Coronavirus pandemic may cause 400,000 excess deaths in US by end of the year, suggests study
Deaths between March and August increased 20% compared to previous years, but deaths attributed to Covid-19 only accounted for 67% of those
Since Covid-19’s spread to the US earlier this year, death rates have risen significantly, and a new study suggests the total deaths recorded among Americans during the pandemic far exceed those attributed to the coronavirus. A massive 400,000 excess deaths or more may occur in the US by the end of 2020 due to the Covid-19 pandemic, according to estimates by researchers. This projection includes people who would have died due to the disease as well as those who would have died due to disruptions caused by the pandemic. For every two deaths attributed to Covid-19 in the US, a third American dies as a result of the pandemic, find authors.
The study, led by researchers at Virginia Commonwealth University (VCU), shows that between March 1 and August 1, a total of 1,336,561 deaths occurred in the US, an estimated 20% increase compared with the number of expected deaths, and representing 225,530 excess deaths. But only 67% (150,541) of these excess deaths could be directly attributed to Covid-19, whereas excess deaths attributed to other causes also could have been related to the pandemic in general. Excess deaths refer to the number of fatalities above what would be expected in a typical period.
The gap between reported Covid-19 deaths and all unexpected deaths can be partially explained by delays in reporting coronavirus deaths, miscoding, or other data limitations. But the pandemic’s other ripple effects could explain more, the team emphasizes. They caution about the indirect deaths caused by the response to the pandemic: people who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship, or emotional distress. The study, for example, specifically shows the US experienced significant increases in deaths from dementia and heart disease. Death rates from Alzheimer’s disease and dementia increased twice not only in March and April, when the pandemic began, but again in June and July when the Covid-19 surge in the Sun Belt occurred.
“Some people who never had the virus may have died because of disruptions caused by the pandemic. These include people with acute emergencies, chronic diseases like diabetes that were not properly cared for, or emotional crises that led to overdoses or suicides,” explains lead author Dr Steven Woolf, director emeritus of VCU’s Center on Society and Health, in the findings published in JAMA.
Based on this study, the total number of excess deaths for 2020 — compared with previous years — is likely to be greater than 400,000, according to Dr Howard Bauchner, editor-in-chief of JAMA, and Dr Phil Fontanarosa, executive editor of JAMA. This estimate assumes that a similar number of excess deaths will occur over the period from August through December as they did between March through August.
“The importance of the estimate by Woolf et al — which suggests that for the entirety of 2020, more than 400,000 excess deaths will occur — cannot be overstated, because it accounts for what could be a decline in some causes of death, like motor vehicle crashes, but increases in others, like myocardial infarction. These deaths reflect a true measure of the human cost of the great pandemic of 2020,” the experts write in an accompanying JAMA editorial. They add, “These deaths far exceed the number of US deaths from some armed conflicts, such as the Korean War and the Vietnam War, and deaths from the 2009 H1N1 (Swine flu) pandemic, and approach the number of deaths from World War 2.”
The study authors pulled data from the Centers for Disease Control and Prevention (CDC) for 2014 to 2020, using regression models to predict expected deaths for 2020. The 10 states with the highest per capita rate of excess deaths were New York, New Jersey, Massachusetts, Louisiana, Arizona, Mississippi, Maryland, Delaware, Rhode Island and Michigan.
Woolf paints a grim picture, warning that long-term data may show a broader impact of the pandemic on death rates. Cancer patients who have had their chemotherapy disrupted, women who have had their mammograms delayed — preventable, early deaths may increase in the coming years, he said. “And death is only one measure of health. Many people who survive this pandemic will live with lifelong chronic disease complications. Imagine someone who developed the warning signs of a stroke but was scared to call 911 for fear of getting the virus. That person may end up with a stroke that leaves them with permanent neurological deficits for the rest of their life,” cautions Woolf, also a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine.
In a separate editorial, Dr Harvey V Fineberg, Gordon, and Betty Moore Foundation, US, states that a general indication from the coronavirus death toll and the excess deaths related to the pandemic, 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,” he recommends.
US death rate high compared to other countries
Another analysis compared the US to Organisation for Economic Co-operation and Development countries with populations exceeding 5 million, and greater than $25 000 per capita gross domestic product. The authors found that since the beginning of the pandemic, among the countries with moderate mortality (5-25 deaths per 100,000 people) or high mortality (over 25 deaths per 100,000), the US ranked third, with 71.6 deaths per 100,000.
The team includes experts from Harvard Graduate School of Arts and Sciences, and University of Pennsylvania Perelman School of Medicine. They note that the US experienced high Covid-19-associated mortality and excess all-cause mortality into September 2020. After the initial peak in early spring, US death rates from coronavirus and all causes remained higher than rates in countries with high Covid-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic, they explain. “Few people will forget the great pandemic of 2020, where and how they lived, how it substantially changed their lives, and for many, the profound human toll it has taken,” concludes Bauchner and Fontanarosa.