COVID: Worse than the great pandemic of 1918-19?

It’s well known that the so-called Spanish flu epidemic killed approximately 675,000 Americans in 1918-19. Given that the US population is now more than three times larger than it was then, it’s true that the pandemic killed a far larger percentage of the population than COVID-19 has, which has claimed about 557,000 lives officially and directly, but probably more like 670,000, when you include undercounts and secondary effects. (That’s how many excess deaths there have been in the US since February of last year, if you assume that but for the pandemic age-adjusted death rates would have remained the same).

But there’s one very relevant sense in which the COVID pandemic has been a good deal more lethal than the pandemic a century ago. 100 years ago, America, like every other nation, was a vastly more dangerous and deadly place than it is today. This is illustrated by the fact that the tremendous carnage wreaked in 1918 by the epidemic increased the overall age-adjusted death rate by “only” 11.7%, from 2276 to 2542 deaths per 100,000 population.

The CDC has just released preliminary age-adjusted death rates for 2020 — and these rose by 36% more between last year and 2019 than death rates rose during the worst year of the Spanish flu pandemic. And this figure doesn’t account for the fact that already 37% of the COVID death total in the USA has been incurred this year rather than in 2020. (As I discussed a few weeks ago, a very strange and as far as I know still unexplained fact about the 1918-19 pandemic is that even though about a quarter of the 675,000 totals deaths were incurred in 1919, the age-adjusted death rate that year actually fell below the pre-pandemic baseline.).

Now the flip side of all this is that, despite the constant gloom and doom from so many public health types about how terribly unhealthy Americans are, what these stats illustrate is that the age adjusted death rate for the population has continued to fall steadily in recent years. And this is despite the wholly imaginary deadly scourge represented by the “obesity epidemic,” and the actual deadly scourge represented by the recent serious spike in both drug and alcohol-related deaths and suicides among working class whites, etc.

In other words, the reason the mortality spike during COVID has been worse in percentage terms than that during the Spanish flu is that, even with the nearly half million excess deaths caused directly and indirectly by the current pandemic in 2020, age-adjusted death rates merely slid back to where they were in the middle of the previous decade.

So the bigger picture here is that, while COVID-19 has been an enormous public health catastrophe, it has been a catastrophe in the context of what overall continues to be a constantly improving public health situation, despite the seriously screwed up economics of our health care system, the large numbers of deaths of despair in Trumpland and so on.