Most Older Americans Might Not Realize They Have Already Lived Through Several Pandemics
Recent Pandemics and Historic Precedents for COVID-19 / D. Brian Krier – Ben Franklin Technology Partners/CNP
Table of Contents:
Recent Historical Pandemics
Asian Flu, 1957
Hong Kong Flu, 1968
Spanish Flu, 1918-1919
H1N1 Pseudo-Pandemic, 1947
The Pandemic That Wasn’t, 1976
SARS & MERS, 2003 and 2012
Analysis and Conclusions
The purpose of this paper is to describe pandemics and other serious epidemics in historical terms (the recent history of the past one hundred years in this paper specifically, subsequent papers may include other pandemics and epidemics from the more distant past) along with the economic and other consequences that attended them. These pandemics and disease outbreaks are not presented in chronological order but arranged differently to support a different narrative on their impact economically, culturally, and otherwise. As each pandemic and individual disease is different and came to prominence in different times, in fact in widely separated times in some cases, with different levels of affluence, societal organization, and technological attainment, it is difficult to draw direct comparison or support analogies. However, some historical perspective can be enlightening and perhaps general comparisons or lessons can be developed from the information.
A virus is a small infectious agent that uses other cells to replicate. These cells can be from any living organism, single or multi-celled, from bacteria to fungi to plants or animals. Viruses have developed that infect and parasitically use all forms of living cells. Viruses are very small, typically under 300 nm, though a few are much larger than that ranging to 1400 or 1500 nm. This size distribution means that most viruses are smaller than the wavelengths of visible light. Therefore, they cannot be “seen” or imaged by light microscopes as bacteria and other single-celled organisms can. Electron microscopy and other means that can magnify in excess of 2000x are necessary to ascertain the details of most viruses (See https://en.wikipedia.org/wiki/Virus for an expanded definition).
Information in the latter part of the Nineteenth Century indicated that there was something smaller than the visible bacteria that were responsible for a host of infectious diseases. Initially, these agents were thought to be molecular toxins produced by bacteria. However, further research that filtering out all bacteria yielded agents that could not be seen but could be cultivated and multiplied to produce infection (much of this was done with a virus that affected tobacco plants). By the early Twentieth Century, the idea of a virus that could infect living cells took shape. A class of viruses that killed bacteria were identified and once heralded as a means of defeating bacterial infections, but this research essentially came to a halt with the advent of penicillin and other antibiotics (though it has resurfaced recently as a potential means of combating antibiotic resistant bacterial agents).
Viruses were first imaged in the early 1930’s with the first electron microscopes. Viruses in solutions were also crystallized and their structures analyzed by how they refracted various electro-magnetic radiation, usually X-rays. X-ray diffraction was the chief means of understanding virus structure and make-up until very recently when other imaging techniques have advanced to show more detail.
Viruses are very simple. They consist of a piece of genetic material, either DNA or RNA, surrounded by a protein shield, called a capsid. The genetic material has only instructions for the creation of the necessary proteins to encapsulate replicated genetic pieces and a means of commanding this production within host cells. The virus has no other components and produces nothing on its own. The virus finds its host cell, effects some opening or point of entry in the cell’s exterior, injects its genetic material, which replicates itself within the host cell. In replicating itself, the virus highjacks the cell’s own internal chemical processes and metabolism. Often, this favors the virus over the cell, typically interrupting vital cell processes that eventually lead to the death of the cell (lysis). Cell death is often how the replicated viruses then spread within the host or the environment, though some are able to exit without cell death.
Debate goes on as to whether viruses are actually “alive” as they have no metabolism and undertake no other life functions on their own. They require a host to replicate both protein and genetic material, usually at the host’s ultimate expense. They are also not motile and travel only by passive means from one host cell to another. Debate also continues about their origin: Are they more primitive forms of life, or are they simply the most primitive form of parasite that required that there be living cells in existence first? Some argue that they evolved from self-replicating pieces of genetic molecules like DNA and RNA. Others insist that they evolved once there were living cells. Estimates indicate that there are as many or more viruses extant as there are living cells. Most infect very specific types of cells, e.g. human liver cells, in the case of Hepatitis C. However, some are able to cross species boundaries either because of their structure or by slight differences caused by evolution.
In more complex organisms, immune systems have evolved to deal with viral and other types of infections. Infected cells often display odd proteins on their surfaces as a result of the viral interference with their internal chemical processes. These can be signs for immune cells to kill the infected cell to eliminate or slow an infection. Large scale cell death, either from viral interference or immune responses, can cause larger effects in the body. These effects, from dehydration to organ failure, can have both acute and chronic effects. Some viruses are known to cause cancer in humans and other animals (e.g. HPV) by creating uncontrolled cell growth and division. Others can be dormant and cause problems years or decades later (e.g. Hepatitis B and C). Viral DNA is also occasionally incorporated into the human genome as a result of infection. This can cause mutations and other issues over time as well as providing the potential to address some congenital and other diseases (See viral therapy).
