(Bloomberg Opinion) -- In late March 2009, two kids living more than 100 miles apart in Southern California came down with the flu. By mid-April, their illnesses had been diagnosed as being caused by a new strain of H1N1 influenza, aka swine flu. Flu outbreaks that had started a few weeks earlier in Mexico were soon ascribed to the new H1N1 as well. On April 25, with cases confirmed or suspected in 19 Mexican states and five U.S. ones, the World Health Organization declared the disease’s spread a “Public Health Emergency of International Concern.”
Swine flu has a history that makes health authorities pay special heed. In 1918, a variant of H1N1 influenza caused a global pandemic that is estimated to have killed as many as 50 million people, or 2.7% of the world’s population. After tests found H1N1 in two soldiers during a flu outbreak at the Fort Dix army base in New Jersey in 1976, the U.S. government jumped into action, with President Gerald Ford announcing a plan to vaccinate “every man, woman, and child in the United States.” That turned into something of a debacle, though, as the virus didn’t seem to spread beyond Fort Dix and the hastily assembled vaccine killed about 30 people.
In 2009, the reaction was more muted. In its public-health-emergency declaration in April, the WHO noted that the illnesses caused by the new H1N1 tended to be quite mild, with only one brief hospitalization and no deaths from the 20 confirmed U.S. cases. It also advised against any travel restrictions or border controls. When the U.S. government declared its own public health emergency the next day, Secretary of Homeland Security Janet Napolitano termed it more of a “declaration of emergency preparedness.”
It’s like declaring one for a hurricane. It means we can release funds and take other measures. The hurricane may not actually hit.
The hurricane did hit, although in some ways it was more like a tropical storm. The virus continued its spread, with the Centers for Disease Control and Prevention switching over on May 4 from counting confirmed cases to making estimates. As of May 5, 980 schools with 607,778 students had been closed in an effort to slow the epidemic. By late June, the CDC was estimating that 1 million Americans had contracted the disease. Meanwhile, on June 11, WHO Director-General Margaret Chan had declared that with the virus spreading in 74 countries “the world is now at the start of the 2009 influenza pandemic.” She also said that a vaccine was on the way, and that measures had been taken “to ensure the largest possible supply of pandemic vaccine in the months to come.”
By the time the vaccines became widely available in November, though, H1N1 was already on the decline. By January, many countries were canceling their vaccine orders, and a German physician and former Social Democratic politician was leading a campaign lambasting the WHO for declaring a “fake” pandemic to gin up business for pharmaceutical manufacturers.
That doesn’t seem fair, given that H1N1 did infect as much as 24% of the world’s population. The overall fatality rate was quite low, at about 0.02% of estimated cases — five time lower than the 0.1% average fatality rate for the seasonal flu — but that’s mainly because H1N1 had little effect on the demographic usually hit hardest by influenza: those 65 and older. For younger people, H1N1 was more dangerous than the seasonal flu, and in countries in South Asia and Africa with youthful populations the H1N1 pandemic really was a big deal, with the CDC later estimating a global death toll ranging from 151,700 to 575,400.
Still, that’s lower than the range that the CDC and WHO now put on the annual death toll from seasonal flu: 290,000 to 650,000. In the U.S., an estimated 60.8 million people contracted the new H1N1 virus from April 2009 through April 2010, 274,304 were hospitalized and 12,469 died. Because the CDC changed the statistical model it uses to make such estimates in 2010 that last number can’t really be compared to recent estimates of seasonal flu fatalities, which ranged from 12,000 in 2011-2012 to 61,000 in 2017-2018. But earlier estimates of overall flu-related deaths in 2008-2009 and 2009-2010 indicate that both flu seasons were less deadly than average.
I bring all this up of course because we are in the throes of new global virus outbreak, although current WHO Director-General Tedros Adhanom Ghebreyesus has so far refused to call it a “pandemic.” I’ll admit that I had entirely forgotten about the H1N1 pandemic until a couple of readers emailed to ask about its absence from a column I wrote last week about the risks posed by the new coronavirus.
Calling attention to 2009 pandemic has become a theme in pro-Donald-Trump circles, with extremely similar articles on PJ Media, Red State and Printly all claiming that President Barack Obama didn’t declare a public health emergency until the H1N1 outbreak had been raging for months (as seen above, the public health emergency was declared less than two weeks after the virus was discovered, although Obama did up that to a “national emergency” in late October). President Trump himself argued on Twitter that “the April 2009-10 Swine Flu, where nearly 13,000 people died in the U.S., was poorly handled.” Such charges are to some extent just “whataboutism,” a propaganda technique used heavily by the Soviet Union back in the day to divert attention from misdeeds and problems by calling attention to the purported misdeeds and problems of others. But comparing Covid-19 with H1N1 can shed some light on why the former has elicited the reaction it has.
For example: Why was H1N1 allowed to spread around the world more or less unchecked, while countries are going to far greater lengths to try to halt Covid-19? Why did the WHO call H1N1 a pandemic but not Covid-19? Isn’t 12,469 deaths a lot worse than the 26 that have been attributed to Covid-19 in the U.S. so far?
That last one is the simplest to answer: Covid-19 is near the beginning of its spread in the U.S., and thus cannot be compared with H1N1’s effect over a full year. If the U.S. death toll from Covid-19 is only 12,469 a year from now, that will likely be counted as a great success. The legitimate worry is that it could be many, many times higher, because Covid-19 is so much deadlier for those who get it than the 2009 H1N1 influenza was.
How much deadlier is still unknown, but of the cases reported to the WHO so far 3.4% have resulted in fatalities. That’s probably misleadingly high because there are so many unreported cases, and in South Korea, which has done the best job of keeping up with the spread of the virus through testing, the fatality rate so far is about 0.7%. But even that is 35 times worse than H1N1 in 2009 and 2010. Multiply 12,469 by 35 and you get 436,415 — which would amount to the biggest U.S. infectious-disease death toll since the 1918 flu. Hospitalization rates are also many times higher for Covid-19, meaning that if it spread as widely as H1N1 it would overwhelm the U.S. health-care system.
That’s one very important reason governments (and stock markets) around the world have reacted so much more strongly to Covid-19 than to the 2009 H1N1 pandemic. Another reason is somewhat more hope-inspiring. It’s that public health experts generally don’t think influenza can be controlled once it starts spreading, other than with a vaccine, whereas several Asian countries seem to have successfully turned back the coronavirus tide, for now at least.
Influenza can’t be controlled because as much as half the transmission of the disease occurs before symptoms appear. With Covid-19 that proportion seems to be lower, meaning that even though it’s more contagious than influenza once symptoms appear, it may be possible to control by testing widely and quickly isolating those who have the disease. This is one reason (there are others) the WHO’s Tedros won’t call it a pandemic. “The threat of a pandemic has become very real,” he said Monday. “But it would be the first pandemic in history that could be controlled.” H1N1 couldn’t be controlled in 2009, but was mild enough that this did not lead to disaster. Covid-19 is a much more dangerous disease that maybe, just maybe, can be stopped.
To contact the editor responsible for this story: Stacey Shick at sshick@bloomberg.net
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Justin Fox is a Bloomberg Opinion columnist covering business. He was the editorial director of Harvard Business Review and wrote for Time, Fortune and American Banker. He is the author of “The Myth of the Rational Market.”
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