Solving the Mystery of the 1957 and 1968 Flu Pandemics
Why didn’t they spark a much bigger reaction? Partly because they were tons less deadly than widely reported.
After quite 500,000 deaths in only 12 months, the Covid-19 pandemic is now decidedly the deadliest short-term infectious-disease epidemic to hit the U.S. since the influenza pandemic of 1918 and 1919. it's clearly merited an aggressive public-health response, albeit probably not the precise combination of policies that federal, state, and native authorities have wielded over the past year.
Since early therein response, though, I’ve wondered about the 2 big post-World War II influenza pandemics that wont to be called the “Asian flu” and “Hong Kong flu,” and are now labeled by the Centers for Disease Control and Prevention because the “1957-1958 Pandemic” and therefore the “1968 Pandemic.” consistent with the CDC, the previous killed 116,000 Americans and therefore the latter 100,000. Adjusted for a population that might amount to 221,000 and 164,000 people today — tons but Covid-19, but still staggeringly large numbers, especially once you consider that those deaths weren’t nearly as concentrated among those 65 and older as Covid’s are.
Yet life went by more or less as normal during those pandemics. there have been school closures and many workers staying home sick, but no restaurant or “essential-business” shutdowns that I’m conscious of and positively no shelter-in-place orders or mask mandates or border closings or mass experiments in working and schooling from home.
These weren’t the Middle Ages, or maybe 1918. In both 1957 and 1968, scientists identified the new influenza strains that caused the pandemics before they became widespread, the media and public health authorities warned of the approaching threat, and vaccine developers immediately set to figure to thwart it. Beyond that, though, the reaction seems to possess been nothing like what we’ve experienced over the past year.
Why the difference? Have we become too careful and fearful, or were people too insensitive to death back therein higher-mortality-rate era? Are we a bunch of sheeple being led to our doom by Gates and therefore the remainder of the Illuminati? Or is it that, especially within the case of that mass experiment in working and schooling from home, we've options that didn’t exist within the 1950s or 1960s that we chose to exercise out of legitimate fear that things could end up much worse than they have?
Those are complicated questions. Here’s one simple, if partial, answer: The “1957-1958 Pandemic” didn’t actually kill 116,000 Americans and therefore the “1968 Pandemic” didn’t kill 100,000.
The apparent source of these numbers, which the CDC lists because the first reference on its pages about the 1957-1958 and 1968 pandemics, maybe a 1996 article within the journal Epidemiological Reviews by since-retired Baylor College of drugs virologist W. Paul Glezen. I finally got around to reading it recently and discovered to my surprise that the death tolls reported above are multi-year totals.
That is, U.S. deaths attributed to the pandemics totaled 115,700 from 1957 to 1960, consistent with Glezen’s article, and either 111,927 (the number is given during a table within the article) or 98,100 (the number is given within the text) from 1968 to 1972. The article also reports influenza deaths from 1918 to 1920 as 675,000, which is what the CDC says was the amount of U.S. deaths within the “1918 Pandemic.” I had been wondering why another estimates put that pandemic’s toll at 550,000, and now I understand that was just during the primary full flu season; 675,000 was over two seasons.
When the CDC was still calling it the “Spanish Flu,” employing a multi-year tally wasn’t wrong. But while I’m all for moving far away from naming pandemics after countries, continents, and special administrative regions, if we’re getting to call it the “1918 Pandemic” we should always probably stop citing death tolls that run through mid-1920. Still, a minimum of the primary flu season in 1918-1919 accounted for the overwhelming majority of deaths, therefore the 675,000 total isn’t all that misleading. the primary flu season in 1957-1958 also accounted for a majority of 1957-1960 excess deaths, albeit a smaller one. The 1968-1969 share of the “1968 Pandemic” toll appears to possess been even lower.
