The Centers for Disease Control and Prevention must learn from the mistakes it made during the height of the COVID-19 pandemic if it wants to win back public trust, according to Wharton health care management professor Ingrid Nembhard.
She thinks CDC Director Rochelle Walensky is on the right path to do just that. Walensky, who was appointed by President Joe Biden in 2021, has announced a major overhaul to modernize the agency and get the public messaging right.
Nembhard is particularly hopeful about Walensky’s focus on changing the culture at the CDC. The infrastructure to conduct the science and disseminate the information is vital, but so is the culture. Reports have surfaced that paint the agency as clunky with a risk-averse culture.
“If you have all of the structures but nobody is speaking up, where are you?” Nembhard said. “You don’t have all the information that you need, and I think that’s been one of the realities that we’ve seen them having to deal with. You really do need to have your systems in place to be flexible, to be able to manage under ever-changing circumstances.”
Early government mortality numbers show that the number of U.S. deaths has stayed very high this summer, both for members of the general population and for working-age people.
For all U.S. residents, for the period from July 3 through Aug. 27, the number of deaths recorded in the U.S. Centers for Disease Control and Prevention’s FluView reports was 426,881, according to the report released Friday, which included data sent to the CDC by Sept. 3.
The “all cause” total for the general population was down just 0.8% from the total for the comparable period in 2021, and it was 22% higher than the total for the comparable period in 2019, before the COVID-19 pandemic began.
For U.S. residents ages 25 through 64, the all-cause death total during that same period was 113,665, according to early, weighted data in the CDC’s Weekly Counts of Deaths by Jurisdiction and Age reports, as of Sept. 8.
To what extent, are these drops of life expectancy due to Covid-19, rather than other causes?
From 2019 to 2020, the CDC reports that 90% of the drop in Hispanic life expectancy was attributable to Covid; the corresponding rates were 68% for whites and 59% for blacks. (No breakdown was provided for the AIAN or Asian categories.) However, the CDC data splits its breakdowns into “contributions to decreases” and “contributions to increases” rather than overall net effect. Those readers who are used to looking at data and charts will expect a “waterfall” style chart; the CDC version is not this, and is not particularly helpful.
In any event, relative to the 2020 baseline, the further decreases in life expectancy during 2021 had multiple causes. Only among the White demographic group was Covid the cause of over half of the decline; unintentional injury (including overdoses) was the second-largest contributing factor and for the AIAN demographic group, worsening rates of death due to chronic liver disease and cirrhosis played almost as substantial a role.
And, finally, it is important to understand that the CDC data shows a continued improvement in life expectancy due to reductions in death due to such causes as influenza/pneumonia, COPD/emphysema, Alzheimer disease, diabetes, and perinatal conditions (infant deaths). In fact, strikingly, in 2021, heart disease was a contributor to increased life expectancy in the Black, Hispanic, and Asian demographic groups, but a contributor to decreased life expectancy for the White and AIAN groups.
Again, though, the way the CDC provides its information means that, when it comes down to it, there is much that is simply missing; we do not know the magnitude of the improvements in life expectancy due to these causes, just that it exists. It even seems likely, or at least possible, that some of the apparent improvement in mortality due to these factors was actually because deaths were actually recorded as Covid deaths instead (whether due to multiple causes of death or other reasons).
Over the past two decades, the U.S. maternal mortality rate has not improved while maternal mortality rates have decreased for other regions of the world. Furthermore, the rate at which women in the U.S. experience short-term or long-term negative health consequences due to unexpected outcomes of pregnancy or childbirth has also steadily increased over the past few decades, with nearly 50,000 women in the U.S. experiencing these health consequences in 2014. Significant racial and ethnic disparities persist in both the rate of women in the U.S. who die due to complications of pregnancy or delivery and the rate that women experience negative health consequences due to unexpected pregnancy or childbirth outcomes.
