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Despite major advancements in medical technology in the last 100 years, more people have now died from COVID-19 than died during the 1918 influenza pandemic.

1918’s influenza killed at least 50 million people around the world, according to the Centers for Disease Control and Prevention, a number which they say is equivalent to 200 million in today’s population. Out of that staggering figure, the CDC estimates that 675,000 of those deaths happened in the United States.

As reported by ABC News, the U.S. has officially surpassed that death count after fighting against COVID-19 for over a year. According to data collected by Johns Hopkins University, at least 675,446 Americans have been confirmed to have died as a result of the coronavirus pandemic, with thousands still dying in the States each day. While surpassing the death count from one of America’s deadliest pandemics is a grim milestone, experts suggest that a few key differences must be considered. 

“These are two different viruses, two different times in history, at two different times of medical history, with what you have available to combat or treat it,” Howard Markel, professor of the history of medicine at the University of Michigan, explained to ABC News.

Experts say it’s important to note that the number of deaths recorded during the 1918 pandemic were just estimates. Dr. Graham Mooney, assistant professor of the history of medicine at the Johns Hopkins University School of Medicine, told ABC News that the 1918 death count was likely underestimated because of underreporting, missing records, non-registration, and misdiagnosis. America’s coronavirus case fatality rate is around 1.6%, compared to the 2.5% fatality rate during the 1918 pandemic. This means that the 1918 pandemic was likely far deadlier then was reported. 

“People were desperate for treatment measures in 1918. People were desperate for a vaccine,” Christopher McKnight Nichols, associate professor of history at Oregon State University, told ABC News. “We have effective vaccines now, and so what strikes me in the comparison, if you think about this milestone, this tragedy of deaths, is that same number but we have a really effective treatment, the thing that they most wanted in 1918 and ‘19, we’ve got. And for a lot of different reasons, we botched the response.” Nichols added that the same kind of preventative measures were also put in place in 1918, which included “lockdowns, social distancing, hygiene masks, limits on gathering places.”

The one major difference between the two pandemics, according to Howard Markel, is that a disproportionate number of those who died in 1918 were between the ages of 18 to 45 years old. The coronavirus pandemic so far has most affected those who are over the age of 65, which accounts for 78.7% of deaths from COVID-19.

“I’m a little pessimistic going into winter, given the fact that there’s such a large unvaccinated population that it is a lot like 1918,” Nichols said.