The source of Glezen’s estimates, he noted in his article, was Lone Simonsen, an epidemiologist then performing at the CDC who is now a professor at Roskilde University in Denmark. Two years after Glezen’s piece appeared, in 1998, Simonsen and a number of other co-authors published a piece of writing within the Journal of Infectious Diseases that reported, based partly on yet one more study from 1971, that excess deaths from all causes totaled 66,000 within the 1957-1958 flu season and 28,100 in 1968-1969. As a share of the population, that’s about 127,000 and 46,000 today.
A sudden sharp increase in weekly deaths attributed to respiratory conditions, a heart condition, and other causes amid an influenza pandemic probably represents deaths caused or a minimum of accelerated by the flu. So pandemic mortality is usually estimated by measuring excess deaths from all causes compared to the amount that was expected given experience and demographic change, not by watching what doctors write of people’s death certificates. Still, there are alternative ways of measuring excess deaths, and therefore the numbers don’t all begin an equivalent.
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The Simonsen et. al. excess-deaths estimate for 1957-1958 seems to be widely accepted if often rounded up to 70,000, but there are several higher (if still far below 100,000) estimates floating around for 1968-1969. A 1981 article within the American Journal of Epidemiology put excess deaths from all causes at 56,300, while the foremost widely circulated estimate in public-health circles (for which I haven’t located the source) counts 34,000 victims, and a 2005 article co-authored by Simonsen included an age-adjusted excess-mortality rate that appeared to compute to about 40,000 deaths.
When I asked Simonsen about this she referred me to steer author Cecile Viboud, an infectious-diseases-mortality expert at the National Institutes of Health’s Fogarty International Center. Viboud emailed that the truth 1968-1969 price was likely above 28,100 but that for purposes of comparison I used to be best off employing a single consistent data source and Simonsen’s 1998 article was the simplest available. So here goes, although you’re welcome to multiply the 1968-1969 mortality numbers by anything up to 2 if you would like.
I’ve listed two sets of numbers for 2020-2021 because (1) the unprecedented testing effort over the past year means a way higher percentage of Covid-caused deaths are directly identified intrinsically than is generally the case with influenza, and (2) the unprecedented economic and social disruptions of the past year mean that a number of the surplus deaths are a fatal accident of Covid and therefore the efforts to fight it instead of directly caused by it. Because these numbers change on a daily or weekly basis and, within the case of excess deaths, the CDC offers several to settle on from, I rounded the totals to 525,000 and 600,000, which I feel will end up to be pretty conservative. The age distributions are from the CDC’s latest accounting of Covid deaths by age and, for excess deaths, a comparison of deaths by age in 2019 with the CDC’s provisional estimate of an equivalent for 2020.
Overall, Covid-19 has been a minimum of fourfold deadlier, adjusted for population change, than the 1957-1958 pandemic, which successively was somewhere between moderately worse and 3 times worse than the 1968-1969 pandemic. Break things down by age and therefore the gap shrinks, although not exactly within the way that I expected. Covid has been 2.4 to 2.9 times deadlier than the 1957-1958 flu for those under 65, and 2.9 to 3.4 times deadlier for those 65 and older. Not that big a difference between the groups, in other words.
The main reason that victims of the 1957-1958 and 1968-1969 pandemics were after all younger than those of Covid-19 seems to be that the U.S. population was much younger then. If those 65 and older had been as large a share of the population as in 2020, and their death rate stayed constant, they might have accounted for 78% of deaths in 1957-1958 (versus 64% in reality) and 72% in 1968-1969 (versus 59%). That’s shortly from the 81% of reported Covid deaths and 75% (or so, there’s no way at now to urge a particular count) of excess deaths in 2020-2021 among those 65 and older.
The same isn't true of the 1918 flu, that death rates were actually higher for those under 65 than for the elderly. The 2009 pandemic, caused by a strain of the H1N1 swine influenza that struck in 1918, was also harder on those under 65 than on their elders, although overall mortality was much, much less than in any of the opposite pandemics discussed here.