Most therapies for viruses focus on the immune system. Vaccinations have been the most widely used and effective. This introduces inactive viruses or antigens associated with the virus into the body to provoke an immune response. This typically involves the production of antibodies, which are long tailed molecules that bind to specific portions of the capsid proteins or “keys” on the virus structure. They essentially “flag” the virus for destruction by other cells or immunological processes. Other systems identify infected cells for destruction. Once the body’s immune system is provoked, it retains the ability or some form of immunity to fight a subsequent infection by that virus. Some anti-viral drugs bind to the viral genetic material rendering it inactive or interrupt the cell processes needed to replicate the viruses. This allows them to affect ongoing infections. Most anti-viral and immunological treatments beyond vaccination are relatively new and rapidly evolving. As a result, some have had only mixed success, but continual improvements in various methods and success with particular viruses are apparent.
Recent Historical Pandemics
Asian Flu, 1957
The 1957 pandemic is important because it was the first sizable influenza outbreak that was studied under modern laboratory and healthcare conditions. This led to the confirmation that influenza itself could cause a viral pneumonia that led to death. Previously, with the 1918/1919 pandemic (See below), most deaths had occurred in the presence of acquired bacterial infections or pneumonia.
The Asian Flu of 1957 was also the first time there was a vaccine intervention in a pandemic. In the years between 1918/1919 and 1957, most influenza epidemics were local or regional and did not cause significant problems or responses, so little had been done to produce wide scale vaccination, although vaccines were developed and deployed in some cases (See below).
The medical community was alerted to the pandemic when an influenza strain was noted in Singapore in February of 1957 and quickly infected 250,000 people in Hong Kong in the spring of 1957. The virus showed up in U.S. coastal cities in the summer of 1957. The origin of the strain was narrowed to East Asia (See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291411/) and likely originated in China in 1956. Researchers in Australia, England, and the U.S. quickly analyzed samples from Hong Kong and determined that it was part of the Influenza A family (Avain Flu). However, the hemagglutinin (HA) and neuraminidase (NA) antigens, the two means of classifying Influenza A, were different than previous versions of the flu. Thus, the Asian Flu was given the designation H2N2 (as opposed to earlier flu strains which were all classified as H1 variants). The implication of this difference was that the population, which had already had various strains of H1 influenza was not primed for the new virus and, therefore, had little immunity to the new strain of flu.
A vaccine was prepared for the strain but was available late in the season. Only 7 million were vaccinated in the first season, which was too few to prevent many deaths in the first year. It was also found that the unprimed population required more vaccine to develop an immunity as the subsequent outbreaks in 1958, 1959, and 1960 showed that less was needed. The virus continued to circulate for eleven years before disappearing, though after 1960 the size of the population that had had the disease or been vaccinated (at least in the U.S. and developed countries) meant that the effect of the outbreaks decreased greatly after 1960. Older people and those with underlying lung and heart conditions were vulnerable, though deaths from viral pneumonia in otherwise healthy individuals were not unknown.
Estimates of the impact of this pandemic are uncertain. WHO, CDC, and other estimates place the worldwide death toll between 1 million and 4 million people. The estimated number of people infected is greater than 500 million (at least 17% of world population at that time). This implies a fatality rate at worst of 0.8% and at best below 0.2%. Most estimates of the fatality rate tend toward 0.4% to 0.2%. The CDC indicates (See https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html) 116,000 U.S. deaths (0.07% of the population), though other sources indicate a lower level of around 69,000. The higher numbers may include those who died in subsequent years, while the lower number indicates the number who died in the 1957-1958 season. Using the 0.2% fatality rate implies 58 million people infected or 33.7% of the U.S. population at that time.
Economically, the outbreak did have some effect. There was a steep recession that began at the end of 1957 and continued until May of 1958. One cause listed for the recession was absenteeism by workers who were sick with the flu in the fall and winter of 1957 and into 1958. However, other factors also existed. The government had cut back on defense purchases in 1957, and auto sales had been falling since 1956. Auto sales were at their worst levels since World War II in 1957. Capital goods orders also fell as planners anticipated falling demand with the contraction in defense and automobile purchasing. There was also monetary tightening, and housing and other construction fell as interest rates climbed. As U.S. economic activity sank, the problems were transmitted to Canada and Western Europe, causing a global recession.
This was seen as the worst recession since the end of World War II, but by the end of 1958, an expansion was again propelling the economy to new levels of employment and activity. In retrospect, the recession was considered a mild one with a steep downturn and then equally steep recovery. GDP fell by about 3.85% in eight months but recovered by the end of 1958.
While the pandemic may have played a role in the downturn, the other factors cited probably had much more of an impact. Most treatments of the recession cite monetary tightening and a rapid contraction of investment as the main causes of the decline. The pandemic is not mentioned or only mentioned with respect to the higher-than-normal absenteeism. The overall GDP decline was also small, meaning that even if the flu had an equal impact with the other factors, its overall impact on the economy was small, probably less than 1% of GDP and more likely around 0.5% of GDP. Despite the deaths incurred from the flu for 1957-1958, which were tens of thousands (0.03 or 0.04% of the population), the economy rapidly recovered in 1958.
