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Dr Dobbs looks at Tate Reeves
Mississippi State Health Officer Dr. Thomas Dobbs, listens to Mississippi Gov. Tate Reeves respond to a question about the distribution of COVID-19 vaccine during his briefing for reporters in Jackson, Miss., Monday, Jan. 4, 2021. Mississippi State Health Health department data shows Mississippi's 2020 excess death toll surpassed the excess death toll in 1918, when the Great Influenza killed thousands. AP Photo/Rogelio V. Solis

In Mississippi, COVID-19 Exceeds Great Influenza’s 1918 Death Toll

As the influenza pandemic spread across Mississippi in early October 1918, the state’s top physician, State Board of Health Executive Officer Dr. W.S. Leathers, began issuing sweeping orders to local health officials statewide that shuttered schools, churches, theaters and cancelled public gatherings to slow the pathogen’s advance.

Later known as “The Great Influenza,” the 1918 virus remains the deadliest pandemic in modern history, killing between 20 and 50 million people worldwide, including 6,219 Magnolia State residents by the year’s end.

Since Monday, Feb. 1, the Mississippi State Department of Health has reported 167 more COVID-19 deaths, bringing the toll since the pandemic first arrived last March to 6,222 by Friday, Feb. 5, meaning Mississippi’s confirmed COVID-19 death toll has officially surpassed the Great Influenza’s 1918 death toll. But a Mississippi Free Press examination of public-health data suggests that already happened weeks ago. 

In a September 2020 press conference, Mississippi State Health Officer Dr. Thomas Dobbs, the top public health official, said MSDH is “almost certainly undercounting” deaths due to “conservative” counting procedures—possibly by the thousands.

The state health officer noted at the time that the number of “excess deaths” for the year was significantly higher than the official COVID-19 death toll. “Excess deaths” measures how many more people have died from all causes in a year compared to the average number of yearly deaths for the prior three years.

“People are dying, there’s just no doubt about it,” Dobbs said on Sept. 10, responding to baseless conspiracy theories some local officials in the state had promoted that claimed MSDH was inflating the death toll.

More Excess Deaths in 2020 Than 1918

By Jan. 1, the Mississippi State Department of Health had confirmed 4,816 COVID-19 deaths for all of 2020. But on Jan. 29, MSDH reported that 39,840 Mississippians died from all causes last year—well above the average of 32,526 yearly deaths from 2017 to 2019 and Mississippi’s highest one-year death since the state began keeping public health records.

The figure means Mississippi’s excess deaths for 2020 reached a record 7,314. In 1918, the state reported just two fewer excess deaths, with 7,312. That year, 30,437 Mississippians died from all causes, compared to an average of 23,125 deaths from 1915-1917.

Last year’s excess death figure also suggests that the novel coronavirus virus’ real toll for 2020 may have been as much as 2,500 deaths higher than what MSDH had officially reported by Jan. 1. In multiple daily updates since, the department has added previously uncounted COVID-19-related deaths that happened in December, including four in today’s update.

MSDH’s current death counts for 2020 are provisional and could still rise higher.

Even as Mississippi officially neared the grim milestone the 1918 pandemic set 102 years ago, though, state leaders highlighted progress in combating the current pandemic during a press conference yesterday, noting that 40% of all Mississippians over 75 and 33% of all Mississippians over 65 have received the COVID-19 vaccine so far, though racial disparities and other issues persist.

Medical scientists had not yet developed an influenza vaccine by 1918, but reporting from the era shows that local and state leaders and health officials dealt with many of the same issues—sometimes differently.

During that pandemic, public-health officials took a more proactive role with their public-health orders, including by closing churches, schools and certain businesses. The current state health officer, Dr. Dobbs, has mostly avoided making unilateral public-health orders during the COVID-19 pandemic, often acting as an adviser to the governor, who has at times listened to the doctor’s recommendations while ignoring them at other times. 

Even during disagreements, Dobbs has often deferred to Gov. Reeves, acknowledging that a governor has political considerations to balance that a public-health official does not.

‘God is Bigger Than Government’

Unlike Mississippi officials in 1918, state leaders have not ordered or supported local efforts to close churches—not even at times when the virus was surging throughout the state or in counties.

“God is bigger than government. The right to freely practice your faith must never be infringed,” Gov. Reeves wrote in a Facebook post, stating his opposition to forced church closures even as COVID-19 was soaring to new heights in Mississippi.

Last April, Greenville Mayor Errick Simmons ordered churches in his Delta town to stop holding in-person worship services, a move a number of local Washington County faith leaders told the Mississippi Free Press they supported.

