No comparison between COVID-19 and Spanish Flu

Provided by the Centers for Disease Control, the first launching of the 1918 flu and people in Nevada had reason to take the illness seriously.

WORLDWIDE — Science, medicine and health professionals have been comparing the Spanish Flu epidemic of 1918-20 to the CORONA-19 pandemic hitting everywhere around the globe.


Research shows there is no comparison. Centers for Disease Control (CDC) reports the  first recorded cases of the 1918 flu were at a U.S. Army camp in Kansas in March of that year. It became the Spanish Flu due to press in Spain.


That information —or lack of it — caused the epidemic to have its international name.


By the late summer and early fall, a second, deadlier, wave of the flu emerged and caused particular devastation at Camp Devens in Massachusetts About a third of the 15,000 people at the camp became infected, and 800 died. Victor Vaughan was one of the doctors who witnessed this outbreak, yet in his 1926 book, A Doctor’s Memories, he barely mentioned this important historical event.


“I am not going into the history of the influenza epidemic,” he wrote. “It encircled the world, visited the remotest corners, taking toll of the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face of science.”


As COVID-19 continues to spread across the United States and the world, many communities have lingering questions about the deadly virus and its impact. To help address concerns, Miami’s office of university news and communications connected with Philip Smith, assistant professor of kinesiology and health. Smith has expertise in psychology, epidemiology, health policy, community health and health behavior. Smith discusses previous outbreaks in a way that’s easy to understand, in his own words.


Social distancing, quarantine and isolation are all measures being used to slow the spread of COVID-19 and ease the stress on America’s health care system, but there’s still little known on what we’re dealing with. According to updates from the Centers for Disease Control (CDC), COVID-19 is a new, previously unidentified virus. 


For COVID-19, just over the course of about two months, the U.S. saw over 775,000 confirmed cases, although this is likely a major underestimate. Daily deaths rose from less than 100 to over 2,000 in a little over two weeks and have stayed at about that number. The current total is over 40,000 deaths.


To think of a pandemic on a similar scale you would have to think all the way back to the 1918 influenza pandemic. That pandemic caused more loss of life than COVID-19 is likely to cause – around 50 million people worldwide and 675,000 people in the U.S. Of course, the CDC didn’t exist and neither did much of our Department of Health and Human Services. 


In 2003, SARS (severe acute respiratory syndrome) affected 26 countries with a little over 8,000 confirmed cases worldwide. Of those 8,000, 774 people died (about 10%). No one died in the United States.


SARS is caused by a type of coronavirus, different from COVID-19. The version of coronavirus that causes SARS is more deadly but much harder to transmit from person to person. The version of coronavirus that causes COVID-19 is less deadly but much easier to transmit from person to person. 


The differences come down to small biological factors: how long the virus stays in the air, how long it can survive on surfaces, how easily it gets to the lower lungs and how resistant it is to changes in weather or climate. This is why there’s an increased number of people getting sick with COVID-19 compared to SARS. It’s also why health officials worry that COVID-19 could stick around from season to season.


H1N1 is a group of flu viruses that caused the influenza pandemic of 1918, as well as the swine flu pandemic of 2009. Comparing influenza to coronavirus is more like comparing dogs and cats. There are differences between the viruses that make them more or less contagious for people, more or less easily passed from animals to people and more or less severe and deadly. 


Of course, the environment is different as well –– in 2009 and 2020, our health system is much better equipped to handle an epidemic than in 1918. So, let’s compare the 2009 H1N1 outbreak to COVID-19.


H1N1 in the U.S. from 2009-2010:
60.8 million people affected.
274,304 hospitalizations.
12,469 deaths.


Keep in mind, this was spread out over the course of a year. At the time, it affected an incredibly high number of people and caused a tragic loss in life. For a better perspective, consider this: For swine flu in 2009, there were 12,000 deaths in a year. For COVID-19, we’ve already seen 2,500 deaths in a day. The quantity and speed of which people are being hospitalized and are dying of COVID-19 are completely unprecedented in modern history.  


Four of the 7 coronaviruses most frequently cause symptoms of the common cold. Coronaviruses 229E and OC43 cause the common cold; the serotypes NL63 and HUK1 have also been associated with the common cold. Rarely, severe lower respiratory tract infections, including pneumonia, can occur, primarily in infants, older people and the immunocompromised.


Three of the 7 coronaviruses cause much more severe, and sometimes fatal, respiratory infections in humans than other coronaviruses and have caused major outbreaks of deadly pneumonia in the 21st century:
SARS-CoV-2 is a novel coronavirus identified as the cause of coronavirus disease 2019 (COVID-19) that began in Wuhan, China in late 2019 and spread worldwide.


MERS-CoV was identified in 2012 as the cause of Middle East respiratory syndrome (MERS).


SARS-CoV was identified in 2003 as the cause of an outbreak of severe acute respiratory syndrome (SARS) that began in China near the end of 2002.


These coronaviruses that cause severe respiratory infections are zoonotic pathogens, which begin in infected animals and are transmitted from animals to people. SARS-CoV-2 has significant person-to-person transmission.


“One of the reasons I think that we didn’t talk about the flu for 100 years was that these guys weren’t talking about it,” says Carol R. Byerly, author of Fever of War: The Influenza Epidemic in the U.S. Army during World War I. “They would say, ‘we really didn’t have much infectious disease, except for the flu;’ and ‘our camp did very well, except for that flu epidemic.’”


The horrific scale of the 1918 influenza pandemic—known as the “Spanish flu”—is hard to fathom. The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims—that’s more than all of the soldiers and civilians killed during World War I combined. 


While the global pandemic lasted for two years, a significant number of deaths were packed into three especially cruel months in the fall of 1918. Historians now believe that the fatal severity of the Spanish flu’s “second wave” was caused by a mutated virus spread by wartime troop movements.


When the Spanish flu first, it had all the hallmarks of a seasonal flu, albeit a highly contagious and virulent strain. One of the first registered cases was Albert Gitchell, a U.S. Army cook at Camp Funston in Kansas, who was hospitalized with a 104-degree fever. The virus spread quickly through the Army installation, home to 54,000 troops. By the end of the month, 1,100 troops had been hospitalized and 38 had died after developing pneumonia. 


Reported cases of Spanish flu dropped off over the summer of 1918, and there was hope at the beginning of August that the virus had run its course. In retrospect, it was only the calm before the storm. Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged that had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection. 


From September through November of 1918, the death rate from the Spanish flu skyrocketed. In the United States alone, 195,000 Americans died from the Spanish flu in just the month of October. And unlike a normal seasonal flu, which mostly claims victims among the very young and very old, the second wave of the Spanish flu exhibited what’s called a “W curve”—high numbers of deaths among the young and old, but also a huge spike in the middle composed of otherwise healthy 25- to 35-year-olds in the prime of their life. 


“That really freaked out the medical establishment, that there was this atypical spike in the middle of the W,” says Harris. 


Only decades later were scientists able to explain the phenomenon now known as “cytokine explosion.”

When the human body is being attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation. But some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines leading to severe inflammation and the fatal buildup of fluid in the lungs. 


British military doctors conducting autopsies on soldiers killed by this second wave of the Spanish flu described the heavy damage to the lungs as akin to the effects of chemical warfare. 


On July 15 of this year, Coronavirus was thought to be spread most often by respiratory droplets.


Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses. Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. 


By its sheer unpredictability, COVID-19 has not been successfully pinpointed and a vaccine is in the works.  Today, the specialists and experts say cleanliness, wearing a mask and maintaining six-foot distances from one another can offer some control.


Most of this information was taken from historic accounts of epidemics and pandemics. 

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