Hong Kong Flu, 1968
Another influenza pandemic arose in Southeast Asia in 1968. This virus showed differences in the HA antigen from the 1957 virus and was later designated H3N2. It was likely an evolutionary product of the H2N2 from 1957, which seemed to die out by 1968. The evolution, changes, or mutations in the HA antigen are referred to antigen drift (See https://en.wikipedia.org/wiki/Antigenic_shift). The disease quickly spread to Hong Kong where it was first noted in the spring of 1968 from an epidemic there. It reached the U.S. in September (spread first in California by troops returning from Vietnam) and Western Europe shortly thereafter. Countries in Northern Asia and the southern hemisphere saw cases in early 1969, making the outbreak a pandemic.
However, the pandemic was not characterized by a wave of cases that spread over the globe, as in most previous ones. The pandemic was marked by localized epidemics or outbreaks that became intense and then rapidly subsided only to appear in another locale soon after. This process continued for several years as H3N2 outbreaks occurred again in 1969, 1970, and 1972. This pattern of outbreak led the Hong Kong Flu to be called a “smoldering” pandemic.
The pandemic was difficult because of the differences in the genes leading to the different HA antigen. This meant that exposure to the 1957 (H2N2) or vaccination for it provided only limited protection against the new strain. A vaccine was developed and used, as well as other vaccines based on the N2 antigen. These provided some protection, increasing resistance by more than 50%, based on a study of air force cadets inoculated with one vaccine.
The death rate was still high, though, especially among the older population. The CDC estimates that 100,000 died in the U.S. from H3N2 and 1 million worldwide (See https://www.cdc.gov/flu/pandemic-resources/1968-pandemic.html). These are cumulative figures over the entire extent of the outbreak. The figures for the outbreak in 1968 are lower at 33,800 (See https://en.wikipedia.org/wiki/1968_flu_pandemic). These figures represented 0.05% and 0.02% of the U.S. population at the time. The total killed by H3N2 in the world was 0.03% of the world’s population at the time. As these figures imply, the U.S. did face a higher death rate, typically cited between 0.4% and 0.5% of those infected, though the main contribution was from older Americans who had much higher death rates. Estimates indicate that the U.S. spent $225 million on Medicare (1968 dollars, $1.7 billion in 2020). Overall, the total economic cost was estimated at $4.6 billion in 1968 or $34 billion today (See R. S. Bray, Armies of Pestilence, 1996, Chapter 23).
Again, this pandemic is associated with or occurred near a recession in the U.S. The recession began in December of 1969 (during the second wave of the pandemic in the U.S.) and lasted until November of 1970. It is considered a mild recession with GDP decreasing by only 0.6%. Unemployment peaked right after the recovery began at 6.1%. Both figures indicate a mild recession that ended the longest expansion up to that time (now the third longest) that began in 1961. The recession was presaged by declines in output and employment throughout the second half of 1968, which initially moderated and recovered somewhat in 1969 but then accelerated into recession at the end of the year.
However, attributing these declines to the pandemic would be problematic, given the other events of 1968. There were riots and political and social upheaval at the end of 1967 and throughout 1968 as various movements took their frustration to the streets and results from the Vietnam War were concerning after the Tet Offensive. This likely greatly reduced expectations among citizens and businesses and increased fears. The situation seemed to calm somewhat after the 1968 election, but the economy again lost steam and fell into recession, though it recovered well in 1971. The total cost of the pandemic of $4.6 billion would have amounted to 0.49% of GDP at the time. That cost was spread over a two-year period, so the cost in any one year was negligible. While this is a large portion of the overall decline in GDP, GDP growth fell from around +7% to -5% (peak to trough) during the time period of the pandemic, indicating that other factors were at work and contributed more significantly. Even if considered a chief source of the decline, that decline was small.
Spanish Flu, 1918-1919
This great pandemic, the most destructive one in modern times, is the obvious choice for a pandemic with outsized social and economic impact. The strain has been classified as H1N1 after later research and recent confirmation based on recreations of the original virus genome from samples taken from exhumed bodies. The strain hit in 1918 and quickly spread over the world. The place of origin is unknown. The pandemic was initially described in detail in Spanish media during the early part of 1918 because Spain’s media was relatively free of censorship, unlike most other developed countries which were involved in World War I and had extensive censorship to control morale. Thus, the pandemic acquired the name Spanish Flu. However, research has revealed other candidates for the origin, including the United States and China, though it seems impossible to tell at this point. Fort Haskell in Kansas, a U.S. Army training depot first reported cases of a new flu strain at the beginning of 1918. Some researchers have speculated on a more serious version erupting in New York in late 1917, based on hospital records of the time.
The flu was fast moving and had brutal consequences. It came in three waves: one in the first part of 1918, another at the end of summer, and the final one at the very end of 1918 and through the beginning of 1919. The second wave was the deadliest by far (See https://en.wikipedia.org/wiki/Spanish_flu):
In the United States all three waves passed through the country in approximately nine months from the summer of 1918 until the spring of 1919. It continued in other countries until the end of the year. After 1919, few outbreaks or cases were reported, and the disease seems to have faded, though the pandemic is listed as continuing through most of 1920. Seasonal flu of the H1N1 classification had outbreaks over the next ten or twenty years, but none were as virulent as the 1918/1919 version.
