The last pandemic the world had experienced was the 2009 H1N1 (influenza) pandemic (Terry, 2020). COVID-19 is not a form of influenza, though both are novel viruses that have migrated from animals to humans and have impacted society on a global scale (Terry, 2020; ).

The designation of a pandemic specifically means that it is not only “an outbreak of disease that spreads quickly and affects many individuals at the same time,” but one that “occurs over a wide geographic area and affects an exceptionally high proportion of the population” (Merriam-Webster, 2020). COVID-19 has also been inaccurately compared to the bubonic plague, experts countering that the biology and socioeconomic effects of the two events vary wildly (McNeil, 2020; Mondschein, 2020).

A useful historical example is the 1918 influenza pandemic. Records of the influenza pandemics date back to the 1500s, but the 1918 pandemic was the worst in recorded history with 546,000 excess deaths in the United States and 50 million people killed worldwide (Taubenberger & Morens, 2010).

Similarly,  COVID-19 was a novel version of the virus that spread at close proximities, novel viruses being those that are previously unseen in any population (Center for Disease Control, 2020). Influenza viruses are “enveloped negative-strand RNA viruses with segmented genomes” and initiate “infection by binding to receptors on specific host cells” (Taubenberger & Morens, 2010). There are also three types of influenza, influenza A, influenza B, and influenza C, humans being primarily susceptible to influenza A (Taubenberger & Morens, 2010). The 1918 influenza was an avian descended influenza A strain and the “direct progenitor of all of the influenza A viruses circulating humans today” (Taubenberger & Morens, 2010).

In the case of the 1918 influenza, the virus was largely spread by World War I troop movement, whereas COVID-19 has largely been spread by civilian travel (CDC, 2020). It wasn’t until 1920 the 1918 virus “[settled] down into a pattern of seasonal endemic occurrences” (Taubenberger & Morens, 2010). In 1918, many of the global health organizations that are intrinsic to society were yet to exist. For example, the World Health Organization (WHO) did not come into existence until 1948 after the founding of the United Nations in 1945. Due to the lack of globally unified infrastructure and less advanced medical technology combined with factors such as overcrowding and poor hygiene, the 1918 virus was especially deadly (CDC, 2020; Taubenberger & Morens, 2010). Most deaths were due to pneumonia complications as opposed to the direct effect of the virus, the 1918 influenza being the deadliest in young children, persons in their 20s, and the elderly (Taubenberger & Morens, 2010). This distribution varies somewhat in comparison to COVID-19, however, the most critical aspect of the 1918 influenza’s distribution is how poverty served as a predictor for fatality.

Trends in socioeconomic data from the 1918 influenza pandemic have been analyzed on both a micro and macro scale. Through analyzing data from the Berkeley Human Mortality Database and B R Mitchell’s International Historical Statistics Series, experts found  “per-head income explained a large fraction” of difference in mortality rates across countries (Murray, Lopez, Chin, Feehan & Hill, 2006). For example, in Latin-America, which had a lower per-head income rate at the time, excess mortality varied from 0.4% to 2.9%, whereas in the United States and Europe excess mortality rates varied between 0.5% to 1.1% (Chowell & Viboud, 2016; Murray et al., 2006). Meanwhile, within the city of Chicago, “pneumonia and influenza mortality rates were found to increase on average by 32% for every 10% increase in illiteracy rates,” suggesting “illiteracy rates and other socio-economic variables could be a proxy for the effect of poor nutritional status, weak immune condition, increased risk of secondary infection, or limited access to care on the risk of severe influenza outcomes” (Chowell & Viboud, 2016).

In terms of the current pandemic, the effects of socioeconomic status are beginning to make themselves known. The ability to stockpile goods, cease work, and maintain social distance requires access to emergency funds, which 40% of Americans lack (Vesoulis, 2020). Additionally, many American families rely on free meals and child care provided by schools that have since been shut down (Vesoulis, 2020; Human Rights Watch, 2020). For communities and countries where the poor have less, the complications only worsen. For example, one of the common pieces of advice to prevent the spread of COVID-19 is to wash one’s hands frequently. According to the WHO, “785 million people lack even a basic drinking-water service, including 144 million people who are dependent on surface water” (WHO, 2019). This number includes both people in developing countries, as well as populations in otherwise developed countries that are undergoing water crises.

The worst and long term effects of the COVID-19 pandemic are still to be seen. HBSF has responded to the crisis by functioning remotely and committing both resources and research to combat COVID-19. In the words of CEO Tanya Juarez, “HSBF is committed to the wellbeing of mankind through utilizing cutting edge technology, and innovative solutions.” Additionally, our patient advocacy group is available to help patients access needed resources, and can be reached at Lastly, if you are interested in assisting HBSF’s research regarding COVID-19, you can donate here.

Written by Senia Hardwick 


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Center for Disease Control. (2019, April 18). 1918 pandemic influenza historic timeline | pandemic influenza (Flu) | cdc. 

Chowell, G., & Viboud, C. (2016). Pandemic influenza and socioeconomic disparities: Lessons from 1918 Chicago. Proceedings of the National Academy of Sciences, 113(48), 13557–13559. 

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