US Response Timeline: COVID-19 vs H1N1

As the saying goes, actions speak louder than words. While the US government’s words on COVID-19 (aka “the coronavirus”) have been all over the place, their actions behind the scenes convey a seriousness and panic we’ve not seen in generations. This is a reflection of the ease with which new virus is transmitted as well as it’s lethality.

Before we get to the data, remember that COVID-19 is an illness caused by a corona virus called SARS-CoV-2. H1N1 is a flu virus that causes the flu. Coronaviruses have been with us forever and commonly cause illnesses ranging from the common cold to much more severe and dangerous illnesses such as 2012's MERS. The more dangerous coronaviruses can attack the respiratory tract with wicked intensity and can be transmitted just by being near someone that might even appear asymptomatic.

It’s difficult to create vaccines for coronavirus — there’s still no vaccine for the MERS coronavirus that hit nearly 10 years ago.

Influenza, or flu, is also caused by a virus. But making a flu vaccine is fairly routine and common. Much of the population receives a flu shot every year that was formulated specifically in anticipation of the upcoming flu season

The Numbers

Let’s start with a generic graph of the deaths of 2009’s H1N1 and 2020 COVID-19 outbreaks in the United States. The deaths (instead of infections) let us skip the question of whether or not testing was broadly available in a specific geographic region. When a person dies, especially in the beginning of an outbreak, there’s enormous interest in determining why they died. And thus the early numbers are usually very accurate in determining the cause of death. As the numbers get bigger, the accuracy of the counts wanes. But that’s fine for what we’re comparing here because we’re only looking at early stages. Ultimately, H1N1 went on to kill about 12,500 people in the United States over a year long period.

In the plot above it’s a bit hard to see, but there were 55 dead from COVID-19 on March 14, 2020 when this post was created, but it does convey the ramp and magnitude of the deaths in the first 6 months relative to H1N1.

Next, let’s scale the Y axis so that we’re seeing just the first 500 deaths from H1N1:

Here we can see the ramp between the two a bit more clearly. The COVID-19 started with a cluster of deaths in a senior-care center and appears to have skipped the more gentle prelude we see above in the H1N1 data.

Origins

Next, let’s take that same data and add annotations for some key milestones. We’ll start with the origins of each virus:

We can see that about 60 days before the first COVID-19 death in the US China alerted the world to the presence of COVID-19. And it didn’t take long for the first case to show up in the US: that case arrived about 39 days before the first COVID-19 death in the US (29-Feb-2009). Because testing wasn’t widely available, it’s hard to know precisely how many others there might have been at that time.

With H1N1, the first widespread outbreak appeared in Mexico about 42 days before the first death in the US (29-Apr-2009). A few weeks later, the first case appeared in the US, and a few weeks after that, the first death was recorded.

Emergency Declarations

Next, let’s take a look at the emergency declarations that were made along the way:

About 29 days before the first COVID-19 death, Trump declared a Health Emergency, and restricted travel from regions of China, effectively putting the first quarantine in place in more than 50 years. That health emergency brought $5B in funds to fight the infection in the US.

A few days before the first death from H1N1, Obama declared a Health Emergency with $1.5B to the fight the infection in the US. Later in July, a request would come for another $9B.

Just 13 days after the first death the US, Trump declared a National Emergency with a plan for $50B to fight the outbreak. At this point, just 46 people had died — mostly residents at the senior-care home. But there were markers all over the world — especially in Italy — about how ugly this could get. At this point, things had changed dramatically for the entire country. Many were working from home, lots of schools were closed, pro sports canceled their seasons and people were advised to limit their “social distance” to others.

The National Emergency declaration for H1N1 didn’t happen until 6 months after the first death, with nearly 4000 dead. During this time, it was largely business-as-usual for most in the US, with school closings generally only happening in areas of high infection. Plus, there was growing confidence that a vaccine would be coming as it was winding through trials. And that vaccine did arrive on October 5, 2009, six months after the first death.

Testing

The testing roll-out for COVID-19 has received a lot of criticism, but even with the early CDC mistakes in test preparation the testing volume for COVID-19 exceeds that of H1N1 just two weeks after the first respective death.

For H1N1, the CDC had a first test ready before the first death, and just 2 days after that first death, shipping of the test began. At the 16 day mark (30 days after first infection), more than 5,000 H1N1 tests had been administered.

For COVID-19, 13 days after the first death some 11,000 tests had been given nationally (same link as above) with many of those tests (6500) focused in areas of high prevalence such as Washington state. As of March 15, Washington state has tested 7764 cases, with 642 (8.2%) coming back positive.

In short, about two weeks after the first deaths from COVID-19 and H1N1, the COVID-19 testing is running at 2X higher than H1N1. But more telling is the scale of testing that is to come. The FDA gave emergency authorization to several commercial high-volume COVID-19 testing platforms which should permit millions of tests in the coming weeks.

Summary

Make no mistake: The government’s response to COVID-19 is unlike anything we’ve seen in decades. The travel restrictions on China and the EU haven’t been seen for generations, the government's financial investment in fighting COVID-19 is easily 10X that of H1N1, the response from private industry is unprecedented, and test capacity here today and that is being built is unmatched.

And add to this the fact that coronavirus vaccines are tough.

If actions speak louder than words, then the government’s fear of what might be coming is real. COVID-19 is nothing like H1N1 in the eyes of the US government.