The Spanish Flu struck rapidly, and symptoms and attendant conditions peaked quickly for those afflicted. The strain was odd in that it seemed to strike healthy and able-bodied people more than other, typically more vulnerable groups. Casualties were high among the twenty-to-forty demographic.
This may be a statistical artifact of the war–those in close quarters in military service or active and involved in the community as part of the war effort or the demands it placed on the private and public sectors were more likely to come in contact with it–but the focus of research has been on other causes. One theory indicates that the virus was able to produce a strong cytokine response that overwhelmed the lungs, prompting bacterial infections. The cytokine response is most expected from those who have healthier immune systems. This explanation has not been universally accepted, and other theories abound. One suggests that the virulence of the second wave was the result of adverse selection from military personnel. The pandemic was first noticed (outside of Spain) in soldiers, who carried it to Europe and quickly spread it through camps and trenches. Those with mild cases (i.e. caused by less virulent strains) stayed on duty in the trenches, where the virus quickly ran out of new hosts. Those with more serious cases (i.e. more virulent strains) were relieved and brought back to hospitals where they spread it to others who were in contact with the general population. Research from recently created 1918 virions has pointed to three unique genes for the H1N1-1918 that allow the virus to infect lung tissue and create an environment open to further bacterial infection or overwhelming viral pneumonia. Subsequent bacterial infections, principally pneumonia, were the reason behind most deaths, though there is some speculation that the virus and its effects on victims’ lungs caused a significant number of deaths absent bacterial infections but there is no way to verify this.
The pandemic took a horrific toll on the world and the United States. Deaths in the U.S. are estimated at 500,000 to 550,000 for the nine months of 1918 to 1919 when it was at its peak. The CDC concludes that the total number of U.S. deaths for the entire length of the pandemic was around 675,000 (See https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html). These figures represent between 0.47% to 0.52% and 0.64% of the population, respectively. This is a large percentage loss, approximately one-quarter to half of the percentage loss of the two most devastating wars (in terms of the fraction of population killed) in U.S. history, the Civil War and Revolutionary War (2.3% and 1%, respectively).
Most estimates indicate that around 500 million people were infected worldwide. World fatality figures are worse than the U.S., with the estimates of dead ranging from 17 to 26 million up to 50 million. Some estimates go as high as 100 million, though these are not widely accepted. Again, these estimates may be influenced by the time frames used and the assumptions made for the estimates. As health records in many places were spotty or non-existent, estimates must be based on many assumptions. World population was around 1.8 billion by available estimates, making the fatality rate worldwide between 0.94% and 2.78% or as high as 5.56%, if the highest estimates are accepted. India was particularly hard hit with perhaps 12 million deaths, close to 5% of the population and a significant fraction of world dead.
Despite the severity and the large number of deaths worldwide, the pandemic was quickly forgotten. It was overshadowed by the war, its end, and the events surrounding the peace negotiations and the new structure for Europe and the rest of the world. The speed with which it passed through America and Europe may also have contributed to its lack of historical impact. Until the late 1980’s and 1990’s, it was not a significant subject for American or world history, except by epidemiologists and some of those engrossed in the social history of World War I, and there was little written on it. As AIDS and other epidemics like SARS became topics of more general discussion and study, interest in the 1918-1919 pandemic was revived.
The impact would seem to have been high, but the pandemic appears to have made little impression on those who went through it. It did not appear to factor into military planning too deeply. Even as the second wave was hitting allied areas, U.S. General Pershing was adamant about continuing the war, despite peace overtures. He, presciently, figured that if the Germans were not pushed back into Germany, the population there would not really know or grasp their defeat. He argued that they would later tell themselves that they had not really lost the war and the defeat was the result of treachery. Other allied leaders agreed, and most were prepared to continue the war. In fact, most thought that the truce on November 11th would not hold and saw no extraordinary logistical issues in continuing.
On the German side, after spending October in a defeatist mood due to the failure of the spring offensive and a summer of reversals, General Ludendorff’s spirits revived in November, and he tried to counsel the Kaiser and against peace. Some historians have cited an earlier appearance of the flu in Germany and Austria with devastating effects (e.g. higher mortality and morbidity) as undermining the Central Powers’ ability to wage war, necessitating that they sue for peace. However, the Germans managed to execute a successful attack in the spring of 1918, nearly reaching Paris, and still acquitted themselves well after being thrown back and put on the defensive through September. U.S. troops encountered a tough adversary during the Meuse-Argonne Campaign in September, and advances were hotly contested. Mutinies, popular unrest, and issues relating to malnourishment began to surface in the fall of 1918, undermining the war effort. Supply problems and food shortages could have and probably did exacerbate the effects of the flu, but these were the result of the British blockade, not the pandemic itself. The civil strife and military mutinies led some around the Kaiser and in the General Staff (who really ran the country) to decide that the country had had enough. They used Ludendorff’s period of defeatism and depression in October to push the Kaiser and government toward peace. No readily available historical data make reference to the pandemic influencing that decision.