Influenza epidemic in United States. St. Louis, Missouri, Red Cross Motor Corps on duty, October 1918. (National Archives)

Gov. Reeves criticized the order, saying it risked causing “Mississippians (to) revolt.” 

“Don’t trample the Constitution,” the governor wrote in an April 2020 Facebook post, saying that Greenville violated his own executive orders that he claimed made “churches safe from these outrageous actions.” 

But those orders did not make churches safe from COVID-19. Since last spring, the state health officer has repeatedly highlighted the high rates of transmission and outbreaks in churches, where large numbers of people gather indoors and sing—an environment conducive to superspreader events. Throughout 2020, a number of church leaders died as the virus spread throughout their sanctuaries.

Racial Disparities Worse in 1918

During the pandemic 102 years ago, public-health officials in the same area were, at times, more likely to close some churches than others. 

“Influenza has almost abated in Noxubee county among white people,” a public health notice in The Macon Beacon reported on Nov. 8, 1918, noting that cases and deaths still remained high among Black residents. “Due to the above fact, the colored schools and churches must remain closed until further notice.”

Some newspapers at the time mocked the racial disparities surrounding the influenza pandemic. On Oct. 15, 1918, the Natchez Democrat printed a joke under the headline, “Ancient Negro Flees in Fear From Influenza Masks,” telling the story of an old Black man whose “memory extended back to the Reconstruction Days” mistaking workers in white masks at a long-distance call center for members of the Ku Klux Klan.

Even as thousands of Mississippians died amid the 1918 influenza pandemic, most of them Black, the Natchez Democrat ran this racist joke about an elderly Black man mistaking telephone operators in white masks for members of the Ku Klux Klan. Image courtesy

Statewide, the 1918 pandemic proved more deadly for Black Mississippians than white ones; the flu killed 4,234 Black Mississippians that year along with 1,985 white residents. Overall, the death rate for Black Mississippians climbed 1,657% from 1917 to 1918; for white Mississippians, it climbed 888%.

The 2020 pandemic began at a similar pace, with Black Mississippians making up about 70% of cases and deaths early last spring, despite only accounting for a little under 40% of the population. By summer, though, those trends began to reverse, and Black Mississippians now account for 32.1% of all COVID-19 cases and 39.5% of all COVID-19 deaths since the virus’ arrival, while white Mississippians make up the vast majority of new cases and deaths.

In an Oct. 16 Zoom press conference, Dr. Dobbs told the Mississippi Free Press that he attributed the reversal to Black Mississippians’ higher rates of compliance with social distancing and masking guidelines.

“As far as case trends, we have had pretty good uptake by a lot of folks in the Black community with masking and social distancing,” Dobbs said at the time. “We’ve worked to make sure the Black community understands where the risks are. Big parts of the white community, especially in areas that are not heavily affected, have not been as compliant and engaged in masking and social distancing, so I think that makes a big difference.”

‘So-Called Experts’

In 1918, Mississippi health leaders not only closed churches, but ordered the cancellation of large annual events—including the 1918 Mississippi State Fair. On Oct. 15, 1918, the Natchez Democrat reported that Dr. Leathers, the executive officer of the State Board of Health whose position was analogous to the modern state health officer, had ordered Jackson’s mayor to cancel the fair five days before Jackson was set to open it to thousands of visitors in response to a continued rise in influenza cases.

In October 2020, though, Mississippi Agriculture Commissioner Andy Gipson held the 161st Mississippi State Fair, with some social-distancing precautions, and even extended it for a weekend beyond its 12-day runtime even as COVID-19 cases escalated to new highs across the state.

A week after Dr. Dobbs and Gov. Reeves said masks would be required at the fair in early October, Gipson later told fairgoers that masking would be “a matter of personal preference.”

A white man wears a mask with the words: "This was preventable"
One reason COVID-19 is now disproportionately affecting white Mississippians is because they are less likely to practice mask wearing and social distancing, Mississippi State Health Officer Dr. Thomas Dobbs said in October 2020. Seen here, A man in downtown Petal, Miss., wears a face mask with the words “This Was Preventable” in May. Photo by Ashton Pittman

Throughout the COVID-19 pandemic, Dr. Dobbs has repeatedly faced pushback, some harsh, from critics of the shutdown, including leaders in DeSoto County who have spread false information about the coronavirus and even discouraged masking. During the 1918 pandemic, Mississippi newspapers reported that  Dr. Leathers faced some initial pushback, too, but that it soon faded.

On Oct. 12, 1918, the Jackson Daily News reported that Mississippians were largely accepting Dr. Leathers’ temporary regime to help suppress the pandemic.

“Opposition to Dr. Leather’s closing order has died down, and before the epidemic is over there will not be a word heard against it,” the editor wrote at the time. “It was a wise move at the right time, and the few who opposed it deserve no credit for putting their opinions up against that of an expert.”

