Excess Deaths From COVID-19 and Other Causes, March-April 2020 | Infectious Diseases | JAMA | JAMA Network
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Excess mortality gives a more complete picture of the death toll of coronavirus disease 2019 (COVID-19) than official daily estimates. A research letter published in JAMA estimates that between March and July 2020, there were 225 530 excess deaths in the US. If the trend continues, the US could see more than 400 000 excess deaths by the end of 2020.

Weekly counts of deaths by state and select causes, 2014-2018. National Center for Health Statistics website. Updated June 5, 2020. Accessed June 10, 2020. https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-State-and-Select-Causes/3yf8-kanr
Weekly counts of deaths by state and select causes, 2019-2020. National Center for Health Statistics website. Updated June 10, 2020. Accessed June 10, 2020. https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-State-and-Select-Causes/muzy-jte6
2018 American Community Survey 1-year estimates: table B01003. US Census Bureau website. Accessed May 15, 2020. https://data.census.gov/cedsci/table?hidePreview=false&tid=ACSDT1Y2018.B01003&t=Total%20population&vintage=2018
QuickFacts: New York City, New York. US Census Bureau website. Accessed May 15, 2020. https://www.census.gov/quickfacts/newyorkcitynewyork
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    4 Comments for this article
    Confounding Variable and Secondary COVID-19 Deaths
    Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, Physician Specialist (retired)
    Thank you for the illuminating research publication. A major confounding variable in any current COVID-19 mortality study will be the change in definitions of the COVID-19 cause of death by the WHO and on death certifications midstream through this pandemic. I would also like to point out that there are many more what may be called 'secondary COVID-19 deaths' that are related to the conditions caused by the virus, but not directly due to infection from the virus. For example, we appear to be witnessing an increase in fatal drug overdoses and suicides during the pandemic. It may be that fatal domestic violence has also increased. COVID-19 may have more far reaching effects on our health than we initially realized. Thank you and stay safe.
    First Do No Harm
    Ben Park, MD | Physician
    Data are and have been available on the health consequences of unemployment, loss of a small business, delay in life saving procedures, failure to vaccinate our population, and the failure to educate our children. During the COVID pandemic we have experienced all of these. Dr. Scott Atlas and his business professor co-authors suggest that we have already lost twice as many years of life from our policy as we have from COVID (1). As COVID mortality slows the adverse impact from the lockdown continues unabated.

    In another article addressing only mortality from job loss (2), authors used administrative data
    on the quarterly employment and earnings of Pennsylvanian workers in the 1970s and 1980s matched to Social Security Administration death records covering 1980–2006 to estimate the effects of job displacement on mortality. This article forecasts much greater loss of lives from the current policy than Dr. Atlas's paper.

    When we believed the mortality rate to be 3.4% closing the borders and shutting down the economy was clearly the right approach. When we got data and then failed to adjust our approach we failed our patients. We do not hesitate to change clinical practice when research shows our current approach is wrong. We must also follow this principle with regard to COVID.


    1. https://www.iedm.org/wp-content/uploads/2020/05/lepoint092020_en.pdf
    2. The Quarterly Journal of Economics, 2009, vol. 124, issue 3, 1265-1306
    Alzheimer/Dementia Excess Mortality
    James Gill | CT Office of the Chief Medical Examiner
    This letter reports that the five states with the most COVID-19 deaths experienced large proportional increases in deaths from non-respiratory underlying causes including Alzheimer and cerebrovascular diseases. A non-respiratory underlying cause of death does not mean that the death did not have a respiratory-related, immediate cause of death. Bronchopneumonia is a common immediate cause of death in patients with dementia and with strokes. The death certificate must include the underlying cause of death (e.g., Alzheimer-type dementia) but does not have to include the immediate cause (e.g., pneumonia). The absence of a respiratory process on the death certificate should not be assumed to mean absence of a respiratory infection. The certifying clinician may have decided not to include the immediate cause and/or attributed the respiratory component to a complication of the underlying disease (e.g., aspiration pneumonia due to dementia) as opposed to an intervening COVID-19 infection. Investigative follow-up in real-time by the medical examiner, or later by the public health department, have found and will find more COVID-19 deaths among these groups particularly in deaths at nursing homes which have many residents with dementia and stroke.
    Possible Understatement of Excess Deaths
    Daniel Frank, MD | MedNorthwest
    This valuable paper shows a spike in mortality, both from obvious COVID-19 as well as from other causes that may have been primarily or secondarily related to SARS-CoV-2 infection. A breakdown by age might add additional information. If expected mortality among younger individuals is lower during this time, owing to fewer motor vehicle deaths for example, then we might be understating the true excess mortality in older populations at higher risk for death from COVID-19.
    Research Letter
    July 1, 2020

    Excess Deaths From COVID-19 and Other Causes, March-April 2020

    Author Affiliations
    • 1Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond
    • 2Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond
    • 3Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
    JAMA. 2020;324(5):510-513. doi:10.1001/jama.2020.11787

    The number of publicly reported deaths from coronavirus disease 2019 (COVID-19) may underestimate the pandemic’s death toll. Such estimates rely on provisional data that are often incomplete and may omit undocumented deaths from COVID-19. Moreover, restrictions imposed by the pandemic (eg, stay-at-home orders) could claim lives indirectly through delayed care for acute emergencies, exacerbations of chronic diseases, and psychological distress (eg, drug overdoses). This study estimated excess deaths in the early weeks of the pandemic and the relative contribution of COVID-19 and other causes.

    Weekly death data for the 50 US states and the District of Columbia were obtained from the National Center for Health Statistics for January through April 2020 and the preceding 6 years (2014-2019).1,2 US totals excluded Connecticut and North Carolina because of missing data. The analysis included total deaths and deaths from COVID-19, influenza/pneumonia, heart disease, diabetes, and 10 other grouped causes (Supplement). Mortality rates for causes other than COVID-19 were available only for underlying causes. Death data with any mention of COVID-19 on the death certificate (as an underlying or contributing cause) were used to capture all deaths attributed to the virus. Population counts for calculating mortality rates were obtained from the US Census Bureau.3,4