Is Covid-19 a Pandemic?

1918-1919 Influenza Pandemic and Influenza Epidemics in Recent Times

Since the beginning of the 20th century, 5 influenza outbreaks have been classified as pandemics: 1918 (Spanish flu), 1957 (Asian disease), 1968 (Hong Kong disease) and 1976 (Russian flu). The 2009-2010 H1N1 influenza outbreak was declared a pandemic by the World Health Organizationbut came under intense scrutiny from the European Council and turned out to be misnomered. Read more here.

With each new virus outbreak, the Influenza Pandemic, which unfolded from 1918-1919 – the so-called “Spanish flu” – is often referred to and used as a “warning” for what may come (1,2).

The pandemic of 1918-1919 behaved like an unusually powerful season of stress that went in three waves where after the third wave it disappeared and since then similar epidemics with such a high mortality among young people have never been observed. The first wave began in March 1918 and spread unevenly across the United States, Europe, and possibly Asia over the next six months.

It is believed that the pandemic is due to the spread of an influenza A virus of the subtype H1N1. Genetic sequence analyzes performed afterwards suggest that the source of this was from a bird. It is believed that the eruption began on March 5, 1918 among recruits in the Funston training camp in Kansas, USA and where a few weeks later half a million soldiers were sent by ship across the Atlantic to the western front. The United States had declared war on Germany, Austria-Hungary and Turkey in April 1917. The first cases of Spanish flu in Europe thus occurred in Bordeaux and Brest,

France’s main ports of call for Allied troops, in early April 1918. Disease rates in the first wave were high. , but mortality was not significantly above normal. The next wave spread globally from September to November of the same year and was very deadly, affecting the younger population. Many countries experienced a third wave in early 1919. Few details have been documented about the true prevalence and intensity of the pandemic and therefore estimates of deaths vary between 50 and 100 million worldwide.

Researchers in medical history at the University of Oslo have pointed out that the Spanish flu was linked to a special age where the conditions for a pandemic were different than today and where one was in the middle of a world war that also saw large transports of soldiers across the Atlantic who all lived close. The conditions on the battlefields and barracks provided fertile ground for an enormous growth and spread of the virus and where the nutrition they received was deficient in relation to important trace elements and vitamins and more – important for a strong immune system.

In the Nordic country of Norway, although it was not directly involved in the war, many Norwegian soldiers and sailors were affected. It has been calculated that in Norway between 13,000 – 15,000 people lost their lives as a result of the Spanish flu, while just over a million became infected. In 1918, Norway had a population of 2,577,729. This gives a lethality of 1.1 – 1.3%. With so many being infected, it resulted in high death rates (3).

Historical Excess Mortality data in England and Wales

Through the careful registration of mortality in England over the years, we can follow figures from Great Britain where we see that the excess mortality from influenza epidemics after the Second World War was still significant for many years but gradually decreases year by year. Common to all these waves is that they have increasingly limited themselves more and are to the oldest part of the population as we have seen with Covid-19 where 85% of those affected are over 80 years old.

Mortality in the UK from 1950 to 2018

Source: UK Office of National Statistics (ONS)


Excess mortality in England and Wales between 1950/1951 and up to 2017/2018 compared to an average of five years. Note that in 1950, excess mortality peaked at well over 100,000. In 2017/2018, half died as many el. 50,000 people in the UK due to what was described as a “serious flu outbreak”.

Excess Mortality in Sweden

In 2020, adult mortality rate for Sweden was 7.35 deaths per 100 population. Over the last 46 years, adult mortality rate of Sweden was declining at a moderating rate to shrink from 14.49 deaths per 100 population in 1975 to 7.35 deaths per 100 population in 2020. If we loook at Swedens total number of deaths since 2011 we see that the overall numbers of overall deaths was slightly larger in 2020 than the reported in the peak years for 2016 and 2017. But 2019 showed the lowest numberof deaths since 2011.

https://www.statista.com/statistics/525353/sweden-number-of-deaths/
Nordic Countries – Age adjusted (standardized death rates)

To compare the relative health status of different population groups, the population’s age distribution needs to be taken into account, because death rates for most diseases generally increase with age (Curtin & Klein, 1995). “Age-standardized mortality rates adjust for differences in the age distribution of the population by applying the observed age-specific mortality rates for each population to a standard population” (World Health Organization, 2020b). In other words, this technique allows comparison between populations with differing age profiles. The populations are thus given the same age distribution structure, so that those differences in mortality which are not due to the ageing of the population can be highlighted.

At a national level, there are age-standardised mortality rates higher than the Nordic average (883.0) in Greenland (2,449.2), Denmark (988.6), and Finland (921.7). These statistics show the number of deaths per 100,000 of the population in each country, after removing variations brought about by differing age structures between the three countries. In the calculation of age-standardised mortality rates, we used the European Standard Population in 2013. It is observable that age-standardised mortality rates are lower in capital regions and large cities in all Nordic countries, suggesting a lower level of ill health in these regions. There is a high variation of mortality rates between municipalities in Finland, Iceland, Norway, and Sweden. The municipalities having the highest mortality rates tend to be economically disadvantaged, with lower levels of disposable household income and a smaller proportion of people having attained tertiary education.