Compared to any other racial or ethnic group,7 Black8 women experience the highest rates of nearly all of Centers for Disease Control and Prevention’s (CDC) severe maternal morbidity9 indicators.10 Black women in the U.S. are 3 to 4 times more likely to die from pregnancy-related complications than White11 women in the U.S., and Native American12 women are more than 2 times more likely to die from pregnancy-related complications than White women in the U.S.13 Pregnancy-related mortality is also slightly elevated for Asian women (a 1.1 disparity ratio),14 and for Hispanic women in some geographic areas.15 Moreover, the risk of pregnancy-related death is so elevated for Black women in certain regions of the U.S. that it is comparable to the
rate of pregnancy-related deaths16 in some developing countries.17 This racial disparity has not improved in decades,18 and is also seen in other middle to high-income countries with multiethnic populations.19 According to the World Health Organization (WHO), the U.S. maternal mortality ratio ranked 56th in the world in 2017.20 According to the National Center for Health Statistics (NCHS), in 2018, the maternal mortality rate in the U.S. was 17.4 maternal deaths per 100,000 live births, with 658 women dying of maternal causes.21 In 2019, the maternal mortality rate in the U.S. was 20.1 maternal deaths per 100,000 live births, with 754 women dying of maternal causes.
On September 15, 2021, the U.S. Commission on Civil Rights published a report entitled Racial Disparities in Maternal Health (the “Report”). This Dissenting Statement and Rebuttal (the “Statement”) is a part of that report.
Among other things, the Statement points out several errors in Report. For example, the Report incorrectly states that maternal mortality has increased 50% over the last generation. What has actually happened is that changes in death certificates have caused more deaths to be classified as maternal in nature. The Report also emphasizes the theory that racism plays a prominent role in causing racial disparities in maternal mortality. The Statement points out in response that maternal mortality rates for Hispanic and Asian American mothers are lower than the rate for white mothers. This tends to detract from the theory that racism is what’s causing the disparities.
Black pregnant women continue to face disproportionately high pregnancy-related deaths, with data from the Centers for Disease Control and Prevention indicating a 26 percent increase in the maternal mortality rate for Black women since the start of the pandemic.
Though researchers do not have an explanation for the disparities, the research suggests it’s a culmination of institutional racism and other health factors, such as the increased risk of obesity and hypertension in Black women. Howell also added that stress and a lack of access to quality prenatal care further exacerbates this issue.
“It really does boil down to how public health officials relate to Black women who are giving birth,” Howell said. “Statistics about Black maternal mortality are high across the board, no matter what your educational level is, no matter what your insurance level is.”
In 2018, tennis star Serena Williams opened up in an interview with Vogue magazine about encountering severe health complications after giving birth because doctors neglected to listen about her existing medical conditions.
“When you have someone like Serena Williams having problems giving birth, and not being treated properly by nurses and doctors when she complains about not feeling well, then you look at the doctor of someone who is poor in Louisiana, and has the same kind of problem — they are probably treated even worse,” Howell said.
The slide was shared on Twitter by Dr. Katelyn Jetelina (“Your Local Epidemiologist”), and retweeted by many influential people including Jerome Adams, Julia Raifman (tweet now deleted), Gregg Gonsalves, and Leana Wen. Only problem? It’s completely and utterly false. The pre-print it’s based on includes significant errors that invalidate the results. And the slide makes additional errors on top of the pre-print. It’s really disturbing that data this poor made its way into the meetings to discuss childhood Covid, and that it took me less that a few minutes to find a major flaw (and then I found many more as I looked deeper). I contacted the study’s corresponding author, Dr. Seth Flaxman, who originally said he’d get back to me on Monday, but responded early Sunday morning to get more information about the source of the Underlying Cause of Death data I used for Covid (the CDC WONDER database, Provisional Mortality Statistics, 2018-present). He later posted on Twitter to say than an updated pre-print would be available soon.
The second major issue with the pre-print are the time periods for the deaths. The underlying cause of death data is for a single year – 2019 (more on that later). However, the rankings of Covid deaths by age group in the pre-print include both cumulative (over 26 months) AND annualized deaths for some strange reason. That means Covid is inexplicably ranked twice for each age group.
Below is the table ranking leading causes of death for 15-19 year olds. Notice that Covid is listed both as the 4th AND the 6th leading cause of death. This is non-sensical and extremely misleading. It is completely inappropriate to compare the cumulative number of Covid deaths over 26 months to deaths from other causes over a one year period. The only way to make a fair comparison is to use an annualized number. There’s no good reason the cumulative number of Covid deaths over 26 months should be included on this list at all.
