Raphael Stevens

Covid-19 is officially the most deadly outbreak in recent American history, surpassing the estimated U.S. fatalities from the 1918 influenza pandemic.
Reported U.S. deaths due to Covid crossed 675,000, the estimated U.S. fatalities from the 1918 flu, and are still increasing.
“This is the pandemic I will be studying and teaching to the next generation of doctors and public-health students,” said medical historian Howard Markel.

A woman and child walk through a field of white flags on the Mall near the Washington Monument in Washington, DC on September 16, 2021.
Mandel Ngan | AFP | Getty Images

Covid-19 is officially the most deadly outbreak in recent American history, surpassing the estimated U.S. fatalities from the 1918 influenza pandemic, according to data compiled by Johns Hopkins University.
Reported U.S. deaths due to Covid crossed 675,000 on Monday, and are rising at an average of more than 1,900 fatalities per day, Johns Hopkins data shows. The nation is currently experiencing yet another wave of new infections, fueled by the fast-spreading delta variant.

The 1918 flu – which came in three waves, occurring in the spring of 1918, the fall of 1918; and the winter and spring of 1919 – killed an estimated 675,000 Americans, according to the Centers for the Disease Control and Prevention. It was considered America’s most lethal pandemic in recent history up until now.

“I think we are now pretty well done with historical comparisons,” said Dr. Howard Markel, a physician and medical historian at the University of Michigan. He added it is time to stop looking back to 1918 as a guide for how to act in the present and to start thinking forward from 2021.

A personal note is seen on a white flag at the ‘In America: Remember’ public art installation near the Washington Monument on September 18, 2021 in Washington, DC.
Robert Nickelsberg | Getty Images

“This is the pandemic I will be studying and teaching to the next generation of doctors and public-health students,” he said.
To be sure, a direct side-by-side comparison of raw numbers for each pandemic doesn’t provide all of the contexts, considering the vast technological, medical, social and cultural advances over the past century, Markel and other health experts say.

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It’s important to consider population when talking about outbreaks or disasters, health experts and statisticians say.

In 1918, for example, the U.S. population was less than a third of today’s with an estimated 103 million people living in America just before the roaring 1920s. Today, there are nearly 330 million people living in the U.S. That means the 1918 flu killed about 1 in every 150 Americans, compared with 1 in 500 who have died from Covid so far.
The 1918 virus also tended to kill differently than Covid, experts say. With World War I, there was a massive movement of men across all of America and Europe. While the coronavirus can be especially severe for the elderly and those with underlying health conditions, the 1918 virus was unusual in that it killed many young adults.
Globally, the 1918 flu killed more people, an estimated 20 million to 50 million, according to the World Health Organization. Covid has taken the lives of approximately 4.7 million people worldwide so far, according to Johns Hopkins data.

Members of the Red Cross Motor Corps, all wearing masks against the further spread of the influenza epidemic, carry a patient on a stretcher into their ambulance, Saint Louis, Missouri, October 1918.
PhotoQuest | Getty Images

Unlike today, there was no vaccine for the 1918 flu. There was also no CDC or national public health department. The Food and Drug Administration existed but consisted of a very small group of people. Additionally, there were no antibiotics, intensive care units, ventilators or IV fluids.
Scientists hadn’t even seen a virus under a microscope. They didn’t have the technology and they knew almost nothing of virology, which was considered a nascent science because viruses are physically smaller under a microscope and more difficult to identify than bacterial infections.
“Obviously, we have much better advantages now, 100 years later,” Dr. Paul Offit, who advises the FDA on Covid vaccines, said, adding he is “frustrated.”
The U.S. is worse off now than it was a year ago as a large portion of the nation’s population remains unvaccinated, he added.
“I can tell you that we see a lot of children hospitalized as well, who have high-risk conditions and the problem is not that they didn’t get their third dose. The problem is that they are unvaccinated,” said Offit, also director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
Markel agreed that the U.S. has made advancements, saying, “the reality is we have no historical precedent for the moment we’re in now.”

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The Biden administration will lift a travel ban on most noncitizens from entering the U.S. in November, as long as they are vaccinated.
The eased rules are expected to drive up demand for trans-Atlantic travel and other international routes.

Tourists look at the Bridge of Sighs in Venice, Italy, on Aug. 25, 2021.
Andrea Merola | Bloomberg | Getty Images

The window to find dirt-cheap fares to Europe is closing.
The Biden administration on Monday said the U.S. in November will start allowing in vaccinated foreigners from 33 countries, including the U.K., China and EU nations, easing rules set early in the pandemic.

