Note: I’m back from a fantastically relaxing vacation!

Question: A friend of mine questions the Covid death count, asserting that we do not know that each institution reporting their count can be relied upon to provide accurate numbers (i.e. some of the individuals they are reporting as having died of Covid may have, in fact, died of something else, but Covid is listed as the cause of death). He went on to say that years from now, when we look back, we will likely see that the total rate of death from all causes during the pandemic was pretty much on par with the total rate of death from all causes in prior years; now, people are dying from Covid as compared to prior years, when they were dying from other illnesses or health complications. Is there clear data that demonstrates the overall rate of death from all causes is significantly higher during the pandemic than it has been in recent years?

Answer: We talked about mortality reporting in our Q&A of 5/5 (#Coding Deaths), about COVID mortality as compared with influenza mortality in our Q&A of 5/22 (#Monitoring), and about case fatality rates in our Q&A of 6/10 (#CFR). These posts have touched on the issues of COVID death monitoring, and largely answer your friend’s first issue/question about reporting. None of these posts, however, answer your friend’s second question/assertion on all cause deaths, so let’s address it! The short answer is: To understand the impact of COVID-19, we need to calculate “excess mortality.” In doing so, we see that deaths are MUCH higher (already 200,000+ deaths higher) during the pandemic than in other recent times. Read on for more information…

Excess Mortality Measurement

OurWorldInData offers a nice overview of excess mortality and how it’s measured. It’s a simple concept: excess mortality is the number of deaths above what would have been expected under “normal” circumstances (excess mortality= observed number of deaths during crisis period — expected number of deaths during normal period).

Excess Mortality in the USA

The NY Times ran a fantastic article with loads of great data visualizations ~10 days ago, finding that “Across the United States, at least 200,000 more people have died than usual since March… This is about 60,000 higher than the number of deaths that have been directly linked to the coronavirus.” Meanwhile, earlier in July, JAMA published a couple of papers that also reveal large increases in excess mortality in the United States — one paper concluded “the number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths” while the other paper concluded, “Between March 1, 2020, and April 25, 2020, a total of 505,059 deaths were reported in the US; 87,001 (95% CI, 86,578–87,423) were excess deaths, of which 56,246 (65%) were attributed to COVID-19.” JAMA’s accompanying editorial concluded “The United States and other countries have been focused on understanding the mortality and morbidity that can be directly measured among individuals who have tested positive for COVID-19. However, the 2 new studies published today in JAMA and JAMA Internal Medicine suggest that up to one-third of excess deaths during the pandemic may occur in those who have not tested positive for COVID-19. Thus, these studies underscore the importance of continuing to measure excess deaths…” Finally, CDC offers regularly updated data on excess deaths, including data visualizations here. For ease of reference, I’ve included CDC’s excess death bar chart herein (Figure 1). Importantly, data reporting is slow, so the number of deaths in recent weeks is incomplete, which means that excess deaths will be higher than what is shown below. Nonetheless, since March the number of weekly deaths in the United States has been statistically significantly higher than would be expected in “normal” times. The data are clear and conclusive!

Figure 1. Excess Deaths in the USA (note: data for recent weeks are incomplete) (from CDC as updated 8/19/2020)