Thursday, January 28, 2021

Excess Deaths

Even though C19 isn't that frequently mentioned here compared to other sites, you may be tired of me focusing on the one particular statistic of Excess Deaths. It is born of some frustration, as I keep reading comments on other sites that 'what they are saying Covid deaths aren't "really" Covid deaths.' I don't know what the percentages are - perhaps I am solving a problem that doesn't much exist. Still, I worry. As explanation, some will point out that hospitals get a lot of money for Covid patients. One of my sons, who works at a hospital, even said that offhand. If we could establish that there weren't that many more deaths, then we might go looking at why the reported numbers were so high. CS Lewis made an analogy of bringing your child to the doctor, only to be told many reasons why your child is sick, without having established that he is sick.

He is like a doctor who makes no diagnosis and prescribes no cure but tells you how the patient got the disease (still unspecified) and tells you wrong because he is describing scenes or events on which he has no evidence. The fond parents ask, 'What is it? Is it scarlatina or measles or chicken-pox?' The doctor replies, 'Depend upon it, he picked it up in one of those crowded trains.' (The patient actually has not traveled by train lately.) They then ask, ‘But what are we to do? How are we to treat him?' The doctor replies, 'You may be quite sure it was an infection.' "On Criticism" Of Other Worlds: Essays and Stories by CS Lewis.

So also with the false distinction of dying from Covid and with Covid.  If there were not about a half-million more deaths than we get in other years, which will be 400-600,000 by the time we hit our one-year anniversary, then we would be justified in asking where all this exaggeration comes from, and guessing whether it is ordinary flu, other respiratory illnesses, or heart disease that is getting renamed Covid for political reasons. It is at least not illogical to say that these extra deaths are coming from more suicides, more homicides, or postponed medical care because of our focus on the coronavirus. If you want to take that tack, then show your numbers, not just scattered reports of those, but real numbers of "We have half a million excess deaths this year because we had 100,000 more suicides, and 100,000 more homicides, and 300,000 extra deaths because of medical care that was not given because hospitals and clinics were too busy treating nonexistent (or at least exaggerated) Covid."  Show your work.

But you must certainly suspect that no such numbers are forthcoming, and if you go that route you will bring poor results to the discussion.  They ain't there. I will say again, C19 deaths are underreported, not overreported. Hospitals and doctors may have incentives, but governors have incentives too.

Right from the beginning I have stressed that I think it important that we balance what we lose versus what we gain from any interventions, mandated or voluntary.  Businesses went under or downsized, laying off workers.  We think that more children's educations are being harmed than are being helped by the remote education, particularly those with special needs. We wonder whether their social development is being harmed. Is not loneliness itself a bad consequence, even if we cannot precisely measure the ill effect?  On the flip side, there are things to put in the other balance pan.  Those who died left behind friends and relatives whose lives are harmed. There is increasing evidence that even people who recovered from C19 have long-term effects. If hearts and lungs are damaged then lives will be shortened down the road. Loss of taste and smell fairly screams "neurological symptoms." Your taste buds didn't go away, after all. That is a terrible wildcard.

Yet I think it is a fair discussion to have, and have said so all year.

But I will not have that discussion with someone who refuses to accept that the deaths are real, or denying they are coronavirus without providing at least a plausible explanation what it is instead. It would be like discussing foreign policy with someone who thinks Iran is part of Europe, or botany with someone who is sure oaks are conifers.

This problem may be about to fix itself because reports are coming out that Cuomo underreported Covid in nursing homes, and some other states may be similarly making their numbers look better than they are.  The previous skeptics have a sudden incentive to switch sides on this. I suppose I should be grateful.

Two more sections.

You can get to the CDC web page about Excess Deaths, which has interesting information in itself, such as a graph I have linked before, now updated. Sorry for the lack of clarity.  I apparently haven't the skill. The spikes in excess deaths on the far right begin last February, continuing to the present and the y-axis numbers are in increments of 20,000 deaths (per week), for all causes of death.  The other section above the line over toward the left is right around Jan 1, 2018.

But to get to the state-by-state data: Scroll down to "Options," then select the fourth entry in the first column, "Number of Excess Deaths." If the state you are looking for isn't listed, there is a drop-down on the far right that will allow you to add it.  I am interested in neighboring Vermont and Maine as well as NH, for example.

