by examining history of the 1918 epidemic.
For instance consider the research letter from the JAMA Network Open referred to in The New York Times entitled “In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu“. This did a analysis and comparison of public data from New York with actual mortality figures from the surge period of the 1918 flu epidemic and comparing it to the actual mortality rates at the peak surge in 2020.
In both time periods, they compared with the mortality rates for the same period in three previous years prior to the outbreaks to determine a baseline mortality rate. This approach effectively eliminated most questions about the cause of death and allowed for better inter-period comparisons.
The 1918 influenza pandemic is the deadliest in modern history, claiming an estimated 50 million lives worldwide, including 675,000 in the United States.
By some measures, the toll of the Covid-19 surge in New York City this spring resembled that of the 1918 flu pandemic. In March and April, the overall death rate was just 30 percent lower than during the height of the pandemic in the city, despite modern medical advances, according to an analysis published on Thursday in JAMA Network Open.
Many people liken Covid-19 to seasonal influenza while regarding the 1918 flu pandemic as a time of incomparable devastation, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston and lead author of the analysis.
“But in reality, what 1918 looked like is basically this,” he said, except with dead bodies in refrigerated trucks rather than piled in the streets.
“I want people to realize the magnitude of what we just saw this spring, what we’re seeing now again, is truly historic,” Dr. Faust added.
Historians who have studied the 1918 pandemic agreed. “It’s especially important to the pandemic deniers who are saying, ‘Oh, this isn’t any worse than, say, the 1968 flu pandemic,’” said Dr. Howard Markel, a historian at the University of Michigan.
“This is a pretty deadly pandemic. And it’s only getting worse — that’s the scary part.”New York Times: In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu
In New York in 2020 between March 11 and May 11th 33,500 people died. This was about 202 deaths per 100,000 people-months. It was about 4 times that death rate for the same period in the previous three years. It was despite the best of medical treatment that is available in one of the richest cities per capita in the world.
In New York of 1918 in October and November, there were 31,589 deaths giving about 287 deaths per 100,000 person-months – slightly higher than 2020. However this was only about 3 times higher than the death rate in same period for the three years prior.
The cumulative deaths over the months added up.
In the end, 4.7 of every 1,000 New Yorkers died of the 1918 influenza, a lower rate than those of other cities on the East Coast: 6.5 in Boston and 7.4 in Philadelphia, Mr. Wallace wrote.
“New York did not suffer as badly as some other cities,” said Paul Theerman, the library director at the New York Academy of Medicine. “It’s always had a vigorous public health movement,” he said. “And luck.”New York Times: “What New York Looked Like During the 1918 Flu Pandemic“
The graphs of mortality over the comparable period are striking.
1915-1917 was a much more unhealthier time than 2017-2019 – the base level of deaths in 1915-1917 in New York was higher than in 2020. Back then medicine was really primitive. It wasn’t in a war zone. Essentially the United States had remained at peace inside their own country – merely sending troops in 1917 to Europe.
Given the enormous leaps in medicine over the past century, the similarity in death rates today and in 1918 is particularly disconcerting, she and other experts said.
In 1918, a vaccine against the flu mistakenly targeted Haemophilus influenzae, a bacterium, instead of the flu virus. Penicillin — which would have vanquished the bacterial pneumonia that killed many people with the 1918 flu — would not be discovered for another decade. Intravenous fluids to hydrate the severely ill came into use even later.
Without these tools, the hospitals of 1918 were little more than places to rest.
“There was no such thing as an intensive care unit, there was no ventilator, there was nothing,” said Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego.
“I mean, they basically had masks and distancing. We have so much more, and yet the mortality is roughly comparable.”New York Times: In N.Y.C.’s Spring Virus Surge, a Frightening Echo of 1918 Flu
As the research paper succinctly points out:-
One limitation of this study is that a direct comparison of the native virulence of the 1918 H1N1 influenza strain and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not possible. It is unknown how many deaths due to SARS-CoV-2 infection have been prevented because of modern interventions not widely available a century ago, including standard resuscitation, supplemental oxygen, mechanical ventilation, kidney replacement therapy, and extracorporeal membrane oxygenation. If insufficiently treated, SARS-CoV-2 infection may have comparable or greater mortality than 1918 H1N1 influenza virus infection.
These findings suggest that the mortality associated with COVID-19 during the early phase of the New York City outbreak was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic.JAMA Network Open: “Comparison of Estimated Excess Deaths in New York City During the COVID-19 and 1918 Influenza Pandemics” My bold and italics.
My view is that it is quite clear that covid-19 is clearly worse than the 1918 pandemic in terms of mortality in humans. The level of lock down present in New York in the 1918 was far lower than was present in New York of 2020. These public health measures limit the spread of the disease and the rate of infection considerably.
Covid-19 has a much longer incubation period, people are infectious before they are symptomatic whereas with H1NI victims feel quite sick when they are become infectious, and it lasts a lot longer in its effects and infectiousness. Where it breaks loose into a city without adequate social distancing or control, it will overwhelm the medical system in the way that it did to New York in 2020.
As an aside, compared to the 5.5 million in New York in 1918 our 1918 response can only be described as chaotic and poorly run. I wrote about this in a previous post “On Mike the Moron and handling infectious diseases“. This was reflected in the results – it is estimated that New York had 20,000 deaths directly from influenza – about 3.6 people per thousand. NZ was a population of about 1.15 million in 1918 and had 9,000 deaths – about 7.8 people per thousand in a much lower density environment.
But covid-19 is a far greater long term risk. This corona family of viruses isn’t like H1N1 influenza. There are no signs that it is waning over 2 months as influenza did in every area that it hit hard.
It isn’t going to disappear to be a mild recurring disease. From the available data to date, it appears to be unlikely to become something that as a population we can acquire a herd immunity to naturally. By the time that immunity is acquired by a sufficient proportion of the populations, it seems likely that the immunity levels in some of the earlier infected will have waned enough to allow the epidemics to continue.
The reported known levels of herd immunity in Stockholm are appalling low compared to what is required to limit spread. It looks to me like that level of herd immunity will merely slow the rates of infection to something that will cause waves of reinfection. Based on the data available about immunity exhaustion of patients infected with covid-19, we’re likely over time to find that having covid-19 in our communities just causes a slow progressive deterioration in overall health of communities.
Regardless strategies human societies take, over time covid-19 with limited mitigation appears likely to impose large significiant costs on our economies for decades or even hundreds of years. It is more likely to be akin to the black death in its impacts than either measles or influenza.
Unless we beat the odds and find a effective vaccine. Or society changes radically to limit its impacts.
In the meantime I’m content to be a slow follower in NZ that got lucky. The economic cost of learning how to lock the disease out by suffering the odd lock down is economically cheaper than having it become endemic when there isn’t a vaccine or effective treatment. Meanwhile we should keep watching the infected parts of the world to see what works and what does not.
But I’ll get around to writing another post about that topic.