I want you to notice something — the blue bars are the “with COVID” portion of deaths, and the chartreuse bars are the ones “without COVID”. The bars are weekly counts of deaths when they occurred. Ignore the most recent weeks because they don’t have full data reported yet.
The red pluses indicate excess mortality, defined as exceeding the 95th percentile for expected mortality for that week (so it includes seaonality). You can see the excess mortality from the 2017-2018 flu season, which was bad for a flu season.
The non-COVID mortality has been in excessive mortality range for almost all 2020 after March. But since the beginning of 2021, it has dropped off…. and COVID mortality has also dropped off.
I think we may be almost in “normal” range soon. We shall see!
Today, June 4, Alameda County’s COVID-19 dashboard will be updated to reflect the total number of COVID-19 deaths using the State’s death reporting definition. Alameda County previously included any person who died while infected with the virus in the total COVID-19 deaths for the County. Aligning with the State’s definition will require Alameda County to report as COVID-19 deaths only those people who died as a direct result of COVID-19, with COVID-19 as a contributing cause of death, or in whom death caused by COVID-19 could not be ruled out. Based on data available as of May 23, 2021, this update will decrease the overall number of deaths from 1,634 to 1,223.
This update does not disproportionally impact reported deaths for any specific race or ethnic group or zip code.
Close observers of Alameda County’s dashboard may have noticed a substantial increase in the COVID-19 death totals prior to this update, during the week of May 17. This increase was due to a separate quality assurance process intended to correct previously incomplete data; adjustments were made based on additional information that became available regarding date of death and county of residence. These corrections are unrelated to the current alignment with the State’s definition of death due to COVID-19, and some of the deaths will be removed from the updated totals because COVID-19 was not a contributing cause.
Author(s): Neetu Balram
Publication Date: 4 June 2021
Publication Site: Alameda County Health Care Services Agency
Alameda County revised the total number of deaths caused by the coronavirus to 1,223, down from 1,634.
County officials decided to revise the numbers to align with the California Department of Public Health’s guidance on how to classify deaths. The county previously included deaths of anyone infected with the virus, regardless of whether COVID-19 was a direct or contributing cause of death.
Mortality in 2020 significantly exceeds what would have occurred if official COVID-19 deaths were combined with a normal number of deaths from other causes. The demographic and time patterns of the non-COVID-19 excess deaths (NCEDs) point to deaths of despair rather than an undercount of COVID-19 deaths. The flow of NCEDs increased steadily from March to June and then plateaued. They were disproportionately experienced by working-age men, including men as young as 15 to 24. The chart below, reproduced from Mulligan (2020b), shows these results for men aged 15–54. To compare the weekly timing of their excess deaths to a weekly measure of economic conditions, Figure 1 also includes continued state unemployment claims scaled by a factor of 25,000, shown together with deaths.
The overall age-adjusted mortality rate for 2020 was 828.7 deaths per 100,000 of population. This rate was 15.9% greater than the 2019 overall age-adjusted mortality rate. This high level of mortality has not been experienced in the U.S. since 2003.
If deaths coded as COVID (COVID deaths)3 were excluded, the overall age-adjusted 2020 mortality rate would have been 737.2 per 100,000 or 3.1% higher than the 2019 rate. This increase excluding COVID deaths is also noteworthy because it reverses the two previous calendar years of decreasing mortality; however, some or all of this may be due to the misclassification of CODs as discussed in Section 6.
2020 mortality rates increased in both sexes, with the male rates increasing more than the female rates. The differences in the increases between males and females were about 3% when all causes of death (CODs) are included and about 1% when COVID deaths are excluded.
The slope of the 2020 COVID mortality curve by age group is not as steep as the slope of the non-COVID deaths, indicating that COVID impacts younger ages more evenly across age groups that all other non-COVID CODs combined.
In the review of the 2020 mortality rates by age group, it is interesting to see that the highest percentage increases were in the younger adult ages, not at the very old ages. When COVID deaths were removed, ages 15-44 saw the largest increases in mortality rates.
