Excess mortality from COVID-19 in NYC comparable to peak of 1918 flu pandemic
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The excess mortality observed during the initial 2 months of the COVID-19 outbreak in New York City was comparable to the excess mortality observed during the peak of the 1918 influenza pandemic, according to a study.
“For those who have seen this disease up close, this study will affirm that what they have experienced is truly historic,” Jeremy S. Faust MD, MS, instructor in emergency medicine at Brigham and Women's Hospital in Boston and Harvard Medical School, told Healio. “For those who have not yet seen this disease and what it is capable of, we hope that this gives a context so that they prepare adequately and give their patients guidance on how to avoid infection and how important some of the well-known behavioral changes — nonpharmacologic interventions — are.”
Faust, along with Zhenqiu Lin, PhD, of Yale New Haven Hospital, and Carlos del Rio, MD, of Emory University School of Medicine, compared the incident rates (IRs) of mortality in New York City during the 1918 H1N1 influenza pandemic and the early months of COVID-19. They used CDC data for the 1918 pandemic and data from the New York City health department and U.S. Census Bureau for COVID-19.
Results showed that during the peak of the 1918 influenza pandemic, 31,589 all-cause deaths occurred among a population of 5.5 million residents, for an IR of 287.17 deaths per 100,000 person-months (95% CI, 282.71-291.69). The IR for all-cause mortality during the influenza pandemic in comparison with corresponding periods from 1914 to 1917 was 2.8 (95% CI, 2.74-2.86).
There were 33,465 all cause deaths among a population of 8.28 million residents during the early period of the COVID-19 outbreak in New York, for an IR of 202.08 deaths per 100,000 person-months (95% CI, 199.03-205.17). During the 2020 study period, the incident rate ratio (IRR) for all-cause mortality compared with 2017 to 2019 was 4.15 (95% CI, 4.05-4.24). The researchers calculated an IRR of 0.7 (95% CI, 0.69-0.72) for all-cause mortality during the height of the 1918 influenza outbreak and early 2020 COVID-19 pandemic.
Faust said one of the most surprising elements of the study was that the per-capita death rate in New York throughout March, April and May was higher than baseline death rates in the 20th century just before the 1918 influenza outbreak.
“In 1915, for example, the all-cause incidence rate for deaths in New York City was around 100 per 100,000 residents each month. In 2019, we were around half of that,” Faust said. “But in spring of 2020, the all-cause death rate rose to around 200 per 100,000 residents per month. Sure, in the fall of 1918, at the peak of H1N1, the death rate rose a bit more, to over 280 per 100,000 people per month, but it's amazing to think that New York City in April 2020 was twice as deadly a place to live as April 1914, 1915 and 1916.”
Faust emphasized that New York’s spring outbreak is a “case scenario” for the potential impact COVID-19 can have.
“It's likely that other areas will have longer, flatter curves because we all saw what happened in New York,” Faust said. “I anticipate that for other locales, a longer time window of study will be useful in measuring excess mortality. Certainly, many people are looking at other cities now. We don't know whether what we experienced this spring was the peak or not.”
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