“Just like a bad flu year” – debunking the Covid clichés
“Unprecedented” has been the buzzword to describe Covid-19, yet countless deadly viruses and pandemics predate it. To make sense of the true scale of what has unfolded over the past year, it feels logical that we would look to the past.
But historical comparisons produce mixed messages. At one end of the spectrum, there are claims that this is no worse than a bad flu season. At the other, the perception is that we’re witnessing an almost unparalleled loss of life. It’s important to unpack these claims, to understand why certain comparisons are misleading and to debunk others which are categorically not true.
“Hospital beds are always full this time of the year,” is one response to reports that the NHS is being overwhelmed by Covid-19. However we can say definitively that the current capacity crisis is very different to any flu season we’ve witnessed in recent years.
The winter of 2017/18 was one of the worst flu seasons in about 40 years. According to Public Health England, just under 10,000 patients were hospitalised over a 28-week period. That many Covid patients were recently hospitalised in England in just 3 days. Similarly, in 2017/18, just under 3,500 flu patients were admitted to intensive care over that 28-week period. The first three days of 2021 saw the number of Covid patients in intensive care soar to just over 4,000.
Admittedly, we only have to look at headlines from recent years to understand why misguided comparisons with past winters have arisen. “The winter beds crisis reached a new peak last week”, warns one Guardian article from 2018; another published a year later states that “hospital beds are at record low in England as NHS struggles with demand”. Fears about critical shortage of hospital beds certainly predate Covid. Yet, as Royal College of Emergency Medicine Vice President Dr Adrian Boyle explains, “People may feel they have a winter crisis every year but this is a different order of magnitude”.
Aside from comparing hospital capacity, there’s also a desire to look to the past to gain some perspective on the scale of death we are witnessing.
Yet when we compare the mortality rates of Covid-19 with that of past pandemics, we have to ensure we are comparing like for like. Over 600,000 people have died in England and Wales in 2020. We’ve not witnessed this number of deaths since 1918 – the year the Spanish flu broke out and the final year of WW1. While it’s an alarming figure, examining the sheer number of deaths across different historical are somewhat distorted. The population in England and Wales has almost doubled since 1918, so comparisons that look at deaths per thousand of the population provide a more accurate picture. There were 10 deaths per thousand people in 2020 compared to 24 per thousand in 1918.
Another key consideration is that the number of annual deaths has been on a downward trend for most of the past century. We gain more insight into how “deadly” any pandemic is by comparing death rates with the years directly predating it. Looking at “excess deaths”, which compares the death rate to a five-year average, helps to control for life expectancy, advances in healthcare, as well as population size and shape. Using this measurement, the death toll from Covid-19 remains severe: the overall number of deaths registered in 2020 was 75,925 higher than the five-year average figure between 2015 and 2019.
In terms of population-adjusted excess deaths, “it’s worse than any of the post-war pandemics,” says Sky News reporter Ed Conway, who has collaborated with the Continuous Mortality Investigation (CMI) to place 2020 mortality in context. “It’s worse than the Hong Kong flu, the 1951 flu and the 1950s Asian flu”.
For an even more accurate comparison over time, we also need to adjust for the fact the population is ageing – and you’d expect more deaths in an older population. Age-standardised mortality rates, the ‘gold-standard’ of mortality measurements, takes both population size and age-structure into consideration. Using this measurement, the CMI concluded that in 2020, there was a 13 per cent rise in deaths. This is the worst figure since 1929, a year with a flu pandemic and an economic collapse.
One notable way in which Covid-19 diverges from many past pandemics is in the age demographic that has been hit the hardest. In the 2009 swine flu pandemic, 80 per cent of virus-related deaths occurred in those under 65. Similarly, with the Spanish flu, young, healthy adults were the worst affected. Nearly half of those who died were between 20 and 40. As a result, the workforce was decimated and large numbers of elderly people and orphans were left with no means of support. Covid-19, on the other hand, has followed a similar pattern to the seasonal flu. Deaths are heavily concentrated in the elderly – more so than many even realise. Polling has suggested that the median Brit thinks the average age of death from Covid is 65. In fact, the number has hovered around 83 throughout the pandemic.
One historical comparison with a less gloomy takeaway message is that there’s been a considerable drop in flu deaths this year. In September, the WHO stated that missing flu cases was a global phenomenon. For the week beginning 7 September, the flu tracker FluMart recorded just 12 lab-confirmed cases of the flu on the entire planet. This pattern is likely down to social distancing and better hygiene measures prompted by Covid-19.
Ultimately, there is no single, definitive measure to compare the magnitude of this pandemic to any other. It’s also hard to predict exactly how Covid-19 will be remembered in years to come because its long-term consequences are yet to be seen. And the degree of collateral damage – from economic collapse to indirect deaths caused by cancelled elective surgeries and missed cancer checks – is still not clear.
But, by any measure, we can say that the scale of what we’re witnessing is not the same as “a bad flu season”.