An explanation of what the two different bars mean, from the explanations on the page, to save you the time looking for it.

A range of values for the number of excess deaths was calculated as the difference between the observed count and one of two thresholds (either the average expected count or the upper bound of the 95% prediction interval), by week and jurisdiction.

Third section

When one goes browsing among the states and looking at the graphs and charts, some interesting things show up. For example, Massachusetts, Arizona, and Tennessee all have about 7M people.  If you just go to Worldometers and click the "Deaths per Million" column - which is admittedly what I nearly always do - you would think that Massachusetts is one of the worst, worst states for deaths, Arizona sorta bad with 2,000 fewer deaths, and Tennessee (about average for the country) with 5,000 fewer than MA.  But Arizona has a total of 5,000 more excess deaths and Tennessee 2,000. If not C19, what are they? Georgia has almost 4M more people than MA and claims to have about 1,000 fewer Covid deaths. But they have over 4,000 more excess deaths.  Michigan is worse - it has 9,000 more.  FL and CA both seem to be severely underreporting.  Does that trace to their governors?  Could be.  

NH seems good but not stunning here.



Grim said...

OK, let's run some numbers to see what's plausible.

Suicide is a leading cause of death in any year (second biggest cause in the young, fourth biggest in middle age, tenth biggest among the old). It averages around 48,000, though, so for there to be 100,000 excess deaths the rate would have had to have tripled this year. Is that plausible? I have no idea. Suicide numbers aren't available the same year in the USA; only Japan publishes its numbers the same year among industrialized nations. Japan's rate is up 16% after a ten year decline, which is 1/10th what we'd need to be seeing here. (Our rate has been steadily increasing over the last twenty years.)

The murder rate is in fact way up, but 'way up' means 50% more than usual in major cities. Most of America has zero murders per county per year, so double zero is still zero. A minority of America has only a few murders per county per year, which means a very small increase. Chicago and LA are seeing around half again as many more murders this year, but that's hundreds of extra deaths not thousands.

Not sure where we are with opioid/alcohol/etc deaths. That's one I'd expect to be up, but I'd also expect that to play out over time as liver damage usually doesn't kill you right away.

Unintentional injuries? That's a major source of death -- 167,000 in a regular year. If the rate of that doubled it'd account for 167,000 extra deaths. People are out of their usual habits, maybe making mistakes doing things they don't usually do. On the other hand, they're mostly staying home in familiar and relatively safe environments. On the first hand again, though, most accidents do happen at home.

If our suicide rate has increased as much as Japan's, that's about 10,000 extra deaths. Homicide is negligible outside major cities. Chemical deaths are probably up, but that may fall under unintentional injuries for statistical purposes. So if there's money to be made in finding these extra deaths, that's probably where it is.

Of course, it may well be that 'double the unintentional deaths' isn't likely; and it's only going to account for a portion of the 400-600K anyway.

Donna B. said...

I believe there are deaths due to actions taken to curtail Covid spread. That's inevitable, but statistically negligible. Those deaths are very important to the families affected and I am sympathetic. Then there are deaths that occurred or may occur sooner than they likely would have because some people couldn't get or decided to delay treatments needed for other diseases. Could not is a rare thing, but deciding to delay needed treatment might not be. I fall into the deciding to delay some treatment and may die sooner than I would be otherwise expected to. Then again, this treatment I'm deciding to delay is one I didn't want to undergo and I'm not sure how much that reluctance accounts for. How can it be calculated how many years that might take off my life?

Then again, I wonder if my favorite aunt's death last week is going to be attributed to Covid. She'd been hospitalized for 3 weeks with Covid, not ventilated, was released and apparently doing well for the week after her release except for some shortness of breath. And then she died, suddenly. One of those gasping last breaths and then... gone. I don't know if there will be an autopsy, but I suspect it would show that the immediate cause of death was either a heart attack or stroke. The questions are was her heart weakened due to Covid and/or did Covid cause a blood clot to be more likely? She was 78 years old and I don't think those questions can be definitively answered. The timing suggests that the immediate cause could be due to a Covid infection. Her family history suggests either event was likely at her age. How will her death be counted?

