Covid-19 could kill 50-100 million like 1918 influenza pandemic did, Lancet paper

If the coronavirus pandemic worsens with high caseloads overwhelming health systems, its impact could be similar to that of the 1918 HINI influenza outbreak, which killed 50-100 million globally, a research paper published in the medical journal The Lancet has said.

“The case-fatality ratio (CFR) of seasonal influenza is approximately 0·1% , whereas the estimated CFR of Covid-19 was 5·9% in Hubei province, China, and 0·98% in all other regions of China,” the research paper led by Gao Fu, the director of the Chinese Centre for Disease Control and Prevention, said.

“High caseloads stress medical systems and can lead to more deaths if health-care systems become overwhelmed. Should the Covid-19 pandemic worsen, its effect might approach that of the 1918 H1N1 influenza pandemic, which had a CFR of more than 2% and caused 50–100 million deaths worldwide,” Gao and his fellow researchers argued in the paper, which was published on June 6.

The paper is titled: “Active case finding with case management: the key to tackling the Covid-19 pandemic”

Since WHO characterised the Covid-19 epidemic as a pandemic on March 11, 2020, the situation has been worsening.

By May 31, 2020, more than 200 countries and areas had been affected and the cumulative number of cases – by June 9 – had exceeded 7.3 million, with rapid daily increases in some countries.

While China has brought the outbreak under control since it first broke out from the central Chinese city of Wuhan late last year, Gao and his colleagues had a note of caution.

China continues to be at risk of facing a second wave of the coronavirus epidemic as the nearly the entire population of the country remains susceptible to the virus, the study said.

The containment and suppression strategies implemented by the government have been successful but the resurgence of the virus remains a possibility as the pandemic rages globally, it said.

“The containment strategy has largely been successful in China. From April 1 to May 31, 2020, there have been, on average, 54 infections reported daily by China’s National Health Commission, which were almost all importation cases or second-generation cases from importations, and an average of 0·6 new deaths have been reported each day, with the most recent death reported on April 14, 2020,” the paper said.

“There is no known ongoing community transmission, but the risk of local transmission introduced by internationally imported cases remains a major concern. Almost the entire population of China remains susceptible to SARS-CoV-2 and, therefore, is at risk of a Covid-19 epidemic,” the paper added.

The research indicated that China’s goal in combating Covid-19 is to maintain zero or minimal local transmission until a safe and effective vaccine is developed and widely distributed among the susceptible population.

The authors argued only implementing non-pharmaceutical interventions (NPIs) without case finding, isolation and contact tracing will not be enough.

“Experience with influenza A (commonly known as the flu) is that NPIs (without case finding, isolation, and contact tracing) can reduce spread by up to 50%, which is potentially insufficient to alleviate critical medical needs caused by the Covid-19 epidemic.”

“With ongoing virus transmission, the Covid-19 pandemic might continue indefinitely until relieved by an effective vaccine response.”