About 2.9 million people die
in the United States each year from all causes. Monthly this total ranges from around 220,000 in the summertime
to more than 280,000 in winter.
In recent decades, flu season
has often peaked sometime from January to March, and this is a major
driver in total deaths. The average daily number of deaths from December through
March is over eight thousand.
So far, total death data is too
preliminary to know if there has been any significant increase in total deaths
as a result of COVID-19, and this is an important metric, because it gives us
some insight into whether or not COVID-19 is driving total death numbers well
above what would otherwise be expected.
Indeed, according to some
sources, it is not clear that total deaths have increased significantly as a
result of COVID-19. In a March 30 article for The Spectator, former
UK National Health Service pathologist John Lee noted that the current number
of deaths from COVID-19 does not indicate that the UK is experiencing “excess deaths.” Lee writes:
The
simplest way to judge whether we have an exceptionally lethal disease is to
look at the death rates. Are more people dying than we would expect to die
anyway in a given week or month? Statistically, we would expect about 51,000 to
die in Britain this month. At the time of writing, 422 deaths are linked to
Covid-19—so 0.8 per cent of that expected total. On a global basis, we’d expect
14 million to die over the first three months of the year. The world’s 18,944
coronavirus deaths represent 0.14 per cent of that total. These figures might
shoot up but they are, right now, lower than other infectious diseases that we
live with (such as flu). Not figures that would, in and of themselves, cause
drastic global reactions.
How do these numbers look in the United
States? During March of 2020, there were 4,053 COVID-19 deaths according to
Worldometer. That is 1.6 percent of total deaths in March 2019 (total data on
March 2020 deaths is still too preliminary to offer a comparison). For context,
we could note that total deaths increased by about four thousand from
March 2018 to March 2019. So for March, the increase in total deaths is about
equal to what we already saw as a pre-COVID increase from March 2018 to March
2019.
As Lee notes, total COVID-19
deaths could still increase significantly this season, but even
then we must ask what percentage of total deaths warrants an international
panic. Is it 5 percent? Ten percent? The question has never been addressed, and
so far, a figure of 1 percent of total deaths in some places is being treated
as a reason to forcibly shut down the global economy.
Yet, as a CDC report recently noted, pneumonia deaths have often
been far more common than COVID-19 deaths are right now: “Based on National
Center for Health Statistics (NCHS) mortality surveillance data available on
March 26, 2020, 8.2 percent of the deaths occurring during the week ending
on March 21, 2020 (week 12), were due to [pneumonia and influenza].”
Meanwhile there
is a trend t of attributing more of those pneumonia deaths to COVID-19 rather
than influenza, although this doesn’t actually mean the total mortality rate
has increased. The CDC report continues: “the percent of all deaths with
Influenza listed as a cause have decreased (from 1.0% to 0.8%) over this same
time period. The increase in pneumonia deaths during this time period are
likely associated with COVID-19 rather than influenza.” This doesn’t
necessarily represent a total increase in pneumonia deaths, just a change in
how they are recorded.
This
reflects an increased focus on attributing deaths to COVID-19, as noted by Lee:
In
the current climate, anyone with a positive test for Covid-19 will certainly be
known to clinical staff looking after them: if any of these patients dies,
staff will have to record the Covid-19 designation on the death
certificate—contrary to usual practice for most infections of this kind. There
is a big difference between Covid-19 causing death, and Covid-19 being found in
someone who died of other causes. Making Covid-19 notifiable might give the
appearance of it causing increasing numbers of deaths, whether this is true or
not. It might appear far more of a killer than flu, simply because of the way
deaths are recorded.
Given
this rush to maximize the number of deaths attributable to COVID-19, what will
April’s data look like? It may be that COVID-19 deaths could then indeed
number 10 or 20 percent of all deaths.
But the question remains: will total deaths increase substantially
compared to April 2019 or April 2018? If they don’t, this will call into
question whether or not COVID-19 is the engine of mortality that many
government bureaucrats insist it is. After all, if April’s mortality remains
“about the same” as the usual total and comes in around 230,000–235,000, then
obsessive concern over COVID-19 would be justified only if it can be proven
April 2020 deaths would have plummeted year-over-year had
it not been for COVID-19.
Update:
Meanwhile the CDC is instructing medical staff to report deaths as
COVID-19 deaths even when no test has confirmed the presence of the disease. In a Q and A on death
certificates published by the CDC on March 24, the agency
advises:
COVID-19
should be reported on the death certificate for all decedents where the disease
caused or is assumed to have caused or contributed to death.
Certifiers should include as much detail as possible based on their knowledge
of the case, medical records, laboratory testing, etc. If the decedent had
other chronic conditions such as COPD or asthma that may have also contributed,
these conditions can be reported in Part II. [emphasis in original.]
This is extremely likely to
inflate the number of deaths attributed to COVID-19 while pulling down deaths
attributed to other influenza-like illnesses and to deaths caused by pneumonia
with unspecified origins. This is especially problematic since we know
the overwhelming majority of COVID-19 deaths occur in patients that are already
suffering from a number of other conditions. In Italy, for example, data shows 99
percent of COVID-19 deaths occurred in patients who had at least one other
condition. More than 48 percent had three other
conditions. Similar cases in the US are now likely to be routinely reported
simply as COVID-19 cases.
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Unfortunately, because total
death data is not reported immediately, we have yet to see how this plays out. We
do know historically, however, that deaths attributed to flu and pneumonia over
the past decade have tended to make up around five to ten percent of all
deaths, depending on the severity of the “season.” Last week (week 14,
the week ending April 4) was the first week during which COVID-19 deaths
exceeded flu and pneumonia deaths, coming in at 11 percent of all death for
that week. (Using a 2017-2019 average as a baseline.) The prior week, (week 13,
the week ending Mar 28) COVID-19 deaths made up 3.3 percent of all
deaths. These numbers are likely to
rise throughout the month. Yet, until we have reliable numbers on all deaths in the coming weeks, it will be
impossible to know the extent to which COVID-19 are “cannibalizing” flu and
pneumonia deaths overall. That is, if the COVID-19 totals skyrocket, but total
deaths remain relatively stable, than we might guess that many deaths formerly
attributed simply to pneumonia, or to flu, are now being labeled as COVID-19
deaths. Potentially, this could also be the case for other patients, such as
those with advanced cases of diabetes.
UPDATE,
April 8:
White House COVID-19 task for member Dr.
Deborah Birx has confirmed it is now standard practice to count all death of
persons “with” COVID-19 as deaths caused by COVID-19. At an April 7
briefing, Birx explained:
We’ve
taken a very liberal approach to mortality. I think the reporting here has been
pretty straightforward over the past five to six weeks. Prior to that, when
there wasn’t testing in January, and February, that’s a very different
situation and unknown. … [Now] if someone dies with COVID-19 we are counting
that as a COVID-19 death.
Here is Dr. Birx saying that the government is recording
anyone who dies with coronavirus in the United States, regardless of any other
health issue, as a death from coronavirus. pic.twitter.com/p2nIhH4bHP
—
Greg Price (@greg_price11) April 7, 2020
Ryan W.
McMaken is the editor of Mises Daily and The Austrian. Send him mail.