This last week, the CDC held their ACIP meeting to discuss whether or not they should recommend the COVID vaccines for children 6 months to 5 years old. While presenting on the danger of the virus for children, a slide was shown claiming that COVID presented as one of the leading causes of death for children.
Kelley, who runs covid-georgia.com, saw this slide and immediately knew it was false. She has been tracking COVID data in excruciating detail in Georgia since the beginning of the pandemic and has recently become an expert on the CDC’s pediatric death data simply because it was such a disaster and she wanted to get down to the truth of the matter.
This slide above is no small error. Not only did it count the wrong number for pediatric COVID deaths, it compared all pediatric COVID deaths in a 26-month period to annualized deaths from other causes. This is a massive data error, and yet it persisted through a supposedly rigorous data check from 11 authors and was selected by top-tier scientists for their landmark presentation to the most knowledgeable experts in the field.
Author(s): Matt Shapiro
Publication Date: 21 Jun 2022
Publication Site: Marginally Compelling at substack
U.S. births increased last year for the first time in seven years, according to federal figures out on Tuesday that offer the latest indication the pandemic baby bust was smaller than expected.
American women had about 3.66 million babies in 2021, up 1% from the prior year, according to provisional data from the Centers for Disease Control and Prevention’s National Center for Health Statistics. It was the first increase since 2014. The rebound spanned age groups, with birthrates rising for every cohort of women age 25 and older.
Births still remain at historically low levels after peaking in 2007 and then plummeting during the recession that began at the end of that year. The total fertility rate — a snapshot of the average number of babies a woman would have over her lifetime — was 1.66 last year, up from 1.64 the prior year, when it fell to the lowest level since the government began tracking it in the 1930s.
Methods—Data are based on 99.94% of all 2021 birth records received and processed by the National Center for Health Statistics as of February 10, 2022. Comparisons are made with final 2020 data and earlier years.
Results—The provisional number of births for the United States in 2021 was 3,659,289, up 1% from 2020 and the first increase in the number of births since 2014. The general fertility rate was 56.6 births per 1,000 women aged 15–44, up 1% from 2020 and the first increase in the rate since 2014. The total fertility rate was 1,663.5 births per 1,000 women in 2021, up 1% from 2020. Birth rates declined for women in age groups 15–24, rose for women in age groups 25–49, and was unchanged for adolescents aged 10–14 in 2021. The birth rate for teenagers aged 15–19 declined by 6% in 2021 to 14.4 births per 1,000 females; rates declined for both younger (aged 15–17) and older (aged 18–19) teenagers. The cesarean delivery rate rose to 32.1% in 2021; the low-risk cesarean delivery rate also rose to 26.3%. The preterm birth rate rose 4% in 2021 to 10.48%, the highest rate reported since 2007.
Author(s): Brady E. Hamilton, Ph.D., Joyce A. Martin, M.P.H., and Michelle J.K. Osterman, M.H.S., Division of Vital Statistics, National Center for Health Statistics
States are categorized from highest rate to lowest rate. Although adjusted for differences in age-distribution and population size, rankings by state do not take into account other state specific population characteristics that may affect the level of mortality. When the number of deaths is small, rankings by state may be unreliable due to instability in death rates.
Drug-overdose deaths in 2021 topped 100,000 for the first time in a calendar year, federal data showed, a record high fueled by the spread of illicit forms of fentanyl throughout the country.
More than 107,000 people in the U.S. died from drug overdoses last year, preliminary Centers for Disease Control and Prevention data released Wednesday showed, roughly a 15% increase from 2020. The proliferation of the potent synthetic opioid fentanyl has been compounded by the destabilizing effects of the Covid-19 pandemic on users and people in recovery, according to health authorities and treatment providers.
The U.S. has recorded more than one million overdose deaths since 2000, and more than half of those came in the past seven years.
The agency has counted about 103,600 overdoses for 2021 but believes the number is several thousand higher due to suspected overdoses that haven’t yet been confirmed by local death investigators, Dr. Anderson said.