Not the great equalizers: Covid-19, 1918–20 influenza, and the need for a paradigm shift in pandemic preparedness

Figures & data

Table 1 Global disease outcomes during seasonal influenza, 1918 influenza, and Covid-19 (Covid-19 data up to 14 June 2021)

Outcomes	Seasonal influenza	1918 influenza	Covid-19
Percentage infected	5–10	30–60	2–20+
Deaths	290,000–650,000	50–100 million	3.8 million
Deaths of infected (percentage)	>0.1	>2.0	0.1–2.0
Deaths of population (percentage)	0.004–0.008	2.5–5.0	0.05

Source: Johnson and Mueller 2002; Mamelund et al. 2016; Iuliano et al. 2017; Levin et al. 2020; Meyerowitz-Katz and Merone 2020; Euromomo 2021; Worldometer 2021.

Table 2 Summary of medical and social risk factors during seasonal influenza, 1918 influenza, and Covid-19

Risk factors	Seasonal influenza	1918–20 pandemic	Covid-19
Age	65+	20–40 years	65+
Chronic diseases	Yes	Yes	Yes
Pregnancy	Yes	Yes	?
Low SES	Yes	Yes	Yes
Indigenous status	Yes	Yes	Yes
Black race	Yes	No	Yes

Source: Mamelund 2003, 2004, 2006, 2011; Chandra et al. 2018; Mamelund and Dimka 2019; Økland and Mamelund 2019; Arrazola et al. 2020; Batty et al. 2020; Dimka and Mamelund 2020; Drefahl et al. 2020; Hatcher et al. 2020; Steyn et al. 2020; Williamson et al. 2020; Wastnedge et al. 2021.

Figure 1 Framework for risk factors leading to unequal pandemic outcomes

Note: The circled numbers indicate pathways 1–3.

Source: Adapted from Crouse and Supriya (2014).

Figure 2 Approach and focus according to current paradigm of pandemic preparedness plans and thinking

Source: Authors’ own.

Figure 3 Approach and focus after a paradigm shift in pandemic preparedness plans and thinking

Source: As for Figure 2.

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