Question: This NY Times article, “Nursing Homes, Racked by the Virus, Face a New Crisis: Isolation,” made me wonder how many of our seniors are dying early and alone in nursing homes due to lockdowns meant to protect them. Is anyone keeping track of excess deaths from domestic violence, drug overdoses, suicides, or loneliness over the last 8 months?

Answer: CDC’s National Center for Health Statistics (NCHS) keeps track of national-level data for a slew of things, including deaths and excess deaths (for more on NCHS, see Q&A of 7/31 #Mortality and Q&A of 5/5 #Coding Deaths). We can find data on excess deaths in the United States related to COVID online, synthesized here. Figure 1 shows the number of excess deaths by underlying cause for those comorbid conditions that are frequently reported alongside COVID. As you can see, deaths due to Alzheimers and other forms of dementia represent the largest number of excess deaths (33,020 excess deaths as of 10/10, incomplete reporting). Unfortunately, there’s still a lot we don’t know. First, as described in a recent CDC MMWR report on this topic, “…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 pandemic.” Second, because deaths due to injury (e.g. accidents, homicides, suicides) have especially lagged reporting times, NCHS excluded them from this initial cause of death reporting. Clearly, much more data and research are required to really answer your question. In the meantime, several other researchers have attempted to look into this question and here’s a snippet of what they’ve found:

Deaths due to motor vehicle accidents decreased during March and April, but have since rebounded and even surpassed recent June/July/August trends (based on preliminary data shared by the National Safety Council’s Injury Facts and visualized by me, Figure 2)

COVID shutdowns were associated with a decrease in overall crime, as described in this paper published in July in the American Journal of Criminal Justice, “Has COVID-19 Changed Crime? Crime Rates in the United States during the Pandemic”. However, overall crime drops hide changes by crime type. Study authors state, “Compared to the pre-pandemic year of 2019, crime — as measured by calls for service to law enforcement — has decreased markedly. However, there are multiple indications that the crime drop is being driven by decreases in minor offenses which are typically committed in peer groups. At the same time, serious crimes which are generally not committed with co-offenders (namely homicide and intimate partner violence) have either remained constant or increased. As such, the crime drop appears to be hiding a very disturbing trend where homicides remain unchanged and intimate partner batteries are increasing.” Once the FBI’s National Incident-Based Reporting System has 2020 data, we can explore violent crime trends even further.

Domestic violence has increased alongside lockdowns, as hypothesized in this perspective published in New England Journal of Medicine andrevealed in multiple studies, including: this study from Massachusetts published in Radiology, which concluded, “There was a higher incidence and severity of physical intimate partner violence (IPV) during the COVID 19 pandemic compared with the prior three years.”; and this overview from the Journal of Clinical Nursing, which described (among other things) that, “In the UK, Refuge, one of the leading domestic abuse organisations reported that calls to the UK Domestic Violence Helpline increased by 25% in the seven days following the announcement of tighter social distancing and lockdown measures by the government. During the same period, there was a 150% increase in visits to the Refuge website.”

Overdoses are also increasing. As the American Medical Association stated in its October issue brief, “ the nation’s opioid epidemic has grown into a much more complicated and deadly drug overdose epidemic. The AMA is greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid- and other drug-related mortality — particularly from illicitly manufactured fentanyl and fentanyl analogs.” Overdoses have been increasing over the last several years, so the degree to which this worrying trend is associated with COVID is still unknown.

Figure 1. Number of Excess Deaths by Cause (from NCHS)

Note from NCHS: “…weekly counts of deaths due to select causes of death are presented. These causes were selected based on analyses of comorbid conditions reported on death certificates where COVID-19 was listed as a cause of death.”

Figure 2. Motor-Vehicle Fatalities (data from National Safety Council Injury Facts)