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February 06, 2021

Comparing death tolls from COVID-19 to past wars is fraught with incongruences

For many, people attempting to compare such death tolls is misguided or offensive. But many media outlets do it anyway

Counting the dead is one of the first, somber steps in reckoning with an event of enormous tragic scope, be it war, a natural disaster or a pandemic.

This dark but necessary arithmetic has become all too routine during the COVID-19 outbreak.

The total U.S death toll has now surpassed 450,000.

Each death is unique, a devastating loss that ripples through a family, a network, a community. But in the aggregate, the national death toll can feel abstract, and its repetition in the news can become numbing. Journalists, commentators and public officials are left searching for new ways to convey the deadliness of this pathogen, and the significance of its mounting fatality rate.

Many have turned to history, citing Pearl Harbor (2,403 killed) or the 9/11 attacks (at least 2,977 killed) as a way of providing perspective when the number of daily COVID-19 deaths in the U.S. reached those levels. (Currently, more than 3,000 Americans are dying from COVID-19 every day.)

Jan. 21, 2021, offered another opportunity for historical comparison: That was the day when the COVID-19 death toll in the U.S. reached — and then exceeded — the 405,399 Americans who died in World War II.

For many, attempting to compare the two death tolls — or even take note of their brief conjunction — is misguided or offensive. It is certainly a morally fraught exercise. The true emotional and social impact of either event can never be quantified, but many media outlets still mentioned it.

This raises the question: Are we as a society too quick to reach for these historical comparisons? Should a politically driven world war and a biologically driven pandemic, more than seven decades apart, be put side by side at all?

"This is comparing apples to oranges," wrote NPR listener Kris Petron in December in response to a story that made use of that comparison. "It is extremely disrespectful to our nation’s veterans, who write a blank check with their lives, to defend our Constitution."

This type of response, over time, has convinced medical historian Dr. Howard Markel not to draw parallels between death tolls from war and a pandemic.

"I try not to make comparisons to an event or group that I know contains within it a great deal of sentiment, feeling and pain," said Markel, a professor at the University of Michigan and author of "When Germs Travel: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed."

The notion that combat deaths carry a unique meaning or value is deeply rooted in human culture. Societies tend to valorize those who died for a cause on a battlefield.

But in this pandemic it’s the frail elderly — many of them living in nursing homes and assisted living facilities — who have died in vast numbers.

"To the watching world, that’s not the same as the death of a young soldier in their 20s, let’s say, on the front lines in a war," said Yale historian Frank Snowden, author of “Epidemics and Society: From the Black Death to the Present.

"But, I don’t think we have a right to weigh up lives and say which is more important," Snowden added.

Unlike COVID-19, the global influenza pandemic of 1918-19 killed many people in their 20s and 30s — yet, as Snowden noted, there wasn’t much collective mourning for those young adults, despite dying in the prime of life.

"People were so used to mortality because of the [first world] war that even the horrible tallies that were coming with the ‘Spanish’ influenza had lost their capacity to horrify the way that one might expect," he said.

When we do compare death tolls, what exactly are we comparing?

The effort to compare the death toll of the pandemic with that of a war strikes historian Samuel Biagetti as an especially "modern" exercise.

"Through the vast majority of human history, people have understood warfare and disease to go hand in hand and to be inextricably linked," said Biagetti, who is the creator and host of the podcast "Historiansplaining."

The flu pandemic 100 years ago was fueled by the conditions of World War I and ultimately killed more people than the war, with an estimated 50 million flu deaths worldwide and upward of 700,000 flu deaths in the U.S.

Biagetti pointed out that World War II was the first conflict in American history in which combat killed more fighters than disease, a pattern that has continued since and reflects medical advances such as vaccines and antibiotics.

The carnage of war doesn’t end just because peace is declared. The spillover effects of war continue long after formal hostilities end, and include disability and disfigurement, mental trauma, addiction, homelessness and suicide.

One example is the ongoing suicide crisis among U.S. veterans. From 2005 to 2017, 78,875 veterans died by suicide — more than the number of soldiers killed in Vietnam, 58,220.

For all these reasons, Biagetti said he worries about comparing the current pandemic to any war, even if just for the purpose of counting the dead: “You can’t just try to sum up in a simple statistic how big is this disaster versus that disaster, as if they can even be summed up in a simple number at all.”

And yet the language of warfare permeates so much of the national discourse about the pandemic.

Nurses work on the "front lines." Coronavirus is described as an invisible "enemy." The country is "battling" the virus. In his inaugural address, President Joe Biden said the pandemic has "taken as many lives in one year as America lost in all of World War II."

'War' metaphor is a call to action, a recognition of sacrifice

Some Americans whose relatives have died of COVID-19 embrace the rhetoric of war and believe comparing the pandemic to past wars is imperative.

"The scale of this is that of a war, it’s just a different type of war and it’s not one that we’re necessarily taught in our history books," said Kristen Urquiza, who co-founded the advocacy group Marked By COVID after her father died from the disease over the summer.

Urquiza said the country struggled collectively to respond to the coronavirus because Americans have little understanding about what it takes to overcome a pandemic.

"In a way, it’s sort of more dangerous [than war] because we are culturally unprepared for it."

There are also veterans who feel the war analogies are appropriate, and even helpful. Dr. Cleavon Gilman, an emergency physician in Yuma, Arizona, has treated COVID-19 patients from the early days of the outbreak and readily compares the pandemic to a war.

"It’s very hard to communicate the severity of this pandemic if you’re not in a hospital, where this war is being waged," said Gilman, who served as a Marine combat medic in Iraq in 2004.

World War II was the deadliest war in world history, but not in American history: That distinction belongs to the Civil War. The death toll has traditionally been estimated to be about 618,000, but new research indicates 750,000 may be more accurate.

But World War II looms large in America’s cultural memory as a "good war," one that united the country against a clear-cut enemy, said Catherine Mas, a professor at Florida International University who studies the history of medicine, race and religion.

In retrospect, the American response to World War II stands in sharp contrast to the current political divisions over the coronavirus, and the fragmented and uneven national response.

Despite the differences, Mas said the comparisons can still be powerful tools as the country tries to reckon with a crisis that has taken place out of sight for many Americans. People are dying in hospitals without family members at the bedside, and only health care workers are there to bear witness.

"The reason we want to compare COVID-19 deaths to something like World War II is not just because the numbers are there, but to acknowledge this is a significant rupture in society," she said.

"This mass death is going to create trauma: How are we going to deal with that? How have we dealt with that in the past? I think it’s part of our human condition to try to search for some reference points."

This story was produced in partnership with NPR and KHN.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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