That’s great news for airlines that are desperate to drum up revenue after a historic lull in demand for routes that were among the most popular before the Covid-19 pandemic. Many EU countries have been welcoming U.S. tourists for months since vaccinations became widely available, but that was not reciprocated by the United States.

“In the past, as restrictions have been eased, there has been an increase in bookings for travel, and we expect a similar reaction here,” Conor Cunningham, executive director of MKM Partners, wrote in a research note to investors.
Bargain hunters eager to take advantage of the relatively cheap flights might be out of luck as demand for trans-Atlantic travel rises.
Round-trip flights to Europe, including the U.K., from the U.S. are going for about $565, a level not seen in its roughly five years of collecting data, said fare-tracking company Hopper.
Fares had dropped 15% from Aug. 30, after the European Union recommended that its member countries reinstate travel restrictions on the U.S. The advisory was nonbinding, however, and U.S. travelers can still visit a host of countries if they meet requirements like proof of Covid-19 vaccination or a recent negative Covid test, if not a combination of both.

Adit Damodaran, economist at Hopper, said he expects airfares to rise from Europe to the U.S. on the lifted travel restrictions and from the U.S. to Europe as more travelers realize the EU notice “was a soft advisory.”
Airlines didn’t immediately say whether they would add flights following the loosened U.S. travel rules, but carriers pounced with added service to destinations like Iceland, Croatia and Greece when those countries started allowing U.S. visitors in earlier this year.

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The International Space Station is expected to be retired by the end of this decade. NASA is turning to companies to build private space stations in orbit and anticipates saving more than $1 billion per year as a result.
NASA’s director of commercial spaceflight, Phil McAlister, told CNBC that the agency “received roughly about a dozen proposals” from a variety of companies for contracts.
“We are making tangible progress on developing commercial space destinations where people can work, play and live,” McAlister said.

An artist’s illustration of the Axiom modules attached to the International Space Station.
Axiom Space

NASA plans to retire the International Space Station by the end of this decade, so the U.S. space agency is turning to private companies to build new space stations in orbit – and expects to save more than $1 billion annually as a result.
NASA earlier this year unveiled the Commercial LEO Destinations project, with plans to award up to $400 million in total contracts to as many as four companies to begin development of private space stations.

In response to NASA’s request, its director of commercial spaceflight, Phil McAlister, told CNBC that the agency “received roughly about a dozen proposals” from a variety of companies for contracts under the project.
“We got an incredibly strong response from industry to our announcement for proposals for commercial, free fliers that go directly to orbit,” McAlister said. “I can’t remember the last time we got that many proposals [in response] to a [human spaceflight] contract announcement.”

The ISS is more than 20 years old and costs NASA about $4 billion a year to operate. The space station is approved to operate through the end of 2024, with a likely lifespan extension to the end of 2028. But, moving forward, McAlister says NASA wants “to be just one of many users instead of the primary sponsor and infrastructure supporter” for stations in low Earth orbit.
“This strong industry response shows that our plan to retire the International Space Station in the latter part of this decade and transition to commercial space destinations is a viable, strong plan,” McAlister said.
“We are making tangible progress on developing commercial space destinations where people can work, play and live,” McAlister added.

NASA is now evaluating the proposals, and McAlister said the agency hopes to announce the contract winners “before the end of the year,” although he is “pushing for earlier.” McAlister noted that the dozen or so proposals came from a “diverse group of companies,” ranging from start-ups to large aerospace corporations. When NASA hosted an industry briefing for company officials in March, interested parties included recognizable names like Elon Musk’s SpaceX, Jeff Bezos’ Blue Origin, Airbus, Boeing and Lockheed Martin.
In addition to cost savings, McAlister emphasized NASA “will not need anything near as big and as capable” as the ISS moving forward. He said the private space stations “could be very large, but NASA will only be paying for the part that we need.”
“We need to right-size our [low Earth orbit] infrastructure,” McAlister said.

The public-private model

SpaceX’s Crew Dragon Endeavour seen docked with the International Space Station on July 1, 2020.

