October 21, 2020

Nearly 300,000 more Americans have died this year than usual, CDC says

Daily Briefing

    America has seen nearly 300,000 more deaths during its coronavirus epidemic than would have been expected in a typical year, with about 66% of those deaths attributed directly to the novel virus, according to a CDC Morbidity and Mortality Weekly Report released Tuesday.

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    The report comes as U.S. officials as of Wednesday morning reported a total of 8,316,000 cases of the novel coronavirus since the country's epidemic began—up from about 8,255,400 cases reported as of Tuesday morning.

    According to the New York Times, the United States' average daily number of newly reported coronavirus cases over the past week was 60,159—which is up by 36% when compared with the average from two weeks ago. On Tuesday, U.S. officials reported about 60,590 new cases of the virus, the Times reports.

    Data from the Times shows that the rates of newly reported coronavirus cases are "staying high" in Guam, Puerto Rico, and 31 states that have had a daily average of at least 15 newly reported cases per 100,000 people over the past week. Those states are Alabama, Alaska, Arkansas, Colorado, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming.

    Twelve states that have had comparatively low case rates are now seeing those rates "going up," according to the Times. Those states are Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, New Hampshire, New Jersey, Oregon, Pennsylvania, Virginia, and Washington.

    In the nine remaining U.S. states and territories, rates of newly reported coronavirus cases are "staying low," according to the Times' analysis.

    U.S. officials as of Wednesday morning also reported a total of 220,987 deaths linked to the coronavirus since the country's epidemic began—up from about 220,058 deaths reported as of Tuesday morning.

    Researchers set out to determine coronavirus epidemic's actual death toll

    Public health officials have long believed that the United States' reported number of deaths tied to the coronavirus likely was an undercount, and CDC in its new report also noted that the country's reported coronavirus death toll "might underestimate the total impact of" the country's epidemic "on mortality."

    For the report, CDC researchers first measured the number of so-called "excess deaths" that have occurred in the country since the epidemic began. CDC defined excess deaths "as the number of persons who have died from all causes, in excess of the expected number of deaths for a given place and time." The researchers calculated their estimate of excess deaths by using regression models and provisional mortality data spanning Jan. 26 through Oct. 3 from CDC's National Vital Statistics System.

    The researchers then analyzed weekly numbers of deaths by age group and race and ethnicity to determine the difference between the weekly number of deaths occurring in 2020 and the average number of deaths that occurred during the same weeks over the four-year period from 2015 to 2019. The researchers also determined the percentage change in excess deaths between the four-year period spanning 2015-2019 and 2020.

    America's had nearly 300K more deaths than expected in 2020

    Overall, the researchers estimated that 299,028 more people in the United States died from Jan. 26 through Oct. 3 of this year than would have been expected in a typical year. Of those excess deaths, the researchers attributed 198,081—or 66%—to Covid-19, the disease caused by the novel coronavirus.

    According to the researchers, America's number of excess deaths so far this year peaked during the weeks ending on April 11 and Aug. 8, with the country’s percentage of excess deaths reaching 40.4% and 23.5%, respectively, during those weeks. In addition, the researchers found that the country's estimated number of excess deaths varied by age group, ranging from approximately 841 deaths among adults under the age of 25 to 94,646 among adults between the ages of 75 and 84. According to the researchers, the number of deaths among U.S. adults:

    • Under age 25 was 2% below average in 2020 when compared with previous years;
    • Ages 25 to 44 was 26.5% above average in 2020 when compared with previous years;
    • Ages 45 to 64 was 14.4% above average in 2020 when compared with previous years;
    • Ages 65 to 74 was 24.1% above average in 2020 when compared with previous years;
    • Ages 75 to 84 was 21.5% above average in 2020 when compared with previous years; and
    • Ages 85 and older was 14.7% above average in 2020 when compared with previous years.

    The researchers wrote that "[t]he age distribution of Covid-19 deaths shifted toward younger age groups from May through August," but they noted that the "disproportionate increases" in overall excess deaths among younger adults "might also be related to underlying trends in other causes of death."

    When the researchers examined excess deaths by race and ethnicity, they found that the numbers of excess deaths by group ranged from 3,412 deaths among non-Hispanic American Indian or Alaska Native adults to 171,491 deaths among white adults. According to the researchers, the number of deaths among:

    • American Indian or Alaska Native adults was 28.9% above average in 2020 when compared with previous years;
    • Black adults was 32.9% above average in 2020 when compared with previous years;
    • Hispanic adults was 53.6% above average in 2020 when compared with previous years;
    • White adults was 11.9% above average in 2020 when compared with previous years; and
    • Adults of other or unknown race or ethnicity was 34.6% above average in 2020 when compared with previous years.

    The researchers wrote that "these disproportionate increases among certain racial and ethnic groups are consistent with noted disparities in Covid-19 mortality."

    The researchers noted that their study had limitations, however, including possible lags in data on reported numbers of excess deaths and other limitations related to potential data inconsistencies. In addition, the researchers wrote that their "estimates of excess deaths attributed to Covid-19 might underestimate the actual number directly attributable to" the disease, "because deaths from other causes might represent misclassified Covid-19-related deaths or deaths indirectly caused by the" epidemic. For example, the researchers wrote, "deaths from circulatory diseases, Alzheimer disease and dementia, and respiratory diseases have increased in 2020 relative to past years, and it is unclear to what extent these represent misclassified Covid-19 deaths or deaths indirectly related to the [epidemic] (e.g., because of disruptions in health care access or utilization)."

    What do the findings mean?

    Despite the study's limitations, the researchers wrote that their findings "provide more information about deaths during the" coronavirus epidemic and can be used to "inform public health messaging and mitigation efforts focused on the prevention of infection and mortality directly or indirectly associated with" Covid-19, as well as "the elimination of health inequities."

    According to STAT News, the estimates likely account for "some otherwise untallied Covid-19 deaths—those who may have died without being tested or who died at home and whose deaths were not counted as caused by the coronavirus," as well as "people who died because they were scared to seek out medical care because of the [epidemic] or had their care interrupted, and because of other causes."

    Paul Sutton, deputy director of CDC's Division of Vital Statistics and one of the report's authors, said the findings indicate that America's coronavirus epidemic "is having a tremendous and significant impact on death in the country, and it may extend well beyond those deaths that are directly classified as Covid deaths."

    Steve Woolf—director emeritus of the Center on Society and Health at Virginia Commonwealth University, whose own research has produced similar findings on U.S. excess deaths—said, "[T[he bottom line is there are far more Americans dying from the [epidemic] than the news reports would suggest." He added, "We're likely to reach well over 400,000 excess deaths by the end of the year" if current trends continue  (Joseph, STAT News, 10/20; Owens, "Vitals," Axios, 10/21; Bernstein, Washington Post, 10/20; Rabin, New York Times, 10/20; New York Times, 10/20; Rossen et al., CDC MMWR, 10/20).

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