Immediately after the war, the pandemic seemed to have little consequence on the unfolding events. It did not stop the followers of Rosa Luxemburg and Karl Liebknecht from taking to the streets and staging their Spartacus Revolt in Germany nor prevent any of the other communist and leftwing uprisings that occurred throughout that country at the end of 1918 and first half of 1919. Nor did it stop the newly formed Weimar government from quickly enlisting returning soldiers in paramilitaries to gradually reassert government control over the country. It did not stop peace negotiations at Versailles and elsewhere, despite a number of diplomats coming down with and dying from the flu like Sir Mark Sykes (whose body was exhumed years later in an attempt to obtain a sample of the 1918 virus). It did not stop other ongoing military operations like the allied operations against the Bolsheviks in Russia, which continued through 1920. It also did not seem to dent the civil war in Russia between Reds and Whites, which actually began to accelerate in 1919. In the U.S. the 1919 baseball season went on as planned, culminating in the Black Sox scandal, which along with the subsequent trials grabbed many of the headlines that fall and winter (though some players, including Babe Ruth, were infected with influenza at the beginning of the season or the previous offseason).
Researching and documenting the pandemic was also difficult because there was little contemporaneous mention of it. It was not a favorite topic of journalists, even after censorship was lifted at the end of the war. Media coverage was limited, and many of the references in newspapers come from companies selling medical supplies. There are even relatively few medical journal accounts, given the scale of the pandemic and number of fatalities. Much of the available research comes from the personal journals and papers of those who were affected directly or indirectly, including the experiences of those who treated victims at civilian hospitals or in the military. Nursing programs are an atypically large source of information, likely due to the importance that nursing care had absent effective treatments or vaccines. This all tends to reinforce the notion that the pandemic, despite its severity, had little lasting impact beyond those nine months of peak activity. It may also be that the population directly affected—i.e. those who lost loved ones—did not wish to dwell on it or remember it. The rapidly moving and changing post-war world provided many distractions for most.
No vaccines or other effective medical treatments were developed. Some of the practices that we now call social distancing were implemented such as wearing masks, quarantining those infected, discouraging large events and crowds, and closing some businesses and schools. Improving hygiene was also an important element, especially because of the prevalence of bacterial infections and their role in many of the deaths. However, these measures were largely applied at the local level and unevenly. Milwaukee, for example, closed schools, encouraged isolation, and banned large gatherings. It also ordered some businesses closed, but most industrial companies continued work along with city services. Bars were also conspicuously left open to foster compliance with the other regulations and prevent working class backlash. Philadelphia, one of the hardest hit cities, was slow to react and allowed a large war bond parade in fall 1918, which resulted, a few days later, in the area hospitals being overwhelmed. St. Louis responded more quickly with various measures and had a lower fatality rate. Pittsburgh had a higher one, presumably because of a slow response and poor air quality from steel production. Most regulations disappeared quickly, certainly by summer of 1919 and were not seen again, except in a few places that experienced significant flu outbreaks in the winter of 1919-1920.
As with social impact, it is difficult to determine economic impact. One estimate claims that world GDP was lowered by 5%, which seems like an appropriate value given the number of dead. But this would be difficult to assess given other events that were contributing to falling GDP at the time like governmental chaos in the Republic of China, civil strife in Germany and the successor states to the Austro-Hungarian Empire, unemployment from the sudden rush of returning soldiers, transitions back to peacetime economies, and civil war and economic collapse in the newly formed Soviet Union. The effects on the U.S. economy are perhaps even harder to discern.
The influenza outbreak coincides with or straddles two recessions in the U.S. The first is a recession at the end of 1918 carrying into 1919. It was brief, lasting only about seven months, and began before the war actually ended. The main reason for the recession given in historical and economic texts is the drop in government procurement for the war, i.e. the switch back to a peacetime economy which took place over the winter of 1918-1919. Returning troops also contributed to high unemployment. It did coincide with the pandemic’s second, deadly wave (and third), but the recession was slight, indicating any contribution from the influenza pandemic was also slight. Some local news accounts did indicate that retail and grocery sales were off as much as 50% during the peak of the second wave in October and November. Presumably, they recovered when the peak passed. Aggregate data is scant, and sales seemed to have recovered within a few weeks or months. Accurate GDP figures are unavailable for the time, but industrial production figures show a decline of 14%. This is about half of what major recessions of the time showed like the one in 1914. The 1919 recession was quickly over, but the ensuing expansion was short-lived, leading to a more serious recession in 1920.
The recession in 1920 was much broader and is occasionally referred to as the Depression of 1920. The recession lasted eighteen months from January of 1920 to July of 1921. Again, accurate estimates of GDP loss are difficult to find, but there is more scrutiny of this recession than 1919. Estimates of GDP loss range from 2.4% to 6.1%. Unemployment (also only available through estimates with many assumptions) is thought to have peaked somewhere between 8% and 12% in 1921. By 1923 it was 2% to 3%. This recession was also characterized by extreme deflation. The Commerce Department at the time estimated an 18% deflation in prices. Subsequent estimates have been lower but still high–13% to 15%. Wholesale prices fell by the largest percentage since the Revolutionary War, over 36%. The deflation was large, given the small drop in GDP estimated. Greater deflation occurred during the Great Depression, but this was accompanied by a much larger drop in GDP.