A study from the Norwegian Institute of Health FHI that analysed age adjusted trends in mortality between Norway and Sweden in the period 2010 to 2020. The study found that in 2020 there were very small differences between Norway and Sweden for age adjusted deaths of all causes and in both countries there were fewer reported deaths due to respiratory infections than expected,

For the differences observed between countries related to excess mortality and seasonal influenza like diseases reflect the differences between countries of numerous variables including physiography, population composition and distribution between city and country, ethnic variations, size and composition and distribution of the country’s immigrant population, organisation of health and care services, elderly care etc. must be tale into account. These individual factors together become the most important factors that affect variations in morbidity and mortality from each known or new viral outbreak in a population and as reflecteted in variations in age standardized mortality rates between countries.

Excess Mortality in UK and US

As in Sweden, both in the UK and US – after one year of observation – the conclusion was the excess mortality could be compared to what was observed in 2017. The Centers for Disease Control and Prevention (CDC) on February 20, 2021 reported that 376,504 deaths were attributed to COVID-19 in the United States in the calendar year 2020. It is worth noting that this figure corresponds well below the estimated total number of deaths of 401,000 in excess the United States in 2017.

The comparison is more striking when comparing lost life years. Goldstein and Lee estimate that the average loss of life for a person who dies from COVID-19 in the United States is 11.7 years. Multiplying 377,000 decedents by 11.7 y lost per decedent gives a total of 4.41 lost life years from COVID-19 in 2020, which is then only a third of the 13.02 million life years lost to excess mortality in the US in 2017. This is due to a significantly higher average age for COVID-19 deaths in 2020 than the average age for excess mortality in 2017 due to flu-like illness.

In contrast to the Spanish flu, where the average age of those who died of influenza in the UK was 28 and with a hundred times greater mortality than what we see with Covid-19 – the average age for those who died with Covid-19 is 80 and for women 84 (UK Office of National Statistics). This is a higher age than average life expectancy in parts of the UK.

It must therefore be emphasized in this context that Covid-19 is an infectious disease that affects the oldest in the population with a significant increase in the risk of a fatal outcome for those over 85 years of age compared (7900 times) compared to the age group 5-17 who is more than for influenza disease.

Mortality rate (per 100,000 population) in laboratory-confirmed cases of COVID-19 by age and sex, from week 27 onwards in England.

ONS Confirmed Covid-19 Deaths in England

If one looks at monitoring the excess mortality in England and Wales in the period 1920 to 2020, the mortality rate in the spring of 2020 seems to be almost as great as in the war years 1940-45. Excess mortality in England and Wales from 1920 to 2020 (incl. November 2020) gives the impression that the mortality associated with the first wave associated with Covid-19 to be significant.

Monthly analysis of mortality from the UK Office of National Statistics (ONS)

But when one takes into account the age and size of the population, the excess mortality, after age adjustment, has shown a steady decrease and so the age adjusted mortality rate for 2020 is not greater than what was seen in the preceding years and much less than was seen in the years up to te millennium. This understanding is important in assessing the so-called “pandemic” severity in relation to measures that are implemented.

From UK ONS


If we look at the age standardised mortality rate in the UK from March 2020 to the end of January 2021, this rate was below that which what was observed in 2000.

It was already clear 6 months into the SARS-CoV-2 outbreak that Covid-19 was not attaining levels of a public health threat that governments anticipated. Stanford’s John P.A. Ioannidis identified 36 studies (43 estimates) along with an additional 7 preliminary national estimates (50 pieces of data) and concluded that among people <70 years old across the world, infection fatality rates ranged from 0.00% to 0.57% with a median of 0.05% across the different global locations (with a corrected median of 0.04%). These are data that area comparable to the common flu. Read more here. Following these excess mortality data up to the latter half of 2021 with some 3000 studies show clearly that both overall, like in 2009, the present outbreak of the novel SARS-CoV-2 does not present a health threat of global concern as was feared. The response must therefore be seen to be disproporionate to the reality and will continue to be of concern as there seems to be different agendas not related to a public health concern.

References:

  1. David M. Morens. 1918 Influenza: the Mother of All Pandemics. Emerg Infect Dis. 2006 Jan; 12(1): 15–22.
  2. David M. Morens, Anthony S. Fauci The 1918 Influenza Pandemic: Insights for the 21st Century The Journal of Infectious Diseases, Volume 195, Issue 7, 1 April 2007, Pages 1018–1028
  3. Mamelund SE. Spanskesyken i Norge 1918 – 1920. Diffusjon og demografiske konsekvenser. Hovedoppgave i samfunnsgeografi. Oslo: Universitetet i Oslo, 1998.