In particular, it is pretty clear to me that specifically in the U.S., the non-COVID excess mortality has been very high. I do not think that’s under-counted COVID deaths. I think it’s due to other causes. We’ve already seen that car accident deaths were up, even though total miles driven was down by a lot.
So yay for their statistics in grabbing the excess deaths, but boo for assuming all those excess deaths were COVID.
Now, results of COVID and COVID policies, sure, I’d go with that. But do you want to start digging into the stats of suicides, drug overdoses, “accidental” deaths, and more? How about deaths of neglect? I bet that is involved in a bunch of non-COVID elderly deaths.
A 30-year-old American is three times more likely to die at that age than his or her European peers. In fact, Americans do worse at just about every age. To make matters more grim, the American disadvantage is growing over time.
In 2017, for example, higher American mortality translated into roughly 401,000 excess deaths – deaths that would not have occurred if the US had Europe’s lower age-specific death rates. Pre-pandemic, that 401,000 is about 12% of all American deaths. The percentage is even higher below age 85, where one in four Americans die simply because they do not live in Europe.
There have been many efforts to account for the US mortality disadvantage. There is no single answer, but three factors stand out. First, death rates from drug overdose are much higher in the US than in Europe and have risen sharply in the 21st century. Second is the rapid rise in the proportion of American adults who are obese. In 2016, 40% of American adults were obese, a larger proportion than in Europe. Higher levels of obesity in the US may account for 55% of its shortfall in life expectancy relative to other rich countries. Third, the US stands out among wealthy countries for not offering universal healthcare insurance. One analysis suggests that the absence of universal healthcare resulted in 45,000 excess deaths at ages 18-64 in 2005. That number represents about a quarter of excess deaths in that age range.
Above age 65, healthcare insurance coverage is nearly universal via Medicare. An international review of medical practice by the National Academy of Sciences suggested that the US does comparatively well in identifying and treating cardiovascular diseases and many cancers. But the prevalence of these diseases, the principal killers in wealthy countries, is unusually high in the US. Heart disease, a type of cardiovascular disease and America’s number one cause of death for decades, is strongly linked to lifestyle factors such as obesity. Although the connection between obesity and health risks is well known, consumer preferences for unhealthy food are strong. Not just because humans are biologically vulnerable to sweets and fats, but because major food producers and distributors are incentivized to turn this weakness into profit.
Variations in the age patterns and magnitudes of excess deaths, as well as differences in population sizes and age structures make cross-national comparisons of the cumulative mortality impacts of the COVID-19 pandemic challenging. Life expectancy is a widely-used indicator that provides a clear and cross-nationally comparable picture of the population-level impacts of the pandemic on mortality. Life tables by sex were calculated for 29 countries, including most European countries, Chile and the USA for 2015-2020. Life expectancy at birth and at age 60 for 2020 were contextualised against recent trends between 2015-19. Using decomposition techniques we examined which specific age groups contributed to reductions in life expectancy in 2020 and to what extent reductions were attributable to official COVID-19 deaths. Life expectancy at birth declined from 2019 to 2020 in 27 out of 29 countries. Males in the USA and Bulgaria experienced the largest losses in life expectancy at birth during 2020 (2.1 and 1.6 years respectively), but reductions of more than an entire year were documented in eleven countries for males, and eight among females. Reductions were mostly attributable to increased mortality above age 60 and to official COVID-19 deaths. The COVID-19 pandemic triggered significant mortality increases in 2020 of a magnitude not witnessed since WW-II in Western Europe or the breakup of the Soviet Union in Eastern Europe. Females from 15 countries and males from 10 ended up with lower life expectancy at birth in 2020 than in 2015.
Author(s): José Manuel Aburto, Jonas Schöley, Ilya Kashnitsky, Luyin Zhang, Charles Rahal, Trifon I. Missov Melinda C. Mills, Jennifer B. Dowd, Ridhi Kashyap