As the COVID-19 crisis worsened last November and hospital ICUs began to fill up across the state, though, Gov. Reeves criticized some of the state’s top medical experts as they urged him to re-enact a statewide mask mandate like the one he had let expire on Sept. 30 after the summer wave had subsided. 

“The upcoming winter is going to be difficult for Mississippians” and “wearing masks will help us continually grow our economy, allow kids to remain in school, parents to work, and most importantly, protect all Mississippians from this deadly virus,” four of the state’s top doctors wrote in a letter to the governor on Nov. 24.

The governor balked, saying he believed they were “completely wrong” and insisting on only enacting mask mandates in counties once they had already experienced significant COVID-19 outbreaks.

“But I get frustrated when so-called experts decide that if we just did one more thing, that we could change this,” the governor said, swiping at the public-health leaders who had called for a mask mandate. “The fact is as follows: There is no silver bullet. There is no one thing we can do as a state. There is no one thing I as a leader or that we as Mississippians can do to make this go away.”

Highest Mortality Rate in 102 Years

After Thanksgiving, COVID-19 surged to new highs in the state, and hospitals began having to stack multiple patients in single-person ICU rooms and fill up hallways with those waiting for a bed.

Around 1,000 Mississippians died of COVID-19 in December 2020, the deadliest month of the pandemic in the Magnolia State so far.

No single month in 2020 proved as deadly as October 1918 for Mississippi, when thousands died of the Great Influenza, but COVID-19 has produced three waves since last spring, prolonging emotional and economic suffering and bringing repeated crises to hospitals and health care infrastructure. Feb. 11 will mark 11 months since public-health officials first confirmed COVID-19’s presence in the state. 

While the 1918 pandemic wreaked havoc worldwide for two years, from February 1918 until April 1920, it did not arrive in Mississippi until late September 1918, producing a large wave of deaths in the Magnolia State that, by year’s end, had begun to abate. With two-thirds of the pandemic already over, the state reported another 3,015 deaths in 1919.

Mississippi’s crude mortality rate, which measures how many people per 1,000 died residents in a given year, rose to a record 16.8 in 1918, up from 13.0 the year before—a level to which it returned in 1919.

A decade after the 1918 pandemic, Mississippi dealt with another deadly outbreak in 1928, when a less lethal flu epidemic killed about a third as many as had the Great Influenza pandemic 10 years earlier.

The 1928 flu epidemic drove Mississippi’s mortality rate to 13.1—a height the state would not reach again for 92 years as medical science progressed and Mississippi modernized its public-health infrastructure. 

Scientists developed the first influenza vaccine in 1940 and made it available to the general public in 1945. From 1940 to 2019, Mississippi’s mortality rate averaged 9.9 deaths per thousand.

New Hope Baptist Church Pastor Jerry Young receives the COVID-19 vaccine on Feb. 1, 2020. Photo courtesy Mississippi State Health Officer Dr. Thomas Dobbs

Even before the COVID-19 pandemic, though, Mississippi’s yearly death rate was on the upswing, rising 1.2 between 2012 and 2019, from 9.9 to 11.1. The year preceding the COVID-19 pandemic’s arrival was already the worst for overall mortality in Mississippi since 1937, when the mortality rate was 11.5.

Then, in 2020, the COVID-19 pandemic pushed Mississippi’s crude mortality rate up by 2.3 in a single year to 13.4—the highest in over a century. While lower than 1918’s 16.8 mortality rate, it is the highest the state has recorded since—and could rise higher as Mississippi health officials revise and update 2020’s provisional death counts.

Weekly deaths remained high as the state entered 2021. MSDH’s Jan. 29 provisional death count shows that 999 Mississippians died from all causes between Dec. 26, 2020 and Jan. 2, 2021—more than in any other week last year. 

Though daily cases, hospitalizations and deaths have fallen in Mississippi in recent weeks and thousands of residents are receiving COVID-19 vaccines, national and state health officials are urging people to continue practicing safety measures, such as mask-wearing, social distancing and hand-washing, noting that it could take months before the nation achieves herd immunity.

“Currently, we do not have enough data to be able to say with confidence that the vaccines can prevent transmission,” Dr. Anthony Fauci, the chief medical adviser to the president and the director of the National Institute of Allergy and Infectious Diseases, wrote during a Twitter question-and-answer session today. 

“So even if vaccinated, you may still be able to spread the virus to vulnerable people. Masks are vital until we learn more and significantly reduce infections.”

This story has been updated to note that Mississippi’s confirmed COVID-19 death toll officially surpassed the 1918 Great Influenza death toll on Friday, Feb. 5.

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