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December 17, 2020

COVID-19 as the Leading Cause of Death in the United States

Author Affiliations
  • 1Center on Society and Health, Virginia Commonwealth University, Richmond
  • 2Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
JAMA. 2021;325(2):123-124. doi:10.1001/jama.2020.24865

The current exponential increase in coronavirus disease 2019 (COVID-19) is reaching a calamitous scale in the United States, potentially overwhelming the health care system and causing substantial loss of life. The news media dutifully report each day’s increase in new cases and deaths, but putting these numbers in perspective may be difficult. The daily US mortality rate for COVID-19 deaths is equivalent to the September 11, 2001, attacks, which claimed 2988 lives,1 occurring every 1.5 days, or 15 Airbus 320 jetliners,2 each carrying 150 passengers, crashing every day.

A helpful approach to put the effects of the pandemic in context is to compare COVID-19–related mortality rates with the leading causes of death that, under ordinary circumstances, would pose the greatest threat to different age groups.3 The conditions listed in the Table include the 3 leading causes of death in each of the 10 age groups from infancy to old age. Using data from the Centers for Disease Control and Prevention, the Table shows mortality rates for these conditions during the period of March through October 20184 (the most recent year for which detailed cause-of-death data are available) with COVID-19 mortality rates during March through October 2020.5

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    9 Comments for this article
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    Regional Infections
    John Kugler, PhD Leadership for K-12 | Chicago Teachers Union
    Appreciate the effort to collect and disseminate data in real time. My comment is more of a containment concern. Are we looking into regional infection variables over time, so we can understand and possibly try to find the reasons the virus is spreading across the nation, thereby mitigating risk to non-infected individuals?
    CONFLICT OF INTEREST: None Reported
    Misleading Title
    Geraldo Cury, PhD | Full Professor of Federal University of Minas Gerais, Brazil
    The article title is misleading because the data presented show that the leading cause of death in the USA is heart disease. According to the data presented, COVID -19 is the third leading cause of death in the period analyzed.
    CONFLICT OF INTEREST: None Reported
    Getting the Scale Right
    Bill Kinsey, PhD | Leiden University
    The daily mortality rates are interesting, but the comparison with 9/11 mortality or the equivalent number of Airbus crashes may fail to give the needed perspective. So how about this? The number of Covid deaths in the US in some 10-11 months of 2020 already exceeds the total number of US military deaths in the nearly four years of the Second World War. Very shortly, Covid deaths will exceed all US military deaths in all the combined wars -- WWII, Korea, Vietnam and the Middle East -- since 1940.
    CONFLICT OF INTEREST: None Reported
    Simple, Scientific & Disciplined Action Needed
    Dr Narayan Bahadur Basnet, MBBS, MPA, PG Ped., Ph.D. | Children’s Medical Diagnosis Center (CMDC), Chabahil, Kathmandu
    Thank you for publishing the alarming situation of COVID-19 especially in a scientifically advanced nation such as the US. I am very sad to read these data, and suggest immediately that people try to follow endless best efforts that we already know control this virus particle. Universal use of masking, physical distancing, and handwashing are already known to be effective measures of controlling this menace (1). Always mind everybody’s face hygiene since face, specially nose and mouth, are the home of this virus!  Regarding this pandemic we must follow simple, scientific, universal voice and action at all strata of society. A disciplined lifestyle may be very useful until we find the combination of intervention to control spread of the virus!

    Reference:
    1. Basnet NB. http://www.inquestpublications.com/pdf/ajfmph-v1-1001.pdf
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Compare to 1918 flu?
    Timothy Bukowski |
    How does this compare to 1918 flu ?
    CONFLICT OF INTEREST: None Reported
    Title of the article misrepresents the data
    Erik Peper, PhD | San Francisco State University
    The title misrepresents the data. COVID-19 according to the data in the table is the third leading cause of death not the first. In addition, it misrepresents the data since the table does not include the death rate of 2020 upper respiratory infections. If those went down then they are partly embedded in the COVID-19 death rate.
    CONFLICT OF INTEREST: None Reported
    Unrelated Comparison
    Zhong Zhao, MD, PhD | Southwest Health Care
    JAMA as a major medical journal has played a very important role in scientific research. However, I was quite concerned after reading the article about Covid-19 as the leading cause of death in the US. I don't disagree with data and facts. However comparing these data with death numbers from unrelated events carries very strong political implications. Maybe the author intends to compare the current Covid-19 situation to the tragic events that hurt Americans the most so that people will be more serious about it. I am afraid such comparison could add unintended consequence. 

    I don't think the
    author had thought about this potential side effect before publishing the article.
    CONFLICT OF INTEREST: None Reported
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    Clarifications
    Jason Gagliano, PhD | Technical School
    Thanks for the paper. It makes several good points to consider.

    I would like to see a few clarifications:

    1) As others have stated, how does the data support the title? Maybe the authors meant to write "...as A Leading Cause" rather than "...the Leading Cause"?

    2) How were the totals calculated in the table?

    Perhaps the CDC's data on tobacco can also be included. According to the CDC, ~500,000 people die annually from tobacco use. This along with cancer and heart disease (in the table) are clearly higher than current COVID-related deaths. Of
    course, one would need to subtract out the number of deaths for tobacco-related cancer and heart disease (e.g. ~160,000 each) and recalculate the numbers. Interestingly, tobacco use relates to your good point on 'the transmission of morbidity and mortality', since second-hand smoke can also be deadly.

    Best Wishes
    CONFLICT OF INTEREST: None Reported
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    In Whom is Covid-19 a Leading Cause of Death?
    Carol Cancelliere, MPH, PhD | Ontario Tech University
    Covid-19 is the 3rd leading cause of death at the time of this article. Are other stratifications possible other than age, e.g., sex, race, co-morbidity status, geographic region, education level? In other words, if Covid-19 is a leading cause of death, in whom is it a leading cause of death?
    CONFLICT OF INTEREST: None Reported
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