The explanations of what caused the recession or depression tend to focus on a few. A severe monetary tightening is usually listed as the chief culprit because of the deflationary pressures. The other major cause listed is adjustments to the large number of returning servicemen from World War I, who were still streaming back to the country from Europe and limited occupation duty in 1919 and the beginning of 1920. The returning troops also expanded the labor supply undercutting unions, which had gained strength and power during the war with a large section of employable men removed from the labor pool. This led to labor strife and approximately four million workers on strike in 1919 as opposed to 1.2 million in each of the previous two years. Other countries also experienced downturns as troops returned and war economies switched to peacetime economies (or there was near economic collapse, as in Germany). A drop in agricultural commodity prices as European production returned to pre-war levels affected U.S. farming (16% of the economy then), and the expectations of future deflation reduced investment in the U.S. With limited fiscal stimulus from the government in the form of tax rate reductions from war time levels and easier monetary policies, the economy quickly recovered for a long expansion that essentially lasted over for the rest of the 1920’s.
None of the available research cites the Spanish Influenza as a contributing factor to the Recession of 1920. All the readily available information focuses on monetary issues or other issues related to the end of the war. This seems proper given the texture of the recession with its deflation and increased unemployment. In fact, most media seem to have ignored the pandemic after the severe second wave at the end of 1918 and beginning of 1919. Only local reports of local outbreaks are available for the end of 1919 and 1920. Nationally, the press accounts focused on the condition of President Wilson (who had had a stroke), the League of Nations Treaty debate, and each of the political party’s arguments for reversing the recession during the 1920 election. It appears no one at the time saw the pandemic as a cause of the recession in 1920.
H1N1 Pseudo-Pandemic of 1947
In 1947, troops returning from stations in Korea and Japan brought back a new strain of H1N1 influenza. Symptoms tended to be severe, even among the young and healthy troops. The vaccines for H1N1 developed for an outbreak in 1943 were also shown to be inadequate. Subsequent research showed some substantial differences between the earlier H1N1 versions and the 1947 version. The strain did spread widely but deaths did not seem to be substantial or beyond what was to be expected from seasonal flu. Older people seemed to be somewhat more immune, perhaps because of exposure during previous outbreaks, including 1918-1919. New vaccines were developed and used against this type, which lasted until 1957 (See above). Though the strain spread far, little data is available on fatalities or its extent.
There was an economic recession in 1948 and 1949. The generally used explanations for the recession are a tightening of monetary policy, the change to a peacetime economy (With occupations and other efforts, the U.S. economy was on a wartime footing through 1946), and a mixed reaction to President Truman’s “Fair Deal” policies. The recession was generally considered to be mild with only a 1.7% decrease in GDP and a maximum unemployment rate of 7.9%. This downturn occurred almost a year after the influenza season in 1947-1948. At such a temporal remove and with other causes cited, this outbreak’s contribution to any downturn was likely negligible or non-existent.
The Pandemic That Wasn’t, 1976
In early 1976, a young soldier at Fort Dix, NJ collapsed and later died from a respiratory infection. CDC and other authorities traced it to a strain of H1N1, indicating that another outbreak of “swine flu,” which H1N1 had come to be called because of its association with pigs, was imminent for the upcoming flu season. The administration developed and funded a plan for widespread vaccination. This began in the fall of 1976 after some wrangling in Congress over the liability and indemnification of pharmaceutical companies who feared legal problems for any adverse reactions among groups in the population (the industry and its insurance carriers were still reeling from claims over the live virus polio vaccine). Total cost of the program was to be $135 million, considered cheap in comparison to the costs of the two previous pandemics (1957 and 1968).
The WHO indicated that they saw no evidence of a pandemic or outbreak of new H1N1. Additional cases of swine flu failed to materialize at Fort Dix or elsewhere in the coming months. Due to this and reports circulating that those who had the vaccine had a higher chance of contracting Guillain-Barre Syndrome, a neurological condition, most vaccinations were stopped. As many as 43 million might have been vaccinated. However, public support for the program quickly collapsed, and the immunization program was widely assailed as a failure and a fiasco at the time.
There are no directly related economic effects of the program, which cost very little, even at the time. Probably the most important result was public suspicion of the flu vaccine and vaccines in general (which may have produced a noticeable cost over the decades since). Later research revealed that those who contract swine flu have a higher incidence of Guillain-Barre Syndrome than those who are vaccinated, which shows some relationship between the virus and neurological effects on certain individuals or groups. Otherwise, inflation, other economic issues, and foreign policy commanded the attention of Americans for the remainder of the 1970’s, despite a similar outbreak of H1N1 called Russian Flu in 1977, about which little was reported (much of the outbreak occurred behind the Iron Curtain).
SARS and MERS, 2003 and 2012
Unlike influenza, Severe Acute Respiratory Syndrome or SARS and MERS (Middle Eastern Respiratory Syndrome) are both caused by coronaviruses, similar to the one that causes COVID-19 (officially designated as SARS-CoV-2). In fact, many of the symptoms and disease progression are similar in all three types. The SARS virus (designated SARS-CoV) originated in China and was initially identified in an infected doctor in Hong Kong. There was an outbreak of SARS in South Asia, but it was contained quickly and only a few cases were noted in the rest of the world. Reported fatality rates for SARS are as high as 9%, but the virus seems to be easily contained once it is identified and also to have a lower velocity when spreading.
