How many more people are dying than usual?
–Excess Deaths From COVID-19 and Other Causes, March-April 2020
“Between March 1, 2020, and April 25, 2020, a total of 505 059 deaths were reported in the US; 87 001 were excess deaths, of which 56 246 (65%) were attributed to COVID-19.”
I wrote about this idea in March:
“it’s not just people getting a really bad flu. It’s people who have a heart attack who can’t get proper care because so many have a really bad flu that the hospital has redirected, or run out of, resources. It’s not just the fatality rate primary to the virus. In healthcare speak, it is the fatality rate, or even the disability rate, secondary to the virus. Which, some will persuasively argue, will become incalculable, if nothing else due to lack of proper data.”
Let’s get up to speed on current events. Example:
–Some Hospitals in Southern, Western U.S. States Near Capacity Amid Coronavirus Outbreaks
““Things are really bad. Every day, I walk into a new chaotic reality,” said Jennifer O’Hea, a critical-care physician at Banner University Medical Center Phoenix.
The hospital’s 120-bed intensive-care unit is now over 100% capacity, she said, and more than half of the ICU beds have been taken up by Covid-19 cases. The case load is increasing so quickly that some critically-ill patients are being treated in the emergency department or in surgery recovery rooms. The hospital is also working to repurpose disused ICU units in an older part of the building and plans to outfit endoscopy units and conference rooms to take in more patients, she said.”
Some more:
““I’ve never seen anything like this,” said Salim Rezaie, an emergency-medicine physician at Main Methodist Hospital in San Antonio. “It’s unrelenting and it doesn’t look like it’s letting up at all.”
He said the three Covid-19 ICUs at Main Methodist are at capacity, and he and his colleagues in the emergency department have been forced to send some patients with less severe illness home who they might normally admit.
“There’s literally nowhere to put them,” Dr. Rezaie said.”
Excess mortality is one way to try and get at the problem of not only how many people are dying from the virus, but how many are dying due to the environment the virus has caused.
It’s by no means perfect. It doesn’t tell us how many people are having mental health issues, how much shorter people’s lives might be decades from now, the quality of life lost for those still suffering symptoms months after being diagnosed (an increasingly studied issue), but it’s something.
Here’s another study over a longer timeframe where COVID only directly made up 78% of excess deaths. That is, over this longer timeframe -March through the end of May instead of the other study’s March to the end of April- excess deaths were more more directly related to COVID diagnosis. (This assumes their modeling, data sources, etc. were similar enough to one another. Big assumption but we’ll go with it.)
March through May was a quieter time relative to March through April. A strong signal that as the pandemic gets into the conscious of people (e.g. people stay home more and avoid needed care), as it gets out of control, as hospitals get overwhelmed, more deaths secondary to COVID happen. You get more COVID and more non-COVID deaths.
-> We’re also getting better at treating the disease, which will influence the numbers over time. But that benefit can be attenuated if the system gets overwhelmed e.g. lack of drug supply.
-> Just as concerning is the morbidity rate -the chronic complications people have to deal with- something we are only learning to understand. After all, you can’t study the six month complications of something when you’re not even six months in, but we are definitely accruing more and more people with lingering problems. Some of the numbers are becoming alarming, like reports of ~85% of patients still having symptoms two months later.
The CDC has a tool where you can see the excess deaths over time. You can see in mid-April the US had some weeks where about 20,000 more people were dying than usual (again, that’s in a week)- about 40% more than predicted. But New York City got to a point where 7,000 more people died in a week than normal- a 600% increase.
From a personal standpoint, one reason this could be important is it could factor into what you feel your risk is. If you’re someone more prone to go to the hospital due to a pre-existing condition, or if you do activities that are more likely to send you to the emergency room, maybe you or your kid(s) do some kind of extreme sports, and you’re in an area where hospitals are currently overwhelmed, that might factor into how much you go about your normal life. You might not be too concerned with your kid dying of COVID, but you might be concerned about the quality of care their broken arm would get with a COVID backdrop.
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As I’ve repeatedly said, please remember I’m no epidemiologist or virus expert. I’m sure, and you should assume, I’m missing things. I’m only a US citizen with some math and health science background who wanted to avoid armchair epidemiology as much I could, but, as I try to navigate my family’s behavior, has felt forced to do some due to how this has played out in America.
These posts are more or less me thinking out loud. They’ve been surprisingly popular -a sign many others out there are trying to find their way too- so I’ve kept them going.
Posted on July 10, 2020