Historical Comparison Between the Death Rate for Spanish Flu and Coronavirus Disease 2019 in Italy

The Spanish flu affected a total Italian population of 36.280 million people and caused 390 000 deaths (crude death rate: 10.7 × 1000 inhabitants), while COVID-19 affected an Italian population of 59.236 million people and caused 77 165 deaths during the first year (crude death rate: 1.3 × 1000 inhabitants). Thus, the risk of dying from Spanish flu was >8 times higher than the risk of dying from COVID-19 before the nationwide rollout of COVID-19 vaccination began (odds ratio, 8.33 [95% confidence interval, 8.27–8.40]; P < .001). A disproportionate evidence was found after dividing mortality during Spanish flu and COVID-19 into three age groups, namely 1621 vs. 2 ×100 000 in the 0–49 years age group, 461 vs. 50 ×100 000 in the 50–69 years age group, and was instead similar (573 vs. 525 ×100 000) in the 70 years or older age group. Overall, our analysis confirms that the Spanish flu pandemic was certainly more deadly than the pandemic caused by severe acute respiratory syndrome coronavirus 2.