MERS was identified in Saudi Arabia in 2012. Cases have only amounted to a few thousand since then, although they have been increasing steadily, numbering 212 in 2019. Less is known about this disease. Outbreaks have been few, primarily in Saudi Arabia and South Korea. The rest of the cases have been singular or in small clusters. Few anti-viral treatments seem to work on it.
While SARS created a stir during its outbreak, there were few lasting economic impacts as it was contained quickly. Any economic damage was limited to Asian countries like Hong Kong and Taiwan and this was confined to some reduction in activity as a result of precautions. No widespread lockdown occurred in either case. The effect on the U.S. was nil. MERS has had no economic impact as it has been largely contained in small outbreaks with less than 250 cases per year since its discovery in 2012.
A novel version of H1N1 influenza virus was discovered in California in April of 2009. Other cases were identified nearby and then in Texas a week later (See https://www.cdc.gov/flu/pandemic-resources/2009-pandemic-timeline.html). Cases quickly spread and the first affected areas were issued warnings in May. This closed schools in the designated areas and sent over 60,000 children home at the localized peak in May, 2009. Despite peaking in May and June, the flu showed up in summer camps and in relation to other summer activities over a wide area. By June 19th, all fifty states had reported cases. Vaccine trials started in July, and the first vaccines were administered at the beginning of October. Widespread vaccination and campaigns started in December and went through the beginning of 2010. Vaccine response was deemed “excellent” by the CDC. Cases seemed to peak in October or November of 2009.
The CDC’s estimates cases and fatalities (See https://www.cdc.gov/h1n1flu/estimates/April_October_17.htm) indicated a mild outbreak. The CDC estimated a total of 22 million people infected through 2009 with 3900 deaths and 98,000 hospitalizations. This yields a fatality rate of 0.02% and a hospitalization rate of 0.45%. Later estimates increased these numbers for the whole extent of the outbreak from 2009 through the end of 2010 to between 8,000 and 18,000 dead and 43 and 89 million infected. Many sources use 14,000 dead as the final toll of this epidemic/pandemic.
Other cases appeared in Mexico City, and the WHO eventually designated the outbreak a pandemic, albeit Class 6 (the lowest). The pandemic infected between 0.7 to 1.4 billion people worldwide and caused between 151,000 and 500,000 deaths for a fatality rate around 0.03%.
This outbreak or pandemic occurred during the Great Recession caused by the financial panic of 2008. GDP growth turned positive around October 2009 and continued so through all of 2010. Growth became steadily less negative during the first half of 2009 as financial conditions improved. There is little to no evidence of an effect from the pandemic or outbreaks in the U.S. Most Americans likely did not know there was a pandemic declared. Most do not remember the incidents or their severity. The effects of this strain were likely masked by the usual number of infections and deaths from flu that occur seasonally each year.
While the COVID-19 pandemic has garnered unprecedented media coverage as it has unfolded, it remains to be seen whether or not it becomes an unprecedented pandemic. It is certainly serious because it is a novel virus for which the entire world population has little immunity and creates severe respiratory problems in at least 10% of its victims. Whether it will produce the number of deaths of previous pandemics like 1957 or 1968 is unknown. Certainly, death rates in Europe will be high, especially in Italy, Spain, and probably France given the present situation. How many deaths will be recorded in the U.S. is unknown.
The fatality rate against confirmed cases has fallen in the U.S. to the range of 1.25% to 1.5%. This is based on current confirmed cases. The number of people actually infected with the disease is unknown. Some estimates have placed that number at ten times or more of the number of confirmed cases. That would presage a fatality rate of 0.13% to 0.15%, which would put it above seasonal flu (0.1%) and below other viral agents, including its cousins SARS and MERS (5% to 12%). A fatality rate of 0.3% to 0.8% would not be unreasonable, especially since the large number of cases recently discovered in the U.S. tends to indicate that there is and was a large pool of infected people. The high infection rate in New York (which has performed the most tests) likely indicates that there was more disease extant than previously thought, meaning that it has been circulating in New York for some time.
Another problem is the rapidity with which the disease can be communicated. The R0 value for COVID-19 is thought to be between 2.0 and 3.0. This is more than influenza (1.3 to 1.8) but lower than many other viral infections such as Zika (3.0 to 3.6), HIV (3.6), and measles (11-18) and comparable to norovirus (1.6 to 3.7). Thus, it can spread quickly in a population that has little resistance to it. That means that it could spread for some time and infect a large portion of the population. If it infected 30% of the population (similar to the two post-war pandemics) that would mean approximately 100 million infected in the U.S. Even with a relatively low fatality rate of 0.3%, this would mean 300,000 deaths due to the virus over several years, a larger toll than either the 1957 or 1968 pandemics. Rates could be higher if acute outbreaks stress local health systems and cause more deaths, hence the lockdown policies in effect at present. On the other hand, the number of deaths could be comparable to the 2009 H1N1 pandemic, which were between 8000 and 18,000 (often given as 14,000), though may be as high as 30,000 or 40,000. This received little notice at the time.