What have we learned here? Well, first of all, that the danger posed by the 1968-1969 pandemic within the U.S. hardly merits comparison with Covid-19. It wasn’t even all that much worse than the previous, non-pandemic flu season of 1967-1968 when consistent with the Simonsen et. al. estimates there have been 22,000 excess deaths (albeit 95% of them among those 65 and older). Last spring there was a flurry of articles and opinion pieces during which authors — among them, my Bloomberg Opinion colleague Joe Nocera — wondered why nobody remembered the 1968 pandemic. Well here’s your answer!
That answer admittedly might not hold in Europe, where the pandemic was much deadlier, especially in 1969-1970. And here within the U.S. the sooner 1957-1958 pandemic really was an enormous deal. It wasn’t the worst since 1918 — the flu season of 1928-1929 appears to possess held that dubious honor until this year, causing an estimated 102,000 excess deaths consistent with the 1998 Simonsen paper, or about 279,000 in population-adjusted terms — but it had been pretty bad. it had been also the primary influenza pandemic to be pre-announced, and quick action seems to possess prevented it from becoming much deadlier.
In the spring of 1957, microbiologist Maurice Hilleman examines a flu epidemic in Hong Kong and immediately set to figure getting a sample of the virus, which he received within the sort of saltwater gargled by a foreign U.S. serviceman. Hilleman had spent the past decade at what's now the Reed National Military center documenting how “antigenic drift” allowed flu viruses to mutate their way around a number of the immunity provided by past infection or vaccine, and sussed out quickly that what he dubbed the “Asian flu” was a special variant of influenza (later dubbed H2N2) from the H1N1 that had been dominant since 1918 and was likely to cause an epidemic. By May he was sending vaccine cultures around to pharmaceutical manufacturers with an invitation that they bestir themselves, by late July the military was beginning to vaccinate recruits, and by the top of the year, 40 million doses had already been made and used. “That’s the sole time we ever averted an epidemic with a vaccine,” said Hilleman, who joined Merck & Co. Inc. later in 1957 and went on to develop vaccines for 1968’s H3N2 influenza and about 40 other diseases.
Vaccine development was so rapid partly because the infrastructure for a flu vaccine was already in situ and partly because Food and Drug Administration safety protocols were far less involved in those days. If your criticism of U.S. authorities is that they were unwilling to take a position in coronavirus vaccine development before 2020 and too slow to approve and accelerate the manufacturing of the highly effective vaccines that were developed last year, the 1957-1958 pandemic offers support for your views. If it’s that we’ve all overreacted to Covid-19, not such a lot.
Now that vaccines are available, and quite 60% of the 65-and-older population has already received a minimum of a primary dose, state, and native governments are rapidly rolling back restrictions and reopening schools. Before the vaccines were available, though, it had been not crazy to believe more-primitive measures. How successful those measures are will remain a matter of much research and debate. It’s clear that countries that treated Covid as a threat far worse than influenza and acted quickly to stop it from gaining an edge — much of East Asia, Australia, and New Zealand — have achieved the simplest mixture of preventing deaths and allowing life to travel on more or less as normal. In the U.S. it’s much harder to understand what percentage lives all the testing and quarantining and mask-wearing and lockdowns have saved.
Last week I used the tactic of extrapolating the Covid death rate within the worst-hit U.S. county with 25,000 people or more (New Mexico’s McKinley County) into a possible national toll of two million, meaning that 1.5 million deaths are prevented, and heard from several readers who thought that a county with a 30% poverty rate and a population that's 80% Native American was perhaps not the simplest stand-in for the state as an entire. they need a point! But it doesn’t seem unreasonable to posit that if Covid clothed to be a touch under 3 times deadlier on a partially age-adjusted basis than the 1957-1958 flu, the potential Covid was four or five or six or seven times worse. but, the 1957-1958 flu could are much worse if it hadn’t been for Maurice Hilleman.
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