Most of the pandemics in the 20th and 21st centuries, have either been caused by an influenza virus or a coronavirus. The 2003 SARS coronavirus pandemic – had a much smaller impact than this current coronavirus pandemic, and killed fewer than 1,000 people.

In terms of the number of deaths COVID-19 has caused (349,095 as of 27 May 2020), it is actually more comparable with previous flu pandemics. The Asian flu in 1957-1958 killed an estimated 1.1 million people, close to the 1 million people thought to have been killed by the Hong Kong flu pandemic of 1968-1970.

In contrast, the 2009-2010 swine flu pandemic – also H1N1 like Spanish flu – seemed to be relatively mild as it didn’t require most infected people to be hospitalised. By the end of the pandemic in 2010, the World Health Organization (WHO) reported around 18,500 confirmed deaths, although with many deaths going unreported the figure was believed to be considerably higher. The US Centers for Disease Control and Prevention (CDC) estimated that it had probably killed 151,700-575,400 people. And in 2013 through statistical modelling of mortality data from multiple countries, researchers sharpened the estimate. They calculated that from 1 April to 31 December 2009, the virus had killed between 123,000 and 203,000 people globally.

Like COVID-19, Asian flu killed mostly people older than 65. Spanish flu was different in that it hit young and healthy people particularly hard - half of everyone who died were aged between 20 and 40 years, and 99% were younger than 65 years. Similarly, 87% of deaths in the 2009 swine flu pandemic were in those younger than 65 years.

How pandemics affect the economy

Responding to a pandemic has a direct impact on the economy – the stricter the public health measures that disrupt economic activity, the bigger the blow to the economy. The economic impact from the COVID-19 pandemic has been particularly brutal.

Apart from the devastating loss of life, the sheer disruption to normal life means that pandemics have long been predicted to damage the economy. Yet each successive pandemic seems to affect the economy more. Largely, responses to previous pandemics relied on hygiene and sanitation measures such as handwashing, but not on lockdowns, physical distancing or other measures that disrupt economies.

Although the Spanish flu pandemic was followed by a recession, that was also largely caused by the first World War. During the 1918 pandemic, the USA and European countries did close schools and churches, and suspend public gatherings. Doctors also encouraged social distancing. But such measures were implemented late. Given the fact that the pandemic coincided with a world war, travel restrictions would have been impossible to implement. Moreover, many people weren’t initially aware that there was a pandemic because of wartime censorship.

In the subsequent Asian flu and Hong Kong pandemics, there were short economic downturns that recovered fairly quickly. During the Asian flu, some schools were closed and public gatherings banned but these measures were carried out simultaneously across the world as has broadly been done to stop the spread of the new coronavirus. During the Hong Kong flu meanwhile, schools didn’t close and factories remained open.

In the 21st century, stricter control measures were starting to be implemented, which would greatly affect the economy. The 2002 SARS pandemic is thought to have cut the global GDP by US$ 33 billion despite being a disease that killed fewer than 1,000 people – a major reason for this was the blow to tourism to countries like Singapore and Canada. By 2002 the global economy had become reliant on international connectivity and 1.6 billion people were travelling the globe by air in 2002 compared with just 310 million in 1970.

No pandemic is likely to have had such a brutal impact on the economy as COVID-19, which has triggered a near-total shut down of social and economic activity. The International Monetary Fund (IMF) predicts that the global economy will shrink by 3% this year.

Inequity puts the vulnerable at greater risk

A notable point from the WHO’s review of the response to the swine flu pandemic is that as it “caused illness that did not require hospitalization in the vast majority of cases” and “spread to several countries within days, the possibility of rapid containment, a tenet of planning in WHO’s multi-stage response, was never really feasible”.

This attitude is in marked contrast to the unprecedented lockdowns and economic shutdown we have seen across the globe to contain COVID-19.

A criticism of the lockdown approach to stopping the spread of the new coronavirus is that it exacerbates privilege and wealth. People living on hourly or daily wages for jobs, especially manual labour, that can’t be done online and remotely suffer an immediate drop in their income, and the most vulnerable won’t have savings to fall back on. In low- and middle-income countries, the lockdown has shown clearly the number of people without secure housing, water and sanitation, and reliable employment. Billions in Africa, Asia and Latin America are without any possibility of locking out the coronavirus, and are now facing devastating economic and health consequences.

It is notable that a committee that advised WHO last year on non-pharmaceutical approaches to tackle a pandemic did not suggest lockdown as a method of controlling the spread of disease. This is because of the enormous social and economic consequences that would hit the most vulnerable communities the hardest.

About half of all jobs in Africa could be wiped out as a result of the current pandemic, and routine immunisation disrupted, as well access to treatment for malaria, HIV, and tuberculosis and family planning. The number of people who are acutely hungry is set to double. This means that aside from the immediate effects of potential COVID-19 infection, the resulting shockwaves from the lockdowns could reverberate for many years to come, especially for the most marginalised communities.

How will COVID-19 evolve?

Although it is far from certain how long we will live with COVID-19, it is possible that we will live with a seasonal version of the virus for many years to come.

The H1N1 flu virus that caused a pandemic a century ago and swine flu in 2009 continues to circulate as a seasonal virus causing infections and deaths every year, as does the H3N2 Hong Kong flu virus.

The current COVID-19 pandemic seems unlikely to be over any time soon, with various scenarios for the future estimating either several overlapping outbreaks or another ferocious wave later in 2020.

What should sound a note of caution for the world is that the second wave of H3N2 was also much more fierce than the first one, potentially because it mutated to become more deadly.

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