A healthcare staff member caring for a Covid-19 patient in a hospital.
©Anne-Christine Paujulet / AFP
Worse than the Spanish Flu?
New data on Covid allows us to better understand the impact of the pandemic.
Atlantico: New studies offer perspective on Covid-linked mortality figures. In a span of four years, the Kovid-19 pandemic has claimed nearly 30 million lives. Given frequent comparisons to the Spanish flu, which may have killed 20 to 50 million people between 1916 and 1919, what are the lessons of the mortality statistics associated with Covid with 4 years of hindsight? What do these statistics tell us about the scale and severity of the Covid-19 pandemic and its devastation across the planet when some spoke of unfounded mass hysteria at the start of the pandemic?
Antoine Flaholt: Official figures, reported to the World Health Organization in Geneva, show 7 million deaths due to Covid worldwide since the start of the epidemic. But these figures are highly underestimated. For example, in China, after the lifting of their zero covid strategy, between December 2022 and March 2023, the government recorded 60,000 deaths from covid, when estimates think there were 1.4 million deaths instead. Death during this period. Similarly, most countries in sub-Saharan Africa have reported very low numbers of deaths from Covid, but they do not test, their health systems often fail and often do not allow patients with the form to be admitted to hospital. Severe covid, their official data is also wrong. Researchers conducted investigations in Zambian morgues, and data from systematic sampling and autopsies conducted during these studies showed that mortality rates attributable to Covid were much higher than those reported by governments. In many countries, reliable civil registration data is not available. We do not count births or deaths, nor is it possible to assess any potential excess mortality. In Europe or the United States, where registers are more reliable, we are able to measure excess mortality. But, since Covid is not a seasonal disease, it was not always easy to attribute the excess mortality observed during the summer months to Covid, as it could also be associated with the heatwaves that have been frequently recorded during this period in recent years. Thus, it is very difficult to accurately estimate the actual death rate attributable to Covid during this pandemic worldwide. It is easy to understand that estimates of mortality from epidemics such as the Spanish flu from the early twentieth century are more difficult to trust. The proposed range of 20 to 50 million deaths between 1918 and 1920 is also very imprecise and subject to very high uncertainty.
According to figures from The Economist, the death toll from the pandemic now stands at 28.5 million, with 700,000 more deaths in the past 3 months. Does this indicate that the Covid-19 pandemic still poses a serious threat, especially to those at risk?
The paradox is that absolute mortality from Covid, and to a lesser extent from flu, is very high even though these diseases are very low in lethality. The mortality rate is now close to one per thousand for Covid but could lead to higher absolute excess mortality during large waves of contamination as we have regularly experienced since the start of the pandemic.
Regarding the lesson of the comparison between Covid and the Spanish flu, isn’t the intensity and scale of the Covid epidemic more important and alarming because these deaths occur in our modern age when antibiotics and vaccines are accessible?
Mortality during the Spanish flu epidemic often affected young people and was often secondary to bacterial infections, especially pneumonia, which we didn’t know how to treat because antibiotics didn’t exist at the time. again.
The mortality rate due to covid has changed a lot with mass vaccination. Before the advent of vaccines, they sometimes affected people with mild comorbidities, for example, being overweight, hypertension, or diabetes. Since the advent of vaccines, people who die from Covid are now very old, suffering from serious co-morbidities, and sometimes lacking immunity. Similar profile to seasonal flu. These people do not necessarily experience acute respiratory distress, but they do develop numerous and severe pre-existing pathologies. Covid can shake everyone very hard, but for people whose health status is very precarious, their unstable balance can lead to complications leading to death. Doctors called to the bedside of these patients do not always make the link between the deterioration of their health conditions and Covid or the flu, which sometimes contracts several weeks before and is not always diagnosed. Thus in France, where seasonal influenza epidemics cause an average of more than 10,000 deaths per year, just under 1,000 deaths from influenza are officially reported during the same period. We haven’t had the same decline for Covid yet, but it’s likely that the phenomenon here is similar to the flu.
How can we explain that despite modern hospital resources, vaccinations, antibiotics and increased living standards, the Covid-19 pandemic could cause nearly 30 million deaths? Is the lack of anticipation of the epidemic and the deteriorating, fragile or dangerous state of the health of the world’s population an explanation?
An infectious disease is capable of rapidly contaminating a very large proportion of the population. Covid is more dangerous because the coronavirus that causes it mutates frequently and almost all of us have been re-infected several times. Although the immunity conferred by vaccines and these recurrent infections have significantly reduced mortality, this low rate, when applied to the population as a whole, results in a significant number of deaths. Covid now kills silently and inconspicuously, without saturating hospitals. It no longer makes headlines but continues to shorten the lives of the elderly and frail with each wave. Our societies, modern, rich and even developed, are effective in treating pneumonia, respiratory failure, but less well manage the pre-existing pathology of old age or the disintegration of the immune system due to illness or drugs. Vaccines, constantly bypassed by new subtypes, are not able to stop the waves several times a year, contaminated in their path, young and old, strong and fragile, causing decomposition not always attributable to Covid and sometimes leading to death. If we really want to limit these risks associated with respiratory viruses, which we know are transmitted by aerosols, in closed, crowded and poorly ventilated environments, then we have to be more concerned with reducing the risks of contamination by trying to improve the quality. Indoor air is what we breathe.
