Can “Excess Mortality” numbers guide the way forward?

Two physicians, Dr. Jeremy Faust from Brigham and Women’s Hospital in Boston and Dr. Carlos del Rio, professor of medicine and global health at Emory University, have proposed that the metric of “excess mortality” be used to define when it is safe to “reemerge” from our current restrictions in an opinion piece in the Washington Post.

They argue that rather than trying to capture COVID-specific mortality it might be easier to simply look at the number of overall deaths in the US vs. the number that was expected from historic figures. When the excess number of deaths returns to baseline (presumably because COVID-19 deaths have returned to baseline), it would be OK to stop social distancing and shelter in place requirements.

The biggest problem making forward decisions with this method is the retrospective nature of the metric. It is always going to be a comparison with past events, usually over a month or more, to account for death recording and to get a large enough comparisons for significance. It would be difficult (maybe impossible) in the current environment to wait for 4-6 weeks to make a decision on moving forward.

Importantly, the result of a decision to re-enter the workplace based on this would not be known for months. Death trends trail infection trends, so “excess mortality” would not help in altering course if infections increased. We need a more immediate measure to guide us.

Tomorrow, I will propose what I feel is the most important thing to do to prevent deaths when liberalizing activity.

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

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