Many people are saying that COVID-19, the new strain of coronavirus that is now spreading throughout the world, is no deadlier than the common influenza and that people are panicking over nothing. The Trump administration in particular has been promoting the narrative that COVID-19 is no deadlier than the common influenza and that it poses no serious threat.
This, however, incorrect; COVID-19 is, in fact, many times deadlier than the seasonal influenza and it is important that the virus be contained. It is true that the vast majority of people who contract COVID-19 do survive. Nonetheless, if COVID-19 is not successfully contained and no vaccine or cure is developed, it could still potentially kill tens of millions of people within the next year or two, many more people than the influenza normally kills in the same amount of time.
COVID-19 and the seasonal influenza
The normal, seasonal influenza has a case fatality rate of about 0.1%; whereas COVID-19 has a case fatality rate of somewhere between 2% and 3%. That means COVID-19 is somewhere between and twenty and thirty times more likely to kill someone who has it than the normal, seasonal influenza.
The elderly are significantly more susceptible to COVID-19 than the young. The fatality rate of COVID-19 for people under the age of fifty is only around 0.5%, but the fatality rate for those over the age of seventy is around 8%. This means those over the age of seventy who contract COVID-19 have almost a one-in-ten chance of dying from it.
While it’s true that the vast majority of people who contract COVID-19 survive, including the vast majority of elderly people who contract it, we have to remember that COVID-19 is extremely contagious, that there are about 7.53 billion people on this planet that the virus could potentially infect, and that there is currently absolutely no known vaccine or cure.
Put together, all of these factors mean that, if COVID-19 becomes a global pandemic, it could potentially kill tens of millions of people within the next year or two. By contrast, the World Health Organization estimates that the influenza only kills around 650,000 people each year worldwide. The influenza may be killing more people than COVID-19 right now because it is currently far more widespread, but COVID-19 has the potential to be far deadlier than the influenza if it spreads out of control.
ABOVE: Scanning electron microscope image from Wikimedia Commons of SARS-CoV-2, the virus that causes COVID-19
COVID-19 and the Black Death
COVID-19 is significantly deadlier than the standard influenza, but some people have gone wildly overboard in describing its deadliness. In popular culture, COVID-19 has sometimes been compared to the Black Death, the pandemic of bubonic plague that spread throughout Europe between 1346 and 1351 and is estimated to have wiped out somewhere between 30% and 60% of the total population of Europe. The comparison between COVID-19 and the Black Death is dangerously misleading, however.
The Black Death was so extraordinarily devastating because nearly everyone who contracted it died of it. Although we can’t possibly know the exact percentages, surviving written sources unambiguously describe the Black Death as having been widely seen as a death sentence, implying that, as soon as the buboes started to appear, people instantly knew they were going to die. The contemporary Sienese chronicler Agnolo di Tura del Grasso, for instance, records the devastation of the plague in a famous passage from his Chronica Maggiore. Here is the passage, as translated by William M. Bowsky:
“The mortality in Siena began in May. It was a cruel and horrible thing. . . . It seemed that almost everyone became stupefied seeing the pain. It is impossible for the human tongue to recount the awful truth. Indeed, one who did not see such horribleness can be called blessed. The victims died almost immediately. They would swell beneath the armpits and in the groin, and fall over while talking. Father abandoned child, wife husband, one brother another; for this illness seemed to strike through breath and sight. And so they died. None could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices. In many places in Siena great pits were dug and piled deep with the multitude of dead. And they died by the hundreds, both day and night, and all were thrown in those ditches and covered with earth. And as soon as those ditches were filled, more were dug. I, Agnolo di Tura . . . buried my five children with my own hands. . . . And so many died that all believed it was the end of the world.”
Judging from this description and others like it, I would say it is likely that probably somewhere around 90% of people who contracted the Black Death in the fourteenth century died of it. Even today with modern antibiotics, the bubonic plague (which still exists) still has a fatality rate somewhere between 8% and 11%.
COVID-19, however, only kills an extremely minute percentage of the people who contract it. Its potential for devastation lies not in it having an extraordinarily high fatality rate, but rather in it having a moderately high fatality rate and there being an extremely large number of people that it could potentially infect.
In the fourteenth century, the Black Death wreaked unbelievable devastation, but the devastation was constrained by the small population of the world at the time and by the fact that there was very little direct contact between different parts of the world, meaning it was not able to expand significantly outside of Eurasia.
ABOVE: Fourteenth-century manuscript illustration of a man and a woman dying of the Black Death
ABOVE: Manuscript illustration by Pierart dou Tielt dated to c. 1353 depicting the people of the city of Tournai burying victims of the Black Death
COVID-19 and the 1918 “Spanish” influenza
We shouldn’t be comparing COVID-19 to the seasonal influenza or to the Black Death. Instead, the comparison we should probably be making is to the 1918 influenza pandemic, known colloquially as the “Spanish influenza,” which is estimated to have killed somewhere between 30 million and forty million people worldwide between 1918 and 1920 in the aftermath of World War I.
Like COVID-19, the case fatality rate for the 1918 influenza is estimated to have been somewhere between 2% and 3%. At the time of that pandemic, the total population of the planet was somewhere between 1.8 and 1.9 billion people. The 1918 influenza is estimated to have only infected around 27% of the world population at the time.
If COVID-19 were to infect 27% of the current population of 7.53 billion people, that would mean around 2.03 billion people would be infected. If COVID-19 infected that many people and we assume that it kills roughly 2.5% of its victims, that would mean around 51 million people would be killed. This means that, if left uncontrolled, COVID-19 could potentially be deadlier than one of the deadliest pandemics in all of modern history.
The dangers of COVID-19 are made even more significant due the fact that it can sometimes have an extraordinarily long incubation period. The incubation period for the seasonal influenza is usually about one to four days. The incubation period for COVID-19, however, is usually somewhere between one to fourteen days. That means you could contract COVID-19 and not show any symptoms until two weeks after you contracted it, which gives the virus many more opportunities to spread.
COVID-19 definitely won’t wipe out the entire human race, nor will it wipe out anywhere close to the same percentage of the world population as the Black Death. Nonetheless, it could potentially be extremely devastating and kill tens of millions of people if it is not kept under control. This is why it is important that governments recognize the disease’s potential for devastation and not pretend like it is of no serious concern.
ABOVE: Photograph from c. 1918 of soldiers sick with the Spanish influenza in the hospital ward of Camp Funston in Kansas
ABOVE: Photograph from 1918 of a temporary ward set up in Oakland Municipal Auditorium for people suffering from the influenza, tended by nurses from the American Red Cross
