We’ve had a couple of people BTL take issue with us regarding the case fatality rate (CFR) of the 1918 Spanish Flu. Citing Wikipedia and the CDC we gave that rate as being between 10-20%. A couple of commenters, however, insisted the actual CFR was 2-3%, and this led us to look further.
What we found was quite interesting.
This is the pre-February 22 2020 opening paragraph of the ‘Mortality’ section on the Wiki page for the Spanish flu (our emphasis):
The global mortality rate from the 1918–1919 pandemic is not known, but an estimated 10% to 20% of those who were infected died (case-fatality ratio). About a third of the world population was infected, and 3% to 6% of the entire global population of over 1800 million died.
This is how the same paragraph reads now:
It is estimated that one third of the global population was infected, and the World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).
That’s quite a big change in a pretty short time.
What’s going on? Why is the CFR suddenly being downgraded so dramatically?
The WHO report they use as a source is not about the Spanish Flu, but simply mentions it in passing. It does indeed say 2-3% of those infected died, but gives no source for this, and also claims this represents 20-50 million people.
The trouble with that is the higher range of this estimate (50 million as 2% of total cases) gives a figure of 2.5 billion total cases. Which is higher than the entire population of the world at the time!(1.8 billion).
So something is clearly amiss.
Worse still, the WHO is the only source we have found so far that claims a death toll of 20 million. Most sources, such as the CDC (and see here), broadly agree that between 50 million and 100 million people died of the Spanish Flu (although one recent study wildly differs, see below). In order for 50-100 million deaths to be 2-3% of total cases there would have had to be 2.5 billion – 5 billion cases.
Obviously totally impossible.
Clearly there is something wrong with that newly revised figure of 2-3%. The only way to make it work is to also dramatically revise downward the number of deaths. And indeed there’s evidence of editors trying to do that on Wiki with someone citing a December 2018 study which used a controversial “new methodology” to establish a mortality figure of just 17 million. Given that this number has previously been estimated for India alone, this is remarkable revisionism.
Now, of course, there are debates about numbers of infections versus fatalities in every case study in epidemiology. It’s not an exact science. It’s fluid. Of course, estimates will vary and errors will be made and corrected. There’s more to be said about the inherent uncertainties in these cases, and we are currently talking to a respected virologist with the intention of covering the question further in future. Maybe the previous estimates of infection and fatality were too high. Maybe there is a rational case to be made for lowering them.
But is that what we are seeing on Wiki?
We all know Wikipedia is a micro-managed propaganda organ, so the fact its page on the Spanish Flu began a huge uptick of edits in December 2019, rising steadily until February 2020, and that the bulk of these edits seem concerned with – subtly and overtly – downgrading the severity of the 1918 pandemic has to be of interest.
Why the sudden decision to vastly downgrade the estimated CFR for the 1918 pandemic and source to a rather obscure WHO article that doesn’t even focus on that issue? And, more importantly, why does this extreme downgrade still exist on the page even when editors are pointing out the impossibility of the figures?
At least this new editorial policy by Wiki is well-timed for those looking to stoke fear, and unfortunate for those trying to bring reason to bear. It allows the media and others to cite the newly downgraded 2-3% CFR as evidence that COVID19 is as dangerous as, or more dangerous than, the Spanish Flu and will end up killing millions. That’s some nice clickbait right there.
Is it just human confusion? Maybe.
There is a report by a virologist, and cited by the CDC, that confirms the heretofore commonly accepted 500 million cases and 50-100 million deaths and adds this is a CFR of ‘over2.5%’. Which of course it is. It’s a CFR of 10-20%, as he would be the first to recognise. And 10-20% is over 2.5%.
Maybe his slightly ambiguous wording has led people astray? Maybe people consulting his work, as many do, including the Wiki editors, have taken ‘over 2.5%’ to mean just over, or even to mean exactly2.5%? Maybe that’s all this is.
But at any rate, the error, whatever it is, wherever it came from, isn’t ours. We didn’t make up the 10-20% CFR of Spanish Flu. It was the standard assessment until very, very recently. It still exists, though somewhat hidden now by ambiguous wording and confusion.
Coming next in my bid to write about nothing but COVID19 for the rest of my life: what are the standard tests for this virus? How reliable are they and should you take one?