Commenter “Montage” writes:
Covid-19 is not just like the flu, which some want you to believe. In all the years of the flu we didn’t have hospital bed shortages or a worry about the number of ventilators that will be needed.
Here’s the part with which I agree: COVID-19 is not like the flu, at least not exactly. First of all, it’s a coronavirus rather than an influenza virus. That may seem like a nit-picking (or virus-picking) point to make, but it actually matters. The reason is this:
Making vaccines is always challenging. Developing this one is made more difficult because there has never been a vaccine for any type of coronavirus. “We don’t have a production platform, we have no experience in safety, we don’t know if there will be complications. We have to start from scratch, basically,” Krammer says.
It was much easier to make a vaccine for H1N1, known as swine flu, which emerged as a never-before-seen virus in 2009. “There are large vaccine producers in the US and globally for flu,” Krammer says. Manufacturers were able to stop making the vaccine against the seasonal flu and start making a vaccine for this new strain of flu. “They didn’t need clinical trials, they just had to make the vaccine and distribute it,” he says.
We have a lot more experience with the flu in every way. But talking about “flu” as though it’s a single entity is misleading, of course. That’s why there are “bad” flu seasons and “good” ones – that is, strains of flu that become ascendant in a particular year that kill more people or fewer people. The range is fairly wide:
Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 290,000 to 650,000 deaths… Death occurs mostly in high risk groups—the young, the old, and those with other health problems.
In the United States, the range of deaths per year from seasonal flu is between 12,000 and 61,000. Those deaths don’t occur at a rate that’s equal throughout the year, either; they are concentrated in flu season, which doesn’t have a strict calendar beginning and end but tends to be late fall to early spring. Therefore, in a “good” year with 12,000 deaths, I would estimate that during the months of flu season the US death rate from flu is very approximately 2,000 per month, and in a “bad” one it is close to 10,000 per month, with deaths dropping enormously in the other non-flu-season months of the year. Or, the deaths may be more spread out than that, but certainly not evenly distributed among all the months.
That’s a lot of people. That number of people may still be dying of the flu, for all I know, and all the COVID deaths are in addition. But maybe not – perhaps someone here can find some statistics on that.
But those are “regular” flu years. There are pandemic flu years such as 1957, 1968, and 2009:
In the 20th century, three influenza pandemics occurred: Spanish influenza in 1918 ([worldwide] 17–100 million deaths), Asian influenza in 1957 (two million deaths), and Hong Kong influenza in 1968 (one million deaths).
The death tolls from these pandemics in the US were much higher than in ordinary flu years, particularly in 1918. The death toll from 2009’s flu pandemic H1N1 (as estimated by the CDC) ended up being not as bad as originally predicted; it caused the death of between 8868 and 18,306 Americans.
So it actually is highly possible that COVID-19 will end up with a death toll no higher than the toll in a “bad” flu year. Or it could be worse, even much worse. Neither of those possibilities takes in the huge economic toll of the extreme strategies used to combat it, of course. How will we know if they will have been worth it? I suppose some day the number crunchers will analyze the data and come up with an answer, or several competing answers from which you can probably pick and choose. We don’t have a control world to compare it to, where we went on with business as usual.
And now let’s take up the last part of Montage’s statement: “In all the years of the flu we didn’t have hospital bed shortages or a worry about the number of ventilators that will be needed.”
Well, we don’t yet have hospital bed shortages in this country with COVID-19 either, although there’s no shortage of people claiming that we do. But at some point we may indeed have some shortages (as they seem to have in Italy), and we’re planning for that and preparing for that (here’s an example of the preparations).
However, we certainly have worried about hospital bed shortages with the flu in the past. Remember this from October 2009? I didn’t either, but take a look:
If a third of people wind up catching swine flu [H1N1], 15 states could run out of hospital beds around the time the outbreak peaks, a new report warns Thursday.
The nonprofit Trust for America’s Health estimates the number of people hospitalized could range from a high of 168,000 in California to just under 2,500 in Wyoming.
The public health advocacy group used government flu computer models to study how quickly hospitals would fill up during a mild pandemic, like the kind the swine flu — what doctors prefer to call the 2009 H1N1 strain — is shaping up to be.
It based its estimates on the mild 1968 pandemic, suggesting up to 35 percent of the population could fall ill.
Even though only a fraction would be sick enough to be hospitalized, health officials are bracing: When H1N1 first appeared in the spring, more than 44,000 people visited emergency rooms in hard-hit New York City, the report noted. Just sorting out which patients are sick enough to be admitted from the vast majority who need to go home is a big job. And hospital capacity varies widely.
By the outbreak’s peak, the new report suggests Delaware and Connecticut hospitals would fill up soonest. Also on that list: Arizona, California, Hawaii, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia and Washington.
I found a host of articles like that one from 2009. But it never came to pass.
And what of a “regular” flu year? This is from January of 2018, entitled “A severe flu season is stretching hospitals thin. That is a very bad omen”:
A tsunami of sick people has swamped hospitals in many parts of the country in recent weeks as a severe flu season has taken hold. In Rhode Island, hospitals diverted ambulances for a period because they were overcome with patients. In San Diego, a hospital erected a tent outside its emergency room to manage an influx of people with flu symptoms.
Wait times at scores of hospitals have gotten longer.
But if something as foreseeable as a flu season — albeit one that is pretty severe — is stretching health care to its limits, what does that tell us about the ability of hospitals to handle the next flu pandemic?
Good question, eh?
More:
That question worries experts in the field of emergency preparedness, who warn that funding cuts for programs that help hospitals and public health departments plan for outbreaks and other large-scale events have eroded the very infrastructure society will need to help it weather these types of crises…
A dozen years ago or so, government officials placed pandemic influenza preparedness efforts on the front burner because of fears that a dangerous bird flu strain — spreading quickly across Asia at the time — might trigger a catastrophic pandemic…
Then in 2009, the first flu pandemic in four decades did hit. But instead of bird flu, it was a swine flu virus called H1N1. There were not mass casualties…
Pandemic influenza lost its big, bad bogeyman status. And in the years since, budgets for preparedness work have suffered…
Hospital and public health preparedness programs have sustained cuts in the order of about 30 percent in recent years, said Dr. Oscar Alleyne, a senior adviser with the National Association of County and City Health Officials, adding: “The level of funding is a concern to us.”
…A modeling program called FluSurge developed by the Centers for Disease Control and Prevention to help hospitals plan generates some pretty sobering scenarios, he noted. In a bad pandemic, hospitals might have four times more people in need of a ventilator than they have ventilators, and far too few intensive care beds for the seriously ill.
“So there would be a big mismatch between demand for care, lifesaving care, and the ability to provide it,” Inglesby said. “We would have a huge problem in this country.”
…Getting help from elsewhere — as a community will often do in the case of a major medical disaster — isn’t really an option during flu epidemics, because other places are either dealing with their own or steeling themselves for a wave that’s about to hit.
Please read the whole thing.