COVID Death Toll in U.S. Reached 675,000, as Many Deaths as Spanish Flu Epidemic

The COVID-19 death toll in the U.S. has reached 675,000, approximately the same number of Americans who died from the Spanish flu epidemic from 1918-19, according to data from Johns Hopkins University.

The University of Washington has projected an additional 100,000 or so Americans will die from COVID-19 by January 1, surpassing the rough guess of the Spanish flu's death toll recorded by the Centers for Disease Control and Prevention (CDC).

The 1918-19 pandemic killed 50 million people across the world when the global population was one-quarter of its current size. Global deaths from COVID-19 are at more than 4.6 million.

For more reporting from the Associated Press, see below.

COVID-19 Pandemic
The COVID-19 death toll in the U.S. has met the death toll from the Spanish flu in 1918-19. Above, a patient is taken on a stretcher into the United Memorial Medical Center after going through testing for COVID-19 in Houston, on March 19, 2020. David J. Phillip, File/AP Photo

The U.S. population a century ago was just one-third of what it is today, meaning the flu cut a much bigger, more lethal swath through the country. But the COVID-19 crisis is by any measure a colossal tragedy in its own right, especially given the incredible advances in scientific knowledge since then and the failure to take maximum advantage of the vaccines available this time.

"Big pockets of American society—and, worse, their leaders—have thrown this away," medical historian Dr. Howard Markel of the University of Michigan said of the opportunity to vaccinate everyone eligible by now.

Like the Spanish flu, the coronavirus may never entirely disappear from our midst. Instead, scientists hope it becomes a mild seasonal bug as human immunity strengthens through vaccination and repeated infection. That could take time.

"We hope it will be like getting a cold, but there's no guarantee," said Emory University biologist Rustom Antia, who suggests an optimistic scenario in which this could happen over a few years.

For now, the pandemic still has the United States and other parts of the world firmly in its jaws.

The ebbing of COVID-19 could happen if the virus progressively weakens as it mutates and more and more humans' immune systems learn to attack it. Vaccination and surviving infection are the main ways the immune system improves. Breast-fed infants also gain some immunity from their mothers.

Under that optimistic scenario, schoolchildren would get mild illness that trains their immune systems. As they grow up, the children would carry the immune response memory, so that when they are old and vulnerable, the coronavirus would be no more dangerous than cold viruses.

The same goes for today's vaccinated teens: Their immune systems would get stronger through the shots and mild infections.

"We will all get infected," Antia predicted. "What's important is whether the infections are severe."

Something similar happened with the H1N1 flu virus, the culprit in the 1918-19 pandemic. It encountered too many people who were immune, and it also eventually weakened through mutation. H1N1 still circulates today, but immunity acquired through infection and vaccination has triumphed.

Before COVID-19, the 1918-19 flu was universally considered the worst pandemic disease in human history. Whether the current scourge ultimately proves deadlier is unclear.

In many ways, the 1918-19 flu—which was wrongly named Spanish flu because it first received widespread news coverage in Spain—was worse.

Spread by the mobility of World War I, it killed young, healthy adults in vast numbers. No vaccine existed to slow it, and there were no antibiotics to treat secondary bacterial infections. And, of course, the world was much smaller.

Yet jet travel and mass migrations threaten to increase the toll of the current pandemic. Much of the world is unvaccinated. And the coronavirus has been full of surprises.

Markel said he is continually astounded by the magnitude of the disruption the pandemic has brought to the planet.

"I was gobsmacked by the size of the quarantines" the Chinese government undertook initially, Markel said, "and I've since been gob-gob-gob-smacked to the nth degree." The lagging pace of U.S. vaccinations is the latest source of his astonishment.

Just under 64 percent of the U.S. population has received as least one dose of the vaccine, with state rates ranging from a high of approximately 77 percent in Vermont and Massachusetts to lows around 46 percent to 49 percent in Idaho, Wyoming, West Virginia and Mississippi.

Globally, about 43 percent of the population has received at least one dose, according to Our World in Data, with some African countries just beginning to give their first shots.

"We know that all pandemics come to an end," said Dr. Jeremy Brown, director of emergency care research at the National Institutes of Health, who wrote a book on influenza. "They can do terrible things while they're raging."

COVID-19 could have been far less lethal in the U.S. if more people had gotten vaccinated faster, "and we still have an opportunity to turn it around," Brown said. "We often lose sight of how lucky we are to take these things for granted."

The current vaccines work extremely well in preventing severe disease and death from the variants of the virus that have emerged so far.

It will be crucial for scientists to make sure the ever-mutating virus hasn't changed enough to evade vaccines or to cause severe illness in unvaccinated children, Antia said.

If the virus changes significantly, a new vaccine using the technology behind the Pfizer and Moderna shots could be produced in 110 days, a Pfizer executive said Wednesday. The company is studying whether annual shots with the current vaccine will be required to keep immunity high.

Spanish Flu Epidemic
Historians think the Spanish flu pandemic started in Kansas in early 1918, and by winter 1919 the virus had killed at least 50 million people, including 675,000 Americans. This photo from the Library of Congress shows a demonstration at the Red Cross Emergency Ambulance Station in Washington in 1918. Library of Congress via AP, File