The virus SARS-CoV-2 causes the disease, Covid-19. And Covid-19 is a worldwide pandemic. But perhaps the pandemic is more than the disease.
You may have seen this Worldometers.info page with statistics on the number of Covid-19 cases and deaths. Covid-19 is a deadly disease, causing more deaths than diabetes or flu/pneumonia or kidney disease would in a typical year [CDC Fast Stats]. But if we add the deaths from Covid-19 to the deaths from other usual causes, at their typical levels, does that account for all the deaths? No, it does not.
A CDC analysis of deaths in New York City during an approximately two month period [Morbidity and Mortality Weekly Report, May 15th, 2020] found thousands of “excess” deaths. These are deaths not caused by Covid-19 directly, and they are well above the usual level in any other year.
“During March 11–May 2, 2020, a total of 32,107 deaths were reported to DOHMH; of these deaths, 24,172 (95% confidence interval = 22,980–25,364) were found to be in excess of the seasonal expected baseline. Included in the 24,172 deaths were 13,831 (57%) laboratory-confirmed COVID-19–associated deaths and 5,048 (21%) probable COVID-19–associated deaths, leaving 5,293 (22%) excess deaths that were not identified as either laboratory-confirmed or probable COVID-19–associated deaths”
DOHMH is the New York City Department of Health and Mental Hygiene. Deaths are reported to that agency in NYC. The reported total of 32,107 deaths is far above the usual level of 7,935. NYC saw 24,172 more deaths in that period of just under two months than usual. Now 13,831 deaths were due to confirmed Covid-19 cases, plus 5,048 probable Covid-19 cases, for a total of 18,879. This leaves 5,293 “excess deaths”, that is, deaths above the usual level and not attributable to Covid-19.
The CDC report concludes that these “deaths might have been directly or indirectly attributable to the pandemic.” But beyond that assertion, nothing more is stated or concluded about the cause in the report.
It might be useful to speculate on two points. But be advised that the following discussion is speculative.
First, does the ratio of excess deaths to Covid-19 deaths hold true for other cities, states, or nations? 5,293 excess deaths versus 18,879 Covid-19 deaths is 28%. Total U.S. deaths from Covid-19 is 116,063 (6/12/20 9:00 ET). And 28% of that figure is 32,498 possible excess deaths nationwide. This figure is highly speculative. It assumes that the proportion of excess deaths in NYC is typical for the nation, which might not be so. But it is also highly unlikely that no other city or region experiences some excess deaths due to the pandemic, but not the disease. Even if the typical excess death rate nationwide is half of NYC, 14% is still a rather alarming rate.
Worldwide, there have been 424,472 deaths from Covid-19. At 28%, there would be 118,852 additional deaths, not found within the Covid-19 statistics. If we reduce the excess deaths rate to half of NYC, 14% of that figure would be 59,426 excess deaths. As the pandemic continues, these excess deaths could make a substantial contribution to the leading causes of death for 2020.
Second, what might be causing these excess deaths? Does the pandemic lead to more deaths from cancer, heart disease and other top causes, because persons are afraid to seek treatment? They might fear to contract Covid-19 at the doctor’s office or hospital, so perhaps they are more likely to die because they are not treated.
Or perhaps survivors of Covid-19 face an increased risk of death after recovery. The disease can cause lasting damage to the lungs, heart, kidneys, and even the central nervous system. The excess deaths might be Covid-19 deaths after all.
Does the stress of a lockdown cause an increase in deaths? Or, more generally, does living under the many additional stressors of the overall situation increase deaths? But stress would cause death only as a factor in some other cause, such as heart attack or stroke. But 28% seems too high to be caused by stress, even with serious co-morbidities.
Are suicide deaths on the rise in NY City and elsewhere? A story in the NY Post quotes a California physician as stating that suicide cases, at a medical center near Oakland CA, are much higher than usual: “we’ve seen a year’s worth of suicide attempts in the last four weeks.” And his colleague, a trauma nurse, agrees: “I have never seen so much intentional injury.”
In a typical year, NYC sees about 1,600 suicides, plus 21,000 unsuccessful attempts (resulting in hospitalization or a visit to the ER) [NY.gov]. It is possible that a substantial proportion of the excess deaths in NYC are from suicide. There may be more attempts at suicide. But another possibility, given the high rate of unsuccessful attempts, is that the usual level of suicide attempts is resulting in a higher percentage of deaths. It is conceivable that suicide attempts are not being treated at hospitals, as people are afraid to seek care at a location where persons infected with Covid-19 are certainly found. And this could result in repeated attempts and a higher number of completed suicides.
Could an increase in violent crime be part of the reason for the excess deaths? A report claimed an increase in the murder rate in NYC by 55%. But this does not explain the excess deaths, as the typical murder rate for NYC is about 562/year (2018 data). A 55% increase adds a few hundred deaths per year, and one sixth of that number in any two-month period.
Apart from a possible increase in the number of deaths from suicide and a limited increase in the deaths from murder, there may have been more deaths due to the usual natural causes. The lockdown saw a sharp decrease in patients seeking care for ailments other than Covid-19. This effect means that persons at risk for heart attacks and strokes, as well as persons living with a diagnosis of cancer were not receiving usual care.
The top two causes of death each year in the U.S. are heart disease and cancer, at approx. 647,000 and 600,000 deaths per year, respectively. If the pandemic causes an increase in deaths from other diseases, due to a reduced access to healthcare, these would be the two most likely underlying causes. Many persons are living with a cancer diagnosis.
In the U.S., about 5.37 million persons are living with a cancer diagnosis (limited prevalence 5 years; 2017 data PDF).
That figure is 1.678% of the total U.S. population of 320 million persons (census.gov, 2017 data). New York City had a population of 8.44 million in 2017, which suggests that about 140,000 persons in NYC are living with a cancer diagnosis (last 5 years). Many more persons are living with heart disease, atherosclerosis, high blood pressure, type 2 diabetes, kidney, liver, or lung disease, as well as diseases affecting the brain or nervous system.
Some percentage of the excess deaths in NYC could be due to an increase in deaths from these common ailments, along with an increase in suicides and murder. A combination of causes is most likely. But this leads us to the more important question, how do we reduce these excess deaths?
If we seek a solution to the Covid-19 problem, we need to determine the cause of these excess deaths. Covid-19 is not going away anytime soon. So in addition to goals of prevention, treatment, and reduced case fatality rate, we should seek a reduction in these excess deaths. At 28% of the total deaths from Covid-19, this excess mortality is a very serious and, until now, an unacknowledged problem.
Ronald L. Conte Jr.
Note: the author of this article is not a doctor, nurse, or healthcare provider.