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History & Risk
By Vaclav Smil

Author Vaclav SmilJapan SPOTLIGHT Introduction

On risk assessment, it is important to compare current risks with similar risks in the past. We need tocompare Covid-19 with previous pandemics, in particular with the one in 1918-1919 called the “Spanishflu”. People concerned about the future path of today’s pandemic may try to see it in parallel with the pathof Spanish flu. History can be a useful source of information for assessing the future, but we cannot becertain it will provide us with sufficient data and lessons. To be well prepared for future pandemics, we willneed to achieve a thorough assessment of Covid-19 which we are now fighting against so that future
generations can take full advantage of it and be prepared for risk mitigation.
Prof. Vaclav Smil has been involved in interdisciplinary research in the fields of energy, environmentaland population change, food production and nutrition, technical innovation, risk assessment and publicpolicy. In his research he employs a long-term perspective on human civilization. In 2010, he was namedby Foreign Policy as one of the top 100 global thinkers.
He kindly accepted our request to republish a recent article he wrote about the risks of pandemics froma historical perspective in Japan SPOTLIGHT.
Too many people are occupied in modeling the duration and impact
of COVID-19. I have no intention of adding to this runaway genre. It is
now the first week of April 2020 – too early to make any solid
judgments even as far as the first pandemic wave is concerned. It may
be dying down in China and sputtering in South Korea, but it is raging
in Italy, Spain, and France, and it has only entered its early exponential
phase in the United States. Once the first wave recedes, we will still not
be sure when the next wave might arrive. That is why I will provide only
some important historical perspectives and comparative risk
assessments, and list a few lessons that are already absolutely clear.

Looking Back
For several reasons, the 1918–1919 flu pandemic is not the best
point of reference. That we still do not know where it began would beirrelevant if we were certain about its global impact and if we could
calculate reliable mortality rates for the most affected countries. We cando neither. The most commonly cited estimate of total global mortality
is between 20 and 40 million. The World Health Organization put it“upwards of 40 million people” and Niall Johnson and Juergen Mueller
go as high as 50 million. Even the lower estimate surpasses all militaryand civilian deaths of World War I, while the total of 50 million would bealmost certainly higher than the toll of the 1347–1351 plague and about
equal to another uncertain aggregate, that of all those who perished inthe USSR between 1929 and 1953, and in Maoist China between 1949
and 1976.
We will never know how many people were infected, but with 20–40
million deaths within a global population of 1.8 billion, the 1918–1919
pandemic had an average mortality rate of 11 to 22 per 1,000. Nationalmortalities are not highly accurate, but the most likely US count is
550,000. That number is higher than all the deaths sustained by the
https://www.jef.or.jp/journal/country’s servicemen in all of the twentieth century’s wars, and equal toa pandemic-specific mortality rate of 5.3 per 1,000. Both the North
American and European data clearly show three successive waves. The
British mortality had its smallest peak at just 5 per 1,000 in July 1918,
the highest peak at five times that rate in October 1918, and anintermediate wave slightly above 10 per 1,000 during late February
1919. Good epidemiological data are available for several large cities,including New York, Toronto, and Montreal. Between February 1918
and April 1920, New York experienced four waves, together with a heatwave, with peak mortalities shifting from teenagers during the firstwave to young adults, with excess mortalities peaking at 28 years ofage. Exactly the same age peak was found in Toronto and Montreal in
October 1918. Alain Gagnon et al. have argued that this heightenedmortality could be explained by an early exposure to the Russian flu
pandemic of 1889–1890. The development of early immunologicalmemory may adversely affect the immune response to new strainsencountered later in life, and thus increase risk of death.
We know the complete genome and virulence of the influenza virus
responsible for the 1918–1919 pandemic; but we also know that most
1918–1919 pandemic deaths were due to bacterial pneumonia. Some
80% of cultures taken from preserved lung-tissue samples contained
bacteria causing secondary lung infection. A generation before thedevelopment of antibiotics, no treatment was available. Andrew Noymerand Michel Garenne discovered that individuals with tuberculosis weremore likely than others to die of influenza; this helps to explain thepandemic’s unusual middle-age mortality profile as well as its higher
incidence among men, which matches the differential incidence oftuberculosis between the sexes.
Excess mortality in 1918–1919 appears less extreme if some deaths
were, in effect, borrowed against future deaths due to tuberculosis.
Because neither pre-existing tuberculosis nor bacterial pneumonia haveJapan SPOTLIGHT • November / December 202055

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been important factors in post-WWII pandemics, the Spanish flu is
worth studying for its sequence of waves and their growth patterns; but
its overall and age-specific mortality were clearly unique.

