Comparison

After reading the re-published article in the Herald Democrat on April 22 (originally from Volume 1, No. 10 of “Mountain Diggings,” a publication of the Lake County Civic Center Association in 1980) about the 1918 “Spanish Flu” in Leadville, I wanted to take a moment to stand up for Lake County’s conservative approach to the “safer-at-home” guidelines. I also want to applaud the business owners who are creatively and proactively getting back on their feet, even as the “new normal” looks different. And, I want to express my gratitude for living in a community where nonprofit and government agencies, and community members across the board, are coming together to ease the hardships associated with the stay-at-home and now safer-at-home guidelines. Finally, I want to implore everyone in our community to continue to take this seriously; together we are #LakeCountyStrong.

According to that recently republished article about the 1918-1920 Spanish flu, “Leadville was ... one of the hardest hit (cities), with close to 250 persons dying from the dreaded disease, but it was one of the first to stop its spread. Credit for this must be given to Mayor M. A. Nicholson, the city council members and the people of the board of health for establishing a stringent program and strictly enforcing it. Equal credit goes to the many volunteers. Without their help and caring, it couldn’t have been done.” That stringent program included quarantining people with infections (and those living with infected individuals), prohibiting gatherings of more than 4 people, reporting infections to public health officials and more. It even included a system for patrolling the town, where volunteers were given the authority of police to enforce these rules and regulations. The measures taken in Leadville in 1918 sound quite similar to our situation today, except we have the benefit of Zoom meetings and Netflix and the 2020 hindsight of experience from past pandemics.

I am heartened that our local, present-day decision makers, led by Public Health Director Colleen Nielsen and Dr. Lisa Zwerdlinger, are taking similar steps and supporting our community in practicing and applying safer-at-home guidelines. I am also inspired by our community members’ similarly strong response, some 100 years later. We are still a community full of caring people and volunteers — and if we can stay the course, we will stay #LakeCountyStrong.

As I write about my gratitude for our community’s response, I know many people are growing increasingly frustrated by social-distancing public health restrictions. Economic and personal hardships are widespread. With this backdrop, it’s no wonder we start to question our public health experts and our leaders. Is COVID-19 really that bad? Is saving some people’s lives “worth” the inestimable destruction to our economy and lifestyles? Are we actually saving people’s lives or just delaying the inevitable? Are we doing more harm than good? Would the virus wreak havoc on the economy with or without social distancing measures? Would the death be as bad as the other consequences (i.e. spiked domestic violence, suicides, other untreated medical conditions, etc)? These largely unanswerable questions and concerns are especially vibrant for those of us who do not know anyone who has fallen gravely ill or died from COVID-19, as we are only experiencing the economic and social fallout from the pandemic.

The above line of questioning is often paired with statistical comparisons and curiosity about why we’re treating COVID-19 differently than other diseases. People will point out annual death rates in the U.S. from the common flu (34,200 during the 2018-2019 flu season according to the Centers for Disease Control (CDC)), heart disease (estimated at 647,000 annually, CDC), and cancer (598,031 in 2016, CDC). These numbers, and those associated with other leading causes of deaths like accidental deaths (169,936 in 2017, CDC), are all sobering and merit significant resource investment to study, prevent, treat, and cure, through medical interventions or social programs. These ills also place untold burdens on our economy. But, the comparison between each of these causes of death and the consequences of COVID-19 is problematic.

First, heart disease, cancer, and accidental deaths lump together several diagnoses under umbrella categories. The cancer category alone includes 17 specific types of cancers, with lung cancer, breast cancer, prostate cancer, colorectal cancer and pancreatic cancer as the top five cancer killers in the United States. Heart disease includes subcategories (also umbrella categories) of blood vessel diseases, heart rhythm problems, congenital heart defects and more. Annual death counts from these umbrella ailments are aggregated, while the actual death rate from any single diagnosis is much lower. As a point of reference, for lung cancer, the leading killer among cancers in the U.S., the annual death rate is below .04% (CDC). COVID-19 currently has an estimated death rate ranging from 1%-4%, depending on the data source and country examined. Using the low-end estimated 1% death rate from COVID-19 (the rate currently estimated in the U.S.), COVID-19’s death rate is about 25 times higher than lung cancer. Secondly, cancers, heart disease and accidental deaths are not contagious. This leaves the modern common flu as the only semi-reasonable comparison to COVID-19 from the list of leading causes of death in the U.S.

Here too, the numeric simplicity of holding up deaths from the flu and COVID-19 side-by-side —without context — misses the point. Saying simply that COVID-19 has “only” caused 70,000+ deaths to date in the U.S. compared with 34,200 deaths in the 2018-2019 flu season is a spurious comparison on a number of levels. Why are these two things dramatically different? Here are a few reasons compiled from The Wall Street Journal’s video, “As Deaths Mount, COVID-19 Proves More Dangerous than the Flu” posted on May 8:

1. We have a flu vaccine and antiviral drugs; we do not have these things for COVID-19.

2. 70,000+ COVID-19 deaths occured in just two months rather than an entire year.

3. Transmission rates are estimated to be twice as high for COVID-19 (i.e. one person with the infection passes it along to two other people vs. the flu, where one person passes it on to one other person).

4. Hospitalization rates from the flu are estimated at 2% compared to COVID-19’s 19%.

5. Death rates from COVID-19 are estimated to be 10+ times those of the flu (COVID-19’s estimated death rate is currently ~1% in the U.S. compared to the flu’s 0.1%). It is worth noting that both the total number of infections (the denominator) and total number of deaths (the numerator) for COVID-19 are likely underreported at this time due to lack of testing, reporting lag time, absence of a diagnostic code during initial phases of the outbreak, mis-assigning COVID-19 deaths to general coronavirus or “COVID” labels, etc).

6. And, although not cited in the Wall Street Journal’s video, we have relatively accurate, and widely available testing for flu; we are still working on this for COVID-19.

A more apt comparison might be to the Spanish Flu that lasted from January 1918 to December 1920. According to the CDC, during that scourge some 500 million people were infected and 50 million people died worldwide. About 650,000 died in the U.S. alone. The death rate from Spanish Flu is estimated at 2.5% (somewhere in the middle of current estimates for COVID-19’s death rate).

The table to the right refers to some similarities and differences between the two. Information about the Spanish Flu comes from: https://blogs.cdc.gov/.

We are fortunate to know more now than we did in 1918. We don’t live in such tight quarters. There is not a massive world war in progress. And, according to the CDC article cited above about the Spanish Flu (published May 14, 2018), “CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.” While this quote is about flu pandemics, it can also be applied to COVID-19, a virus that is similarly spread through droplets and is even more virulent than the flu. We are currently in the ‘absence of a (COVID-19) vaccine’ — so it seems our best defense at this time are non-pharmaceutical interventions. Stay strong, Lake County.

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