Pandemic response: now and then

March 28, 2022 11:33 PM

How would the response have differed if the current pandemic's pattern of fatality had been the same as the previous pandemic of 1918?

"The [1918] pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old."

In the current pandemic the pattern of fatality is essentially reversed. In 2020-2022, approximately 75% of pandemic deaths in the U.S. occured in people over 65, and over 93% of deaths in people over 50, and under 2.5% of deaths in adults 20 to 40 years old.

posted by fairmettle to Society & Culture (8 answers total)

I think that the parallel timings of WW1 and the 1918 pandemic are what make a comparison particularly difficult. In time of war people can fail to report on - or even notice - pandemics at all. For example - we are now over a month into the Russian invasion of Ukraine, Covid will have been infecting people on both sides (and we are maybe aware that Russian may have lost 1 million people in the pandemic prior to this date) - but we are not seeing any reporting of how many soldiers are affected.

So - it seems that the ability of the media to tell the story of losses of young people to Flu was limited. If it had not been then I suspect there would have been a bigger outcry and more serious attempts to impose quarantine.

I think it is also important to look not just at the immediate deaths from flu during the pandemic - but also at the deaths from the sequelae to the flu that panned out in the years after 1918. John Campbell gave an interesting talk about this. and especially about Encephalitis Lethargica. The death rate from this disease shot up to high levels about 4-5 years after the 1918 pandemic and appears to have been linked to earlier infection. The situation may well be similar with relation to those who have had long covid - and we don't yet know the numbers or the death profile of that group.
posted by rongorongo at 3:00 AM on March 29, 2022 [7 favorites]

I think the early response in eg China, Italy or the UK would have been about the same. Those were reasonably tight lockdowns in 2020, quite possibly later than they ought to have been, but definitely a big imposition on people and at least in the UK were always considered at the time to be as far as people would tolerate. That last point may not have been true in fact, but if you're making decisions your guess about what people would do is going to influence your choice.

I'm not sure whether the later response would have been difficult. Younger people are more likely to think they are invincible perhaps, so it may not have made that much difference to people's desire to comply with continuing restrictions. On the other hand, people do respond differently to deaths of different age groups, so maybe there would have been more alarm.

I don't think the vaccine programme could realistically have gone quicker. Although I could be completely wrong about that.

If it had affected young children the most, then the response would definitely have been different. More cocooning of children for sure, as we tend not to worry about compliance challenges.
posted by plonkee at 3:37 AM on March 29, 2022 [1 favorite]

I do think it's worth noting that those numbers are influenced by the demographics of the population in which they took place. The percent of the population over 65 was much, much smaller in 1918 than it is now. I'm having trouble finding numbers for 1918 but folks age 65 and up make up 17% of the US population today; in 1950 they made up 8% of the population, and the numbers worldwide have changed similarly. The numbers for, say, folks age 75+ (who have made nearly half of all COVID deaths in the US, according to those charts) are probably even more dramatic (I found this chart that seems to be taken from a standardized test, so who knows where the data is actually from).

So in 1918 we had a situation where maybe one out of every 20-25 people was over age 65 and nowadays it's like one out of every 5-6. Even leaving aside specifics about who the virus was most likely to kill, people age 65+ were going to make up a smaller percentage of overall deaths in 1918 just because there were a lot fewer of them.

Also older people were significantly less likely to live in congregate settings like nursing homes in 1918, and these settings have accounted for a substantial chunk of deaths among the elderly, especially early in the pandemic.

Anyway, I think by the time we understood the pattern of fatality from COVID-19, it was already too late to make the changes that could have really stopped the virus (South Korea and Taiwan were really successful at locking down in early 2020, but I don't think anyone was getting solid and trustworthy numbers on the ages of the people dying in Wuhan at that point so they made those decisions without knowing the eventual progress of the pandemic).

Would people in their 20s-40s be more likely to make a personal decision to get vaccinated and wear a mask if they knew they were at much higher risk of death? Possibly! (There are still plenty of old people who refuse to mask up and get vaxxed even though they are at high risk.)

Some of the consequences of a higher percentage of younger people dying: labor shortages would be even worse than they have been; lots more pandemic orphans. This would have required a different response from governments, business/industry, and individuals. Would these responses have made the pandemic better or worse? I'm genuinely unsure! It could have led to an even worse "bury our heads in the sand and pretend we can force our way through this" kind of problem.
posted by mskyle at 5:15 AM on March 29, 2022 [4 favorites]

I can't compare to 1918,but I have no doubt our response would have been vastly different if the outcomes for children and the elderly had been reversed.

15% case fatality rate among children would have gotten people's attention in a way that the 15% rate among those over 80 simply did not.
posted by Winnie the Proust at 6:25 AM on March 29, 2022 [5 favorites]

Since the US public health response was run by an Administration headed by a total incompetent with absolutely no ability to see any difference between facts on the ground and whatever self reinforcing brain fart he'd just injected into Fox News the day before, I can't see how the demographics would have made any difference to it whatsoever.
posted by flabdablet at 6:42 AM on March 29, 2022 [2 favorites]

A big difference in public health response is related to the patterns of the two diseases. The 1918 flu tended to move in a devastating surge, spreading through a town and killing many, and then be gone to the next one. So there was not the same kind of need for the long, long prophylactic isolation at home we had earlier in the Covid pandemic.

(There is some speculation that the older generation in 1918 had some exposure to a similar, milder flu in their youths, before the 20-45 year olds were born, and acquired some immunity that way.)
posted by nantucket at 6:46 AM on March 29, 2022 [3 favorites]

2020 US population: 330 million. Number of covid deaths: ~950,000 (0.29%).
1918 US population: 105 million. Number of flu deaths: ~675,000 (0.64%).
posted by Melismata at 8:53 AM on March 29, 2022 [1 favorite]

Response by poster: I appreciate the thoughtful responses - - thank-you!

One additonal interesting factoid I ran across in my reading on this subject:

"The [1918] pandemic lowered the average life expectancy in the United States by more than 12 years."
posted by fairmettle at 12:19 AM on March 30, 2022