Rather than build and own hardware itself, NASA has increasingly turned to public-private partnerships as a way to achieve its goals in space. The agency has had great success through this model in the past decade, with cargo and crew services provided via vehicles built by SpaceX and Northrop Grumman.
NASA last year estimated that the Commercial Crew program alone saved the agency between $20 billion and $30 billion, while funding development for two spacecraft, rather than just one. While Boeing has yet to complete development testing – suffering an extended setback after its first uncrewed Starliner capsule launch in December 2019 failed due to multiple anomalies – SpaceX’s Crew Dragon spacecraft has flown 10 astronauts to the ISS for NASA, as well as four private astronauts to orbit last week.
The agency does not expect to foot the entire bill for helping companies build new space stations, with McAlister saying “the strategy has to work for both the government and the private sector” from an investment perspective.
“You have to find that sweet spot in terms of sharing resources, sharing risks, sharing responsibilities, so that both parties can benefit,” McAlister said.
“It was explicitly part of the original announcement for proposals that we expected cost-sharing,” he added. “Going forward, we do not anticipate paying for the entire commercial destinations. We don’t think that’s appropriate, as the companies are going to own the intellectual property and they’re going to be able to sell that capability to non-NASA customers.”
The Commercial Crew program serves as a guide for the Commercial LEO Destinations project, as initially NASA awarded five companies with Commercial Crew contracts before steadily narrowing down to two through later awards.
“When you’re this early, it makes a lot of sense to have competitors,” McAlister said.
NASA also perceives the strong interest from companies as a signal that the U.S. space industry “is technically and financially capable of building commercial space destinations,” McAlister said, which would decrease the agency’s “financial commitments” to science and research in orbit.
“Then we can use that savings – that we project to be on the order of a billion to a billion-and-a-half dollars [annually] – for our deep space missions and aspirations,” he said.

Working with Axiom already

A window for the Axiom Earth Observatory module seen during manufacturing.
Axiom Space

NASA has already begun funding the ambitions of one company under a separate but related contract, having awarded Axiom Space with $140 million to build modules that will connect to the ISS. When the ISS retires, Axiom plans to detach its modules and turn it into a free-flying space station.
Axiom has begun manufacturing of those modules, including the enormous windows that will make up an observation deck. The company plans to launch and connect the first habitable module to the ISS by 2024, under the assumption that Congress provides the necessary funding to extend the space station’s life to 2028.
“We need the ISS extension, because we are not going to be ready with these [independent] destinations by 2024,” McAlister said.
The House of Representatives’ Science, Space, and Technology Committee is hosting a hearing on ISS extension on Tuesday, with expected testimony from NASA’s ISS director, Robyn Gatens, NASA astronaut Kate Rubins and Nanoracks CEO Jeff Manber.

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Gottlieb told CNBC’s “Squawk Box” that the public has lost trust in U.S. health agencies and called for more funding for the Centers for Disease Control and Prevention.
He said that identifying problematic viruses abroad and equipping the CDC with better crisis mitigation resources would improve the nation’s ability to counter any new contagions that arise.
Besides treating outbreaks as national security matters, Gottlieb said the CDC was ill-prepared at the beginning of the pandemic for the subsequent widespread rollout of Covid tests and vaccines.

Dr. Scott Gottlieb, former Commissioner of the Food and Drug Administration, speaks during the Skybridge Capital SALT New York 2021 conference in New York City, U.S., September 15, 2021.
Brendan McDermid | Reuters

Former Food and Drug Administration Commissioner Dr. Scott Gottlieb said Monday that U.S. intelligence agencies should be tasked with investigating emerging public health threats overseas to combat future disease outbreaks.
Gottlieb, who also sits on Pfizer’s board, told CNBC’s “Squawk Box” that the public has lost trust in U.S. health agencies and called for more funding for the Centers for Disease Control and Prevention.

He said identifying problematic viruses abroad and equipping the CDC with better crisis mitigation resources would improve the nation’s ability to counter any new contagions that arise.

“I think going forward we’re not going to just be able to depend on countries voluntarily sharing information,” Gottlieb said in an appearance promoting his book, “Uncontrolled Spread.” “We’re going to have to go in and have the capacity to collect it and to monitor for these things, and that means getting our foreign intelligence services much more engaged in the public health mission globally.”
World Health Organization officials have said they weren’t sure China disclosed all its data on Covid’s origins. Gottlieb suggested that countries today are less forthcoming with disease details because they fear being isolated. He noted that the U.S. has avoided bringing intelligence agencies into international public health issues because the CDC worried that “anyone wearing a white coat overseas would be perceived to be a spy.”

CNBC Health & Science

Besides treating outbreaks as national security matters, Gottlieb said the CDC was ill-prepared at the beginning of the pandemic for the subsequent widespread rollout of Covid tests and vaccines.The CDC’s changing messaging around Covid prevention tactics also undermined the public’s faith in the agency, Gottlieb said.
But the proper resources, competencies and logistical management could help the CDC better handle public health emergencies, Gottlieb said.  

