So, period life expectancy dropped about 12 – 13% in 1918 in the U.S., mainly due to the Spanish flu, because there was an outsized effect from young adults being the main group killed by the disease (also, period life expectancy was relatively short — under 60 years!). That was a drop of about 7 years.
But life expectancy dropped only about 1 year in 2020 due to COVID impacts, and that was a decrease of less than 3% compared to 2019.
So if you want to compare the effect of the Spanish flu vs. COVID-19 on the U.S. population, all of these rates —- percentage change in period life expectancy, age-adjusted death rates, or even crude death rate — are all more reasonable choices than simply number of people who died.
The U.S. on Monday crossed the threshold of 675,000 reported Covid-19 deaths, according to Johns Hopkins University, which tracks data from state health authorities. The Centers for Disease Control and Prevention estimates the influenza pandemic killed about that many people in the U.S. a century ago, in 1918 and 1919. Both figures are likely undercounts, epidemiologists and historians say.
There are several differences between the current pandemic and the one that claimed nearly as many lives more than 100 years ago. The U.S. at that time was roughly one-third its current size, so the flu pandemic took a proportionately bigger toll on the population. That pandemic had a devastating effect on young people, including small children and young-to-middle-aged adults, while Covid-19 has hit older people hardest, according to health officials.
The Spanish flu pandemic gives us the demonstration of what happens when there is a short-term large increase in mortality.
Using Social Security records of period life expectancy, there was a huge drop in life expectancy in 1918…. and then a huge increase in 1919. But going from 1917 to 1919 wasn’t really that big of a difference.
The period life expectancy drop was 12% for females, 13% for males in 1918.
Then there was an increase of 15% for females, 20% for males in 1919. The Spanish flu hit the U.S. hard in 1918, and let up in 1919.
If you compare 1919 against 1917, the life expectancy from birth increase was 1% for females, and 4% increase for males — male life expectancy was down in 1917 compared to 1916, probably related to World War I.
The “Spanish” influenza pandemic of 1918–1919, which caused ≈50 million deaths worldwide, remains an ominous warning to public health. Many questions about its origins, its unusual epidemiologic features, and the basis of its pathogenicity remain unanswered. The public health implications of the pandemic therefore remain in doubt even as we now grapple with the feared emergence of a pandemic caused by H5N1 or other virus. However, new information about the 1918 virus is emerging, for example, sequencing of the entire genome from archival autopsy tissues. But, the viral genome alone is unlikely to provide answers to some critical questions. Understanding the 1918 pandemic and its implications for future pandemics requires careful experimentation and in-depth historical analysis.
Author(s): Jeffery K. Taubenberger, David M. Morens
The high case-fatality rate–especially among young adults–during the 1918-1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely “wet,” sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0-31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.