In my volunteer work, I have noticed an increased tendency toward hatefulness and insulting behavior in the last few months from people that were generally agreeable in the past. I'm not anonymous to these people and it's escalated to the point I'm getting a security system and cameras installed. I think that this something unaccounted for in the "excess" area.

Christopher B said...

Ok, let's get this out of the way up front. Yes, people die from COVID.

The biggest difficult we have with this disease is, as I think you mentioned obliquely in a prior post or comment about transmission rates, that it's deadly enough to be noticeable but not so deadly to actually assist us in its eradication. There are just too many people who never become sick enough to self-quarantine and mostly unwittingly go about their routines while they spread the virus around.

At what point do we stop counting COVID deaths as excess? We are very unlikely to get rid of this bug in the short term despite the implied claims of many people. It took decades of sustained effort to eliminate smallpox. Even with the rapid production of a vaccine we're only at the starting point of the COVID effort, and we don't really know either how fast this bug will mutate or how long vaccination will provide immunity. The 'new abnormal' is pretty clearly not sustainable. We are not likely going back to life with no COVID. The longer we keep holding that out as the goal the more polarizing the conflict between those concerned about the disease and those concerned about the impact of our mitigation strategies is going to be.

Assistant Village Idiot said...

Grim - good point about the substance-abuse deaths. I had forgotten that and there are very likely some there as well. I do suddenly wonder if fewer young people have gotten involved in drugs and alcohol. Less live contact with peers, less peer pressure. Increased boredom would be a force toward more use, but there are just going to be fewer opportunities, particularly for those who are not drug-experienced.

cmarr said...

I'll bet the total white space underneath the yellow line is about equal to the amount of excess deaths. Doesn't that mean overall we are still at average deaths? It looks like we have been under the excess death curve for most of the time, so something has to come along and equal that out eventually else we would start living forever.

Texan99 said...

I'd be amazed if someone could show me that there are no excess COVID deaths at all. It remains to be seen whether we're counting them honestly. An even harder question is whether they're higher or lower than they might have been if we had done things differently, in terms of either prevention or treatment.

But when someone is reasonably healthy for his age, comes down with a clear symptomatic case, and is dead a couple of weeks later, that doesn't leave me much room to argue. I know personally of too many cases to discount the existence of that experience. Would this 75-year-old person have died soon in any case? Who knows? But we don't apply that standard to car accidents, if we're trying to figure out how to make cars safer. At most, we might take it into account if trying to decide between a car-safety measure that saved 3-year-olds rather than 95-year-olds, when we couldn't afford (or didn't have time for) both.

Zachriel said...

Texan99: It remains to be seen whether we're counting them honestly.

Excess deaths track closely to the COVID death count, whether overall or monthly, and whether divided into subsets such as U.S. states or other countries and their regions.

Christopher B: At what point do we stop counting COVID deaths as excess?

Excess deaths are compared to the average over years, adjusted for demographic changes. So they will stop being excess when the no longer skew significantly higher than the average. They would become part of background deaths, such as heart disease or influenza.

cmarr: I'll bet the total white space underneath the yellow line is about equal to the amount of excess deaths.

That's clearly not true in the latter half of the graph. There is no white space below the yellow line.

You may not be reading the graph correctly. The actual average is below the yellow line. There are always random fluctuations in deaths. There is a 95% chance that random fluctuations will remain below the yellow line. Excess deaths are far above the 95% line. Not only that, but when there is an outbreak, as observed by hospital admissions, excess deaths follow within a few weeks, and this is true wherever in the world the outbreak occurs.

There's no reasonable doubt about the COVID numbers. That doesn't mean the count is perfectly accurate. It's not. However, it is generally correct, and certainly better than someone who discounts the figures entirely.

cmarr: It looks like we have been under the excess death curve for most of the time, so something has to come along and equal that out eventually else we would start living forever.

People are dying sooner than they otherwise would have. Their deaths occurred in 2020-21 instead of in 2025 or 2040. As COVID generally affects older people, the population will be a bit younger going forward.

Zachriel said...

Assistant Village Idiot: Excess Deaths ... If you want to take that tack, then show your numbers, not just scattered reports of those

Excellent analysis, by the way.