“I think coming out of this pandemic, a lot of people have lost confidence in the public health officials,” Gottlieb said. “They felt that guidance wasn’t well informed, it wasn’t well articulated, it wasn’t distributed in a way that we could assimilate it into our lives.”
The pandemic has highlighted the systemic bias in health-care facing people of color as well, Gottlieb said, including unequal access to Covid testing and technology. Improving the country’s outbreak preparedness doesn’t just entail bolstering the CDC and disease surveillance – it involves finding solutions for disparities in health-care and structural disadvantages permeating American society, Gottlieb said.
“If we’re going to make ourselves more resilient going forward to these kinds of public health crises, we’re going to have to address those inequities and do more to make sure that we’re getting adequate health care to people who have historically been locked out of those opportunities,” Gottlieb said.
Disclosure: Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion and biotech company Illumina. He also serves as co-chair of Norwegian Cruise Line Holdings′ and Royal Caribbean’s “Healthy Sail Panel.”

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The Biden administration will require foreign nationals to be vaccinated against Covid-19 to enter the U.S.
The new plan will end broad bans on most noncitizens from entering the U.S. from the EU, U.K. and other countries.
Airlines have urged the Biden administration to lift the rules, which have hurt demand for international travel.

Passengers wearing face masks as a preventive measure against the spread of covid-19 arrive at Orlando International Airport. On April 30, 2021, the Transportation Security Administration extended the federal mask mandate, which was set to expire on May 11, until September 13 for all air passengers over the age of 2.
Paul Hennessy | LightRocket | Getty Images

The U.S. will ease travel restrictions for international visitors who are vaccinated against Covid-19 in November, including those from the U.K. and EU, the White House said Monday.
Noncitizens visiting the United States will have to show proof of vaccination and a negative Covid test taken within three days of departure, said Jeff Zients, who is leading the nation’s Covid response efforts for the White House.

The changes will take effect in early November, which the airline industry expects will spur holiday bookings.
“They must show proof of vaccination prior to boarding a U.S.-bound airplane,” Zients said during a press briefing.
Airlines and other travel industry groups have clamored for the U.S. to lift the restrictions for months. The Trump administration had first issued the rules, which now apply to more than 30 countries, in March 2020. President Joe Biden upheld those rules in January, shortly after taking office.
The Biden administration is also tightening rules for unvaccinated U.S. citizens returning home. They will need to test one day before departure and test again after returning.
European and British officials have lifted entry bans for U.S. and other visitors since vaccines became widely available this spring, but the Biden administration hadn’t reciprocated.

Allowing more international travelers into the U.S. would have wide-ranging impacts. A ban on much of non-U.S. citizen travel has had broad effects on industries including airlines, retail and restaurants.
The Centers for Disease Control and Prevention will also require airlines to collect and provide passenger information to aid contract tracing.
“In the coming weeks, CDC will be issuing a contact tracing order requiring airlines to collect current information for each U.S.-bound traveler, including their phone number and email address,” Zients said.
Shares of American Airlines, Delta Air Lines and United Airlines rose Monday after the White House’s announcement, escaping a broader market sell-off. Those carriers have the most international service of U.S. airlines and will benefit the most from the change in policy. JetBlue Airways, which debuted its first service to London last month, also gained.
“Leisure bookings for the holidays from inbound tourist visits and non-US citizens visiting friends and relatives will accelerate in upcoming weeks,” Jonathan Root, senior vice president at Moody’s Investors Service, said in an emailed statement. “We also now expect a stronger increase in business travel by the first quarter of 2022 than would have occurred if the borders remained closed.”
There will be a few exemptions to the vaccination requirements for foreign visitors, such as for children not yet eligible to be vaccinated, according to a person familiar with the White House’s strategy, but full details of the policy have not yet been released.
The airlines cheered the Biden administration’s decision, which will open up those carriers to customers who have been restricted from flying to the U.S. since early 2020.
“U.S. airlines have been strong advocates for a stringent, consistent policy and are eager to safely reunite the countless families, friends and colleagues who have not seen each other in nearly two years, if not longer,” Nicholas Calio, president of Airlines for America, the lobbying group for the largest U.S. carriers, said in a statement.
In June, the U.S., U.K., EU, Mexico and Canada announced they would form a group to study how to safely reopen international travel.
Monday’s announcement came after the peak summer travel season but it could mean stronger demand for end-of-year holiday trips. Airlines have been using some of their biggest planes, normally reserved for international trips, for domestic routes, a trend that could quickly change if demand from abroad rises with the new rules.
Airline capacity to Europe from the U.S. this summer was down 61% from 2019, according to aviation data firm Cirium.

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