Almost everything about the coronavirus has become politicized. The questions that have been raised include: Is the whole thing a hoax? Are the case reports inflated? Are people who die from non-related causes lumped into the COVID-19 basket? Are face masks effective? Can you catch the coronavirus from doorknobs or elevator buttons? The list goes on. Perhaps the most controversial question is: can the reported deaths from COVID be trusted?

The Death Rate Then and Now:

Researchers have been measuring the toll of excess death from the COVID-19 pandemic. Two research letters published in JAMA (online, Oct. 12, 2020) show that about 20 percent more Americans died from March through July than normal.

Usually, the death toll doesn’t vary much from one year to another. Stop! Please read that sentence again. If you count the number of deaths in the United States from one year to the next it doesn’t vary very much at all. Here is how the researchers describe it in JAMA:

“Although total US death counts are remarkably consistent from year to year, US deaths increased by 20% during March-July 2020. COVID-19 was a documented cause of only 67% of these excess deaths.”

Excess Deaths from COVID:

Let me try to explain this in another way. Between March 1 and August 1, 2020 there were 1,336,561 deaths. That number was much higher the expected number of deaths: 1,110,364 to 1,111,697.

If you were to go back and count the number of deaths that occurred during those five months in 2019, 2018, 2017 and 2016 they would have been, to quote the authors, “remarkably consistent.”

Something changed in 2020! And yes, you are correct. That thing was COVID-19. Instead of the expected number of deaths, the new number was 20% more than normal. But, and this is important, many of those excess deaths were not attributed to SARS-CoV-2.

Some of those people may have died of undiagnosed COVID-19. Others could have died from different causes, such as a heart attack for which they didn’t seek care due to fear of contracting the virus at the hospital. Some of those excess deaths may even have been due to suicide related to unemployment, isolation or grief.

But it is also likely that medical examiners attributed many deaths to things like pulmonary embolisms, strokes or cardiac arrest when in fact the underlying cause was COVID-19. New York, New Jersey and Massachusetts accounted for about 30% of the excess deaths, due to their extremely high peaks in infection last spring. An editorial in JAMA (Oct. 12, 2020) notes: 

“Because fatality counts from death certificates are at any moment incomplete, and the listed causes of death reflect varying degrees of uncertainty and the judgment of the certifier, it is important to consider other ways to estimate the number of deaths due to a condition such asCOVID-19. One useful metric for this purpose is the number of deaths in excess of the number expected in a specified period of time. The number of deaths in a population such as the US over the course of a year shows a highly regular wave pattern, increasing in the winter months and declining in the summer. When an abrupt event arises, such as a war, famine, or pandemic, the excess mortality can be a revealing indicator of the death toll from that event.”

The editorial goes on to state:

“When a portion of excess mortality is attributed to a COVID-19–related condition such as pneumonia, some deaths recorded as due to pneumonia without mentioning COVID-19 probably represent missedCOVID-19 diagnoses during a COVID-19 pandemic. Over time, further analyses of mortality patterns may illuminate the direct, indirect, and missed counts of deaths attributable toCOVID-19.”

Excess Deaths from COVID:

The bottom line is that the number of deaths you read about in the newspaper are almost assuredly an undercount. As the editorialist states, the excess deaths related to the pandemic in the research letter above are:

“…sufficiently mortifying and motivating.”

“When a pandemic reaches the health, social, and economic scale of COVID-19, regardless of the precise number of deaths that have occurred by a certain date, an intense, persistent, multipronged, and coherent response must be the order of the day and an urgent priority for the nation.”

How Do Deaths from COVID in the U.S. Compare to Other Countries?

The second research letter in JAMA (Oct. 12, 2020) also shows significant excess deaths during this period. In addition, a comparison of the US with other countries shows that we did not fare as well as most. The authors point out that the US has had a COVID-19 mortality rate of 60.3 per 100,000 people. In Canada, the rate was 24.6 per 100,000 and Australia had a rate of 3.3 per 100,000. If the US had kept its rate comparable to Canada’s, more than 100,000 Americans who died from COVID-19 would still be alive.

What Do You Think?

Do you believe that the 20% of excess deaths between March 1, 2020 and August 1, 2020 were related to COVID-19? If not, why not? Please share your thoughts in the comment section below. Please share this article with friends or family if you think it is worthwhile.

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