One of the biggest issues that has been raised around the pandemic is how many deaths are actually attributable to COVID-19. There have been many arguments saying that the number of deaths has either been undercounted, because they are being attributed to other diseases, or that they are being over counted because people actually have been dying from underlying diseases such as heart and lung disease rather than from COVID-19 itself.
One of the ways proposed to determine the number of deaths specifically related to COVID-19 has been to look at the excess death numbers in the US and Europe. These numbers basically show the unexpected increase in deaths during the pandemic vs. those observed in previous years. Therefore, the excess numbers of deaths might be attributable to the new source of mortality, COVID-19.
Even this metric has been debated because of the complexity in calculating excess death. For example, every year the population gets older and therefore mortality increases. One needs to control for the change in age of the population along with other variables that might be affecting mortality, such as bad influenza season or reductions in mortality due to decreased numbers of auto accidents during forced home restrictions.
To give a focus to this debate, an article in the Journal JAMA in early July suggested reporting of observed deaths for the 8 weeks between March 1 and April 25, 2020 in the United States and compared these numbers to observed deaths in the prior 7 years.
Large increases in mortality from heart disease, diabetes, and other diseases were observed during this period. The authors felt these deaths were likely associated with coronavirus infection, but admitted ”further investigation is required to determine the extent to which these trends represent non-respiratory manifestations of COVID-19 or secondary pandemic mortality caused by disruptions in society that diminished or delayed access to health care and the social determinants of health (eg, jobs, income, food security).”
To get an independent view on this, I communicated with Jeff Hardcastle who is a graduate of the Ross School of Business at the University of Michigan, President of Hardwood solutions, and someone who has made a hobby of actuarial analysis. I like Jeff because he is, by nature, “skeptical of most data being using in the media right now.” He also enjoys doing his own analysis.
He presented his analysis in a table, shown above. It is based on actual weekly data from the CDC on overall mortality and compares 2020 with the past 2 years. The only adjustment he made was to adjust the 2018/19 totals to reflect the 1.8% average increase in mortality the past 5 years. (Roughly 3 times the average annual population growth which reflects the increasing average age of the US). He then pulled in the reported weekly COVID-19 death totals from the “COVID Tracking Project” as a comparator. He could only analyze until July 24th as newer data was not available.
He made two important observations from his analysis:
- Overall the excess deaths observed are similar to the COVID-19 death totals being reported. Therefore, these totals are legitimate representations of the people actually dying from COVID (circled in red in figure).
- It doesn’t appear that there is any meaningful “under reporting” of COVID-19 mortality. While there were slightly more excess deaths during this period (20-30K) higher, this is insignificant in comparison to normal yearly fluctuations in mortality levels (Increases in annual mortality have ranged from a low of 25K to as high as 80-90K over the past 5 years).
The news is, while the number of deaths from COVID-19 (approximately 190,000 as of today) are awful, the numbers are at least accurate. No one should try to underplay or overestimate their significance.
Another point is that it will be interesting to follow mortality numbers over the next few years as many of the people dying from COVID-19 are elderly. This may actually reduce death rates in the coming few years once the pandemic is under control as these people will not die from other causes.
Pandemic Pondering 