‘We may never know the true mortality consequences of 1918 because of incomplete or inaccurate record keeping, issues that also weaken our ability to quantify the impact of COVID-19’
The 2020 coronavirus and 1918 influenza are two highly contagious respiratory diseases that reached around the world in months and lacked a vaccine when they first occurred. People couldn’t comprehend why they affected some people more than others. For the 1918 flu, healthier, younger people were most at risk.
In 2020, it’s older people with pre-existing health conditions.
But there is one cautionary note from the 1918 flu that has depth in 2020, and it could reinvigorate social-distancing and mask-wearing behavior among those people who are feeling the fatigue of disruption to their daily lives: “While 1918 was deadly, most that contracted the virus survived. But survival does not mean that individuals fully recovered.”
— Economists Brian Beach, Karen Clay and Martin Saavedra in a working paper analyzing the impact of the 1918 flu
That’s according to a study of literature and reviews on the 1918 flu by economists at Vanderbilt University in Nashville, Oberlin College in Oberlin, Ohio, and Carnegie Mellon University in Pittsburgh. “The evidence suggests that, in 1918, those that survived the initial infection faced an elevated mortality risk and some physiological conditions never fully healed.”
“The first lesson from 1918 is that the health effects were large and diffuse. We may never know the true mortality consequences of 1918 because of incomplete or inaccurate record keeping, issues that also undermine our ability to quantify the impact of COVID-19,” they wrote. “The range of lingering health effects for those that contract COVID-19 and survive remains to be seen.”
SARS-CoV-1 in 2003 may provide more clues to what some patients can expect in 2020. This two-year study in the journal Respirology of a selected population published in 2010 of SARS survivors “showed significant impairment” of diffusing capacity for carbon monoxide or lung function, exercise capacity and health status with a more significant adverse impact for health-care workers.
A separate 2009 analysis of patients in Hong Kong in the aftermath of SARS-CoV-1 found that “psychiatric morbidities” (including anxiety and depression) and chronic fatigue among up to 40% survivors almost four years after falling ill.
They recommended more long-term, public-health mental-health strategies to deal with the aftermath of such epidemics or pandemics.
But how about SARS-CoV-2? A recent study of 60 COVID-19 patients published in the peer-reviewed medical journal Lancet this month found that 55% of patients in one study were still exhibiting neurological symptoms during follow-up visits three months later, including confusion and difficulty concentrating, as well as headaches, loss of taste and smell, mood swings and insomnia.
Younger COVID-19 patients who were contrarily healthy are experiencing blood clots and strokes. Many “long-haulers” — COVID-19 patients who have continued showing symptoms for months after the initial infection passed — report neurological problems including confusion, difficulty concentrating, headaches, extreme fatigue, mood changes, insomnia, plus loss of taste and smell.
Some 500 million people, or one-third of the world’s population, became infected with the 1918 “Spanish flu.” Approximately 50 million people died worldwide, with about 675,000 deaths occurring in the U.S., according to the Centers for Disease Control and Prevention.
COVID-19 has now killed at least 795,196 people worldwide, and 174,647 in the U.S., Johns Hopkins University says.
As of Friday, the U.S. still has the world’s highest number of COVID-19 cases (5,595,361). Worldwide, there have been at least 22,773,308 confirmed cases, which does not, for the most part, account for asymptomatic cases. COVID-19 attacks the respiratory system, but doctors say it also affects the cardiovascular system, causing blood clots among some patients, and impacts organs.
— A study on long-term effects of COVID-19 published in JAMA Cardiology in March
A review of cases published last March in the medical journal JAMA Cardiology concluded: “Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias.” It added, “Cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.”
COVID-19 may induce new cardiac issues and exacerbate underlying ones, the researchers said. “During most influenza epidemics, more patients die of cardiovascular causes than pneumonia-influenza causes. Given the high inflammatory burden of COVID-19, and based on early clinical reports, significant cardiovascular complications with COVID-19 infection are expected.”
Throughout the 1918 influenza pandemic as with COVID-19, wealthier people had a better chance of survival: Individuals of moderate and higher economic status had a mortality rate of 0.38%, versus 0.52% for those of lower financial situation and 1% for those who were “very poor,” economists Brian Beach, Karen Clay and Martin Saavedra wrote in the paper published this week.
“Compared to individuals who lived in one-room apartments, individuals who lived in two-room, three-room, and four-room apartments had 34%, 41%, and 56% lower mortality, respectively,”
they added. In 2020, multigenerational households have also faced similar challenges, especially those with elderly inhabitants and younger people who show no symptoms of the virus, experts say.
Though the 1918 pandemic is forever associated with Spain, this strain of H1N1 was discovered earlier in Germany, France, the U.K. and the U.S. But similar to the Communist Party’s response to the first cases of COVID-19 in China and, some commentators say, the early days of the virus in the U.S., World War I censorship buried or underplayed those reports to maintain morale.
President Woodrow Wilson did not make any public announcements on the 1918 influenza in the initial days of the pandemic. Surgeon General Rupert Blue said, “There is no cause for alarm if proper precautions are observed.” Chicago’s director of public health said: