Compared to COVID-19, we have a great deal of experience with flu. But talking about flu as though it’s a single entity is misleading, of course. After all, there are “bad” flu seasons and “good” ones. 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 regular seasonal flu is between 12,000 and 61,000. Then 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. However, 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.

It’s 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 than that, even much worse. In addition, there is the huge economic toll of the extreme strategies used to combat it. How will we know if they will have been worth it? Some day the number crunchers will analyze the data and come up with an answer – actually, several competing answers from which you can probably pick and choose.

In pandemics such as the terrible flu of 1918, many hospitals were overwhelmed by the number of patients in desperate need, although medicine was so limited then that ventilators weren’t just scarce – they hadn’t been invented yet. But what about recent years of seasonal flu, or a relatively mild pandemic such as H1N1 in 2009? Surely we had enough resources then, and didn’t have to worry?

Remember this from October of 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.

But it never came to pass, fortunately; the H1N1 flu was not as bad as epidemiologists had originally feared.

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, isn’t it?


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.”

…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.

…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, as well as this article about how California’s plans for preparedness fell by the fiscal wayside.

Preparedness costs money, and in non-pandemic times people are loathe to spend a lot of it for a crisis that seems remote or that never may occur. Then, when the crisis hits, the media and politicians are quick to whip up fear if it suits their purposes.

[Neo is a writer with degrees in law and family therapy, who blogs at the new neo.]


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