Comparing Risks
Pandemics are feared because of their relatively high mortalities, but
it is impossible to pinpoint those rates while the infection is spreading,and it is difficult to do so even after it ends. The preferred
epidemiological approach is to calculate the case-fatality risk, the ratioof deaths to cases. The numerator is not as clear as one might wish
because comorbidities are often neglected even when they are noted ondeath certificates. Still, it is the choice of the denominator that canmake a difference in risk assessment as large as two orders ofmagnitude.
Studies of the 2009 influenza A(H1N1) pdm09 pandemic used threedifferent case definitions: laboratory-confirmed cases, estimatedsymptomatic cases, and estimated infections (based on serology or on
assumptions regarding the extent of asymptomatic infections). As
expected, laboratory-confirmed approaches yielded the highest risk ofdeath – mostly between 100 and 5,000 per 100,000; symptomaticapproaches were in the range of 5 to 50 per 100,000; and approaches
based on estimated infections yielded risks of just 1 to 10 per 100,000.
The first approach showed fatalities up to 500 times higher than thelast.
These considerations are pertinent as the COVID-19 pandemic
unfolds. The number of tested cases is reported daily, but we can only
estimate how many asymptomatic people have been or will be infected,and once the infection wave spends itself the best we can do is toestimate that total by relying on post-pandemic population serologicalstudies. The most prominent example illustrates the uncertainty. By
April 3, 2020, official Chinese statistics listed 50,007 cases of COVID19 in Wuhan, the pandemic’s epicenter, and 2,553 deaths, implying acase-fatality rate of about 5.1%. But the denominator included onlytested or tested and symptomatic cases. Wuhan has a population of
11.1 million: 50,000 cases would mean a 0.5% infection rate, and thisis impossibly low. Until we can make, at least, a good estimate of actual
infections, we might compare risks by relying on the demographic
approach to mortality: deaths from specific causes per 1,000 people.
Assuming that the worst of Wuhan’s 2020 COVID-19 is over, the deathsof 2,553 people would imply a pandemic-specific mortality rate of 0.23
per 1,000.
According to the Centers for Disease Control, influenza in the UnitedStates will affect 38–54 million people in 2019–2020, with 24,000 to62,000 deaths. Assuming mean fatalities of 43,000, the influenzaspecific mortality rate would be 0.13 per 1,000, compared to 0.23 per
1,000 for Wuhan COVID-19. Wuhan’s COVID-19 mortality rate is thus
almost twice as high as the 2019–2020 seasonal flu mortality rate inthe US. Obviously, this comparison holds only if the Chinese data arereasonably accurate.

Clear Lessons
Perhaps the most obvious consequence of the latest pandemic is toexpose the delusionary nature of recent claims concerning the humanmastery of life. The entire lineup of near-miraculous advances has been
56 Japan SPOTLIGHT • November / December 2020

exposed as irrelevant, and the notion of Homo deus boldly charting thedestiny of a godlike species has imploded. What benefits have wederived from the Singularity? How useful are those endlessly touted,
all-encompassing powers of artificial intelligence? Have our abilities toengineer organisms at will or rapidly produce objects by 3D printing
contributed to preventing, moderating, or managing the COVID-19
pandemic? Where are the powers and decisive contributions of theentire high-tech, Silicon Valley world? What difference do thesetechnologies make for doctors in New York City or Milan when theyneed ordinary rubber gloves, and when 92% of their global supply
comes from Malaysia, Thailand, and China? The only solid promise is
the development of a vaccine. Having it within 18 months would behistoric, but, by then, the pandemic may well have spent itself. The best
we can do is to imitate the residents of Italian medieval towns: stayaway from others, stay inside for 40 days, quaranta giorni.
The COVID-19 pandemic has also exposed an astonishing degree ofstrategic incompetence in the US, and in other countries, as well. Since
the attacks of 9/11 in 2001, which killed 2,977 people, the US has spent
trillions of dollars domestically and abroad to prevent another attack.
But despite the certainty of another pandemic in the near future, the US
remains astonishingly unprepared to manage similar circumstances inan effective and resolute way.
The shortage of gloves, masks, shields, and gowns has been
shocking, outrageous, and predictable because the US chose tooutsource its manufacturing to Asia in general and to China inparticular. While taking this strategically self-defeating step, it also failed
to amass sufficient domestic stocks of needed equipment. The UnitedStates Conference of Mayors concluded that more than 90% ofAmerican cities did not have enough face masks for their first
responders and medical personnel. This mindless, profit-driven
outsourcing goes far beyond simple manufactured products: it includesbasic chemicals, pharmaceutical ingredients, and commonly prescribeddrugs. How are such strategic blunders possible? More than $700
billion a year is spent casually on the military, an utterly uselessinstitution in fighting a pandemic, while domestic manufacturing
capabilities for indispensable healthcare items remain utterly neglected.
Previous financial, military, or public health blunders have gone
unpunished. There is no reason to suppose, with respect to the COVID19 pandemic, that anyone will be held responsible. A reversion toengrained habits is likely. The world did not take any resolute steps after
the pandemics of 1958–1959, 1968, and 2009. Why should we assume
it will be different this time? Governments will not make adequate
provisions for the next pandemic; companies will keep putting profits
above security; people will resume their mindless, endless flying andcruising; and, in places where such foods are sought-after delicacies,
buyers will continue to eat any imaginable kind of wild animals thus
ensuring that sooner, rather than later, one of the animal viruses will
jump again to people and start a new pandemic. Some Homo deus!
This article is reproduced as originally published in Inference
International Review of Science, April 3, 2020.
Copyright © Inference 2020, Inference: International Review ofScience (“Inference”)
Vaclav Smil is Distinguished Professor Emeritus at the University ofManitoba.