Comparing 2009 Pandemic to COVID-19

This is an excerpt from the Washington Post on 21 April 2020 by Glenn Kessler:

The Centers for Disease Control and Prevention has estimated that from April 12, 2009, to April 10, 2010, there were 12,469 deaths in the United States because of the H1N1 (swine flu) virus. That was the midpoint of an estimate that ranged from a low of 8,868 to a high of 18,306. As we noted, Trump often cites this figure as 17,000. But that was an after-the-fact report, based on statistical modeling of excess mortality…

What was the CDC reporting as the swine flu pandemic unfolded? Here’s a comparison of the first 86 days of the 2009 swine flu in the United States and first 86 days of the 2020 covid-19 outbreak.

The 2009-2010 swine flu pandemic is considered to have been relatively mild — and in the United States, it hit harder in a second wave in the fall. Clearly, covid-19 is striking with much more force — and faster.

Only after the swine flu pandemic had passed did researchers use a time series analysis to estimate how many excess deaths in a given period could be attributed to the swine flu but were not counted in the official death statistics. About 6 in 7 deaths are believed to have been missed in the laboratory-confirmed count during the swine-flu pandemic, though such calculations count any death in which the flu might have been a contributing factor. Many deaths are triggered by the flu but occur later, via secondary bacterial infection or exacerbation of underlying chronic diseases, even as flu symptoms may have disappeared.

In other words, when Trump began criticizing Obama over the swine flu, he was comparing apples and oranges — later calculations vs. real-time figures. Now, with the covid-19 real-time death toll more than double the after-the-fact calculations, it’s an especially bizarre comparison.

And what about the administration’s handling of the pandemic — which came at the same time Obama also was dealing the economic fallout from the Great Recession?

In general, Obama got pretty high marks. Going through the after-action reports and Inspector General investigations, it’s hard to find much that would qualify as a “disaster” or “debacle.”

On April 26, 2009, when only 20 cases of H1N1 — and no deaths — around the country had been confirmed, the Obama administration declared H1N1 a public health emergency. The administration quickly sought funding from Congress, receiving almost $8 billion. Six weeks later, the World Health Organization declared a pandemic.

A New York Times assessment in 2010 noted that some flaws in the system were discovered, but overall the government was praised for its response — in part because it turned out that the pandemic was not as severe as it once had appeared. The President’s Council of Advisors on Science and Technology in August 2009 had forecast 30,000 to 90,000 deaths, and the final death toll was much less than that.

“Federal officials deserve ‘at least a B-plus,’ said William Schaffner, chairman of preventive medicine at Vanderbilt University’s medical school,” the Times reported. “Even Dr. Peter Palese, a leading virologist at Mount Sinai Medical School, who can be a harsh critic of public policies he disagrees with, called the government’s overall response ‘excellent.’ ”

The biggest problem that emerged was that not enough vaccines were produced, as the U.S. government decided to rely on a 50-year technology involving eggs — and the H1N1 virus grew more slowly in the eggs than expected.

“Even though the six-month goals for initial vaccine delivery were met, most of the vaccine arrived too late to vaccinate much of the public before the pandemic peaked,” the Health and Human Services Department concluded in a lengthy 2012 report, noting that early projections “regarding timing of vaccine supply changed frequently and were inaccurate. This led to public confusion and temporary erosion of confidence in the federal government and created challenges for the planning and execution of local vaccine administration efforts.”

But, in a bit of luck, it turned out that just one dose was effective, rather than the anticipated two, so the supply that was produced went twice as far. Because the flu turned out to be relatively mild, hospitals were not as stressed as they might have been expected.

The HHS, in its report, noted that “serendipity” played a big role in the successful outcome. “Because the pandemic could have been worse, 2009 H1N1 did not test the nation’s response capabilities to its limits,” the report warned. “Because the health care system was not seriously stressed during the pandemic, its ability to meet a substantial surge in demand was not fully tested and the difficult issues around allocation of scarce resources and crisis standards of care in an emergency did not have to be confronted. If the health care system had been tested to its limits, serious problems may have emerged because the public health and health care delivery systems are not well prepared to address such issues.”