The real death toll from the pandemic in America may already be 300,000

The official Covid-19 mortality figures might be dramatically underestimating the real death toll of the pandemic in the US, according to a new report from the Centers for Disease Control and Prevention (CDC).

From late January to early October, nearly 300,000 “excess deaths” occurred in America, the report authors estimate. That’s about a third more than the 216,025 coronavirus deaths the US reported in the same period.

Excess mortality is a figure that simply calculates how many more people died, of any cause, in a given period and place than what would be typically expected based on historical averages.

It’s important to track excess deaths during a pandemic because official mortality counts may not capture undiagnosed fatal infections, or those who died of causes indirectly related to the virus, such as interruptions in health care. We know of a few such interruptions in the US already: people experiencing heart attacks have been forgoing emergency room visits, and drop-offs in cancer screenings. We also know, from Brazil to Indonesia, excess deaths are way up this year.

To come to an American estimate, the CDC authors looked at weekly death rates by age group and ethnicity this year, and compared those to the averages for 2015 through 2019.

According to the report, 66 percent of the estimated 299,028 excess deaths could be attributed to Covid-19, while the remaining third were linked to other causes — such as misclassified Covid-19 deaths, or deaths from “disruptions in health care access or utilization.”

Young people experienced the greatest relative increase in excess deaths

The most attention-grabbing finding relates to the pandemic’s toll on young people: For 25- to 44-year-olds, the excess death rate is up 27 percent. That’s the largest percentage increase of any age group.

“Historically, increases in death rates like this are rare among young people,” said Sam Harper, a population health researcher at McGill University, “especially across all population groups simultaneously.”

But while the number is certainly worrisome, it also needs to be put in context, Harper added. The report authors were using relative increases in deaths to describe the changes. Since younger people have a much lower death rate at baseline than older groups — 2,500 deaths per week among 25- to 44-year-olds compared to 10,000 per week among 45- to 64-year-olds — “even a few more additional deaths in 2020 will have a much greater impact using this metric,” Harper said.

So, for example, an extra 1,000 deaths would cause a 40 percent mortality increase among 25- to 44-year-olds. But to get to a 40 percent mortality increase among 45- to 64-year-olds, an additional 4,000 people would need to die, Harper explained. And that’s why, in absolute terms, it’s still the older age groups that have borne the brunt of deaths in the pandemic.

Dartmouth economist Jonathan Skinner put it more bluntly: “The absolute mortality rates are one hundred times higher for the 75 to 84 year olds compared to younger folks. That to me is still the take-away finding.”

Look at the breakdown of excess deaths by age group, and you can see the scale of the problem in younger versus older cohorts more clearly:

CDC

But while the coronavirus is much less deadly in younger people compared to older groups, it’s certainly not benign. Already, some Covid-19 patients with no symptoms have been found to have heart and lung damage, while others with the disease go on to experience “long Covid,” or months of debilitating symptoms including fevers, brain fog, pain, and fatigue.

Then, there’s the health effects we don’t yet know about. “The long-term health consequences of the virus have barely been studied,” Vox’s Brian Resnick recently pointed out. “When we expose younger, healthier people ... we don’t know what the consequences of that will be down the road.”

Deaths were already on the rise in America, even among young people

Again, the CDC report doesn’t tell us which deaths in each age group are caused by Covid-19 versus other things. And even before the pandemic, the mortality rate in younger people had already been rising, said Steven Woolf, a family medicine and population health professor at Virginia Commonwealth University.

Drug overdoses and suicides were major contributors to the trend — and the arrival of the coronavirus may be exacerbating these factors.

“If young adults were already dying at higher rates from drug overdoses and suicide before the pandemic, the additional stresses brought on by the pandemic could not have helped matters,” said Woolf.

So even a small uptick in absolute terms is worth paying attention to, Harper said. “[It’s] clear that young people’s mortality is being adversely affected by the pandemic, which should drive home the message that we can’t ignore the experiences of any part of the population.”

Woolf expects that in the years ahead, we’ll find there was a lot more devastation from the pandemic than is currently visible. Future analyses could reveal, for example, a surge in deaths from chronic conditions — like diabetes, congestive heart failure, and HIV — as a result of Covid-19 disruptions in health care or job losses that lead to insurance losses. It’ll take time for these conditions to kill, but when they do, the excess death toll from Covid-19 will grow even larger.

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