How Many People Died Of The 1918 Spanish Flu in Kenya?

This is the abstract and excerpts from Andayi, Chaves, and Widdowson, a paper focusing on the impact of the Spanish flu on coastal Kenya:

The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half a billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been poorly documented in many countries especially those in Africa. We used colonial-era records to describe the impact of 1918 influenza pandemic in the Coast Province of Kenya. We gathered quantitative data on facility use and all-cause mortality from 1912 to 1925, and pandemic-specific data from active reporting from September 1918 to March 1919. We also extracted quotes from correspondence to complement the quantitative data and describe the societal impact of the pandemic. We found that crude mortality rates and healthcare utilization increased six- and three-fold, respectively, in 1918, and estimated a pandemic mortality rate of 25.3 deaths/1000 people/year (emphasis added). Impact to society and the health care system was dramatic as evidenced by correspondence. In conclusion, the 1918 pandemic profoundly affected Coastal Kenya. Preparation for the next pandemic requires continued improvement in surveillance, education about influenza vaccines, and efforts to prevent, detect and respond to novel influenza outbreaks.

We noted, that in 1918, the crude death rates and healthcare utilization drastically increased, six- and three-fold, respectively and stayed relatively high until at least 1925. The sharp increase in health care utilization was certainly due to the pandemic and is corroborated by the anecdotal reporting of overwhelmed health systems. The very large majority of these cases would have been in the native population, though we had no data on race. The higher rates of mortality and facility visits after 1918 compared to before 1918 were likely due to improved reporting health facility expansion rather than prolonged pandemic transmission. Equally, it is plausible that several documented outbreaks such as the plague (1920) and smallpox (1925), also contributed to high reported mortality and morbidity in those late years studied. We estimate pandemic mortality from September 1918 to March 1919 to be approximately 25 deaths/1000 population and morbidity at 176/1000 population or an attack rate of 17.6% (emphasis added).

Read the whole (ungated) paper here.

Writing over at The Conversation, Andayi notes that overall the flu might have killed as many as 150,000 people in the Kenya Colony, or 4-6% of the population at the time. The Spanish flu (which actually probably originated in New York) could have killed anywhere between 1-5% of the global population.

The Spanish flu is believed to have come to Kenya with returning veterans who docked in the Mombasa port. The country was still a British colony at the time. In nine months the epidemic killed about 150,000 people, between 4% and 6% of the population at the time.

COVID-19 is nowhere near these mortality rates. The estimates I have seen (which for some reason are for “Africa” and not individual countries) suggest that between 300k and 1.3m people might die of COVID-19 on the Continent (see image with UNECA estimates). Proportionately, that would mean roughly between 12k – 51k Kenyans, or .03-.01% of the population (still absolutely catastrophic figures).

uneca

If you know of any country-level estimates please share in the comments.

 

The world’s largest measles outbreak has killed over 4000 people in the DRC

This is astonishing news:

The world’s largest measles outbreak has killed more than 4,000 people in the Democratic Republic of the Congo this year, according to UNICEF.

The agency found that 203,179 measles cases have been reported throughout the country’s 26 provinces since January, according to UNICEF, including 4,096 deaths. Seventy-four percent of infections and nearly 90 percent of deaths have been children under the age of five.

According to the WHO:

  • Even though a safe and cost-effective vaccine is available, in 2017, there were 110 000 measles deaths globally, mostly among children under the age of five.
  • Measles vaccination resulted in a 80% drop in measles deaths between 2000 and 2017 worldwide.
  • In 2017, about 85% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
  • During 2000-2017, measles vaccination prevented an estimated 21.1 million deaths making measles vaccine one of the best buys in public health.

The measles outbreak in the DRC is attributable to low immunization rates due to the country’s weak public health infrastructure. According to the UNICEF:

measles.png“We’re facing this alarming situation because millions of Congolese children miss out on routine immunization and lack access to health care when they fall sick,” said Beigbeder. “On top of that, a weak health system, insecurity, community mistrust of vaccines and vaccinators and logistical challenges all contribute to a huge number of unvaccinated children at risk of contracting the disease.”

Two doses of the measles vaccine are recommended and roughly 95 per cent of the population needs to be vaccinated to ensure immunity and prevent outbreaks, according to the World Health Organization.  In DRC, measles immunization coverage was only 57 per cent in 2018.

Emergencies like these are reminders of the unfinished business of state-building in most of the Continent, and not just post-conflict states the DRC.

Mosquitoes May Have Killed up to 54 Billion Humans Over 200 Millennia

How about this for perspective:

Mosquitoes are our apex predator, the deadliest hunter of human beings on the planet. A swarming army of 100 trillion or more mosquitoes patrol nearly every inch of the globe, killing about 700,000 people annually. Researchers suggest that mosquitoes may have killed nearly half of the 108 billion humans who have ever lived across our 200,000-year or more existence.

mosquitoThe author of the piece is Timothy C. Winegard, author of the forthcoming book The Mosquito: A Human History of Our Deadliest Predator.