Mitigating the spread of the disease are several factors. One is the social distancing measures put into effect across the nation to one degree or another. These may slow the spread of the virus in the coming weeks. However, it may have the immediate effect of increasing cases rapidly. There is some evidence from the WHO that the chance of spread with casual contact is low (See https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article) but much higher for those in enclosed spaces or tight quarters. This explains why cruise ships have had poor results. Keeping people at home may have a similar effect, infecting everyone in the household of an infected person. This has the advantage of quickly identifying those infected and isolating them, but it could place stress on the local health systems if enough households of any size are infected. This may explain the situation in New York: the infection was quickly concentrated in apartments as people were ordered to stay home.
Another factor is that the virus seems very vulnerable to ultra-violet light. It also seems to spread more slowly with higher temperatures and humidity (See https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767). This means that the coming of warmer, wetter weather in late spring and summer should reduce the spread. This probably means that there will be seasonality to this virus. The University of Maryland also mapped the sites of the major outbreaks and found that they all shared a similar climate (See https://www.medschool.umaryland.edu/news/2020/Researchers-Predict-Potential-Spread-and-Seasonality-for-COVID-19-Based-on-Climate-Where-Virus-Appears-to-Thrive.html):
This green band will rapidly get warmer and wetter in the coming months, probably reducing transmission. These factors combined with better hygiene will likely improve conditions and help to move the U.S. past the peak of the curve for new infections. This will buy time until the virus returns, likely in the fall. In that time therapies, additional medical capacity, and vaccines may be available.
Thus, it is debatable whether the health impact of the pandemic is unprecedented in its scale or fatality rate. What is unprecedented in this pandemic is the economic impact. The three or four previous pandemics had limited or no discernable economic impact. It is likely that they acted as catalysts in some situations, exacerbating underlying economic problems, but they were not responsible on their own for any economic downturn. Even in the case of the 1918-1919 pandemic, it is not cited as a direct cause of either recession that occurred during the time it was extant. It may have only reduced world GDP by 5%.
This contrasts with the present situation, where the impact of lockdowns in China and the U.S. may already have exceeded that level. Estimates indicate Chinese and U.S. GDP falling by 10% (the two largest economies). Europe may quickly follow suit or even be worse, as the EU’s economic situation was not good at the beginning of 2020. No pandemic in recent times has resulted in such a decrease. Moreover, these estimates could be worse if the economies do not recover quickly after the lockdowns or the virus spreads again in the fall, necessitating additional shut-downs.
A 10% decrease in GDP in a short period of time is associated with only the worst recessions in modern U.S. history. This would be comparable to the 2008 financial crisis (Great Recession) and the deep recession in 1981 caused by drastic monetary tightening to combat inflation. These are just below the drop caused by the stock market crash of 1929. Thus, the COVID-19 pandemic threatens serious economic damage and all of the social, healthcare, and other problems that attend severe economic downturns. Deep recessions, financial panics, and depressions tend to increase fatalities for myriad reasons on their own.
Obviously, lockdowns are unsustainable and can only be used to combat acute situations where the healthcare system may be overwhelmed. It is doubtful the country could (or the populace would) withstand a 20% drop in GDP or an economic depression. Therefore, the present policies will have to eventually be replaced. This will probably be easier to do as warmer weather approaches. However, efforts will have to be made to develop and deploy effective therapies, testing, and vaccines in the months between economic re-emergence and the return of COVID-19 in the fall.
Other efforts will have to focus on preventing an economic depression. This was avoided in 1981 and 2008 but not in 1929. In 1929 a seemingly endless string of bad government policy turned a sharp recession into a depression: a substantial tightening of monetary policy, a ridiculously harsh tariff policy when trade was close to 20% of GDP (Smoot-Hawley), a tax increase, an (unconstitutional) attempt to institute a command economy (the National Industrial Recovery Act), and additional tax increases. Avoiding such policy mistakes will be important to resetting the economy to its March 1st state, which was strong. Widespread testing and vigilance will be needed over the coming months to quickly identify outbreaks of COVID-19 to deal with them before they spread to any degree and set up another situation that may require widespread lockdowns.
Ultimately, vaccines or very effective anti-viral therapies are the only means to control the threat. Presently, all hospitals are on an emergency footing in preparation for handling the severe cases of COVID-19. This means that all “elective” surgeries are on hold. These include surgeries like transplants and cancer surgeries that could, ultimately, lead to life-threatening situations. Many who need new hips or knees will also be adversely impacted, potentially to the point of not being able to get around. The list of additional conditions affected is long. Quality of life for many patients will be diminished, some significantly and a few fatally. Hospitals will remain on emergency footing until the pandemic disappears, but that could take several years. Therefore, vaccines or “cures” are needed sooner rather than later, and every process from research to approval will need to be accelerated to produce them. Without them healthcare cannot return to general treatment, and the economy, the source of all of the nation’s strength and support including for healthcare, cannot fully recover. Most older Americans do not realize that they have lived through several pandemics already, but few are likely to quickly forget this one because of the coverage, policies implemented, and cost. For that reason, COVID-19 is truly unprecedented in modern history.