Each year, about 400,000 people die of malaria alone, with another 300,000 dying from other mosquito-borne diseases.

It is worth noting that the failure to eliminate malaria globally is primarily a function of state weakness.

Is malaria responsible for underdevelopment in Africa?

According to a paper by Depetris-Chauvin and Weil, the answer is no.

Here is the abstract:

We examine the effect of malaria on economic development in Africa over the very long run. Using data on the prevalence of the mutation that causes sickle cell disease, we measure the impact of malaria on mortality in Africa prior to the period in which formal data were collected. Our estimate is that in the more afflicted regions, malaria lowered the probability of surviving to adulthood by about ten percentage points, which is twice the current burden of the disease. The reduction in malaria mortality has been roughly equal to the reduction in other causes of mortality. We then ask whether the estimated burden of malaria had an effect on economic development in the period before European contact. Using data at the ethnic group level, we find little evidence of a negative relationship between malaria burden and population density or other measures of development.\

And here’s a summary of the main finding:

With estimates of the extent of malaria mortality in hand, we then turn to look at the impact of the disease on economic development. We present regressions of a number of measures of development within Africa on a malaria burden measure that we create based on sickle cell prevalence. Of particular note, we apply our analysis to a data set measured at the level of ethnic groups as an alternative to more common country-level analyses. We present simple OLS results, as well as results in which we instrument for malaria burden, using an index of climactic suitability for malaria transmission. The result of this statistical exercise is that we find no evidence of malaria burden negatively affecting historical economic development.

Read the whole paper here.

And here, here, and here are related posts on mosquitoes and malaria.

Which diseases are likely to elicit the highest levels of media hype?

This is from the Visual Capitalist:

The death count for Ebola did eventually hit 11,310 globally, and Swine Flu resulted in 18,500 lab-confirmed deaths (and potentially many more). However, most of these outbreaks were relatively harmless in relative terms. The Zika Virus, for example, resulted in only a handful of deaths.

The figures below show the relative intensity of media coverage of specific disease outbreaks versus the actual number of deaths:

Screen Shot 2018-07-06 at 1.07.06 AM

Screen Shot 2018-07-06 at 1.07.18 AM

H/T Luis F.

Naming Diseases After One’s Enemies

This is an interesting graphic showing the initial names giving to syphilis in various jurisdictions.
Screen Shot 2017-03-08 at 1.57.28 PM.png

The WHO recently came out against naming diseases after people, foods, animals, occupations, or places. However, this decision has raised some new concerns. According to Science:

Many scientists agree that disease names can be problematic, but they aren’t sure the new rulebook is necessarily an improvement. “It will certainly lead to boring names and a lot of confusion,” predicts Linfa Wang, an expert on emerging infectious diseases at the Australian Animal Health Laboratory in Geelong. “You should not take political correctness so far that in the end no one is able to distinguish these diseases,” says Christian Drosten, a virologist at the University of Bonn, Germany.

Naming diseases has long been a fraught process. Badly chosen names can stigmatize people, as did gay-related immune deficiency, an early name for AIDS. They can also lead to confusion and hurt tourism and trade. The so-called swine flu, for instance, is not transmitted by pigs, but some countries still banned pork imports or slaughtered pigs after a 2009 outbreak. More recently, some Arab countries were unhappy that a new disease caused by a coronavirus was dubbed Middle East respiratory syndrome.

 

How to Eliminate Malaria

Sri Lanka is the latest country to be declared malaria free by the WHO.

How did they do it?

According to the New York Times:

In 2000, outside the rebel-controlled areas in the northeast, malaria cases began dropping as the government, with donor help, deployed a mix of indoor spraying, bed nets, rapid diagnostic kits and medicines that combined artemisinin, an effective treatment, with other drugs.

The government also screened blood samples drawn — for any reason — in public clinics and hospitals for malaria infection, and officials established a nationwide electronic case-reporting system.malariaeradication

In war-torn areas, the disease retreated more slowly, although the Tigers often cooperated with malaria-control teams because their villages and fighters also suffered.

Nonetheless, in a population of 20 million, it took years to get rid of the last few hundred annual cases. Most were soldiers and itinerant laborers, often from India, who worked in remote slash-and-burn farming areas and in logging and gem-mining camps.

Someone tell African policymakers that bed nets and behavior change are not enough.

Every other region of the world appears to be willing and able to combine vector (mosquito) control with other strategies of containing malaria with success (and enthusiastic donor support). But for some reason mosquito control is still lagging in Africa, even in otherwise strong and stable states. In some instances this has been due to environmental concerns while in others it has been due to the misplaced priorities of public health officials, donors, development agencies, and academic researchers.

The result:

About 3.2 billion people – nearly half of the world’s population – are at risk of malaria. In 2015, there were roughly 214 million malaria cases and an estimated 438 000 malaria deaths. Increased prevention and control measures have led to a 60% reduction in malaria mortality rates globally since 2000. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of malaria deaths. 

214 million malaria cases amount to lots and lots of lost productivity. Also, losing one Miami every year in deaths is simply unacceptable.

More on this here.