One of the ways we knew things were going on during the early stages of the pandemic was the number of “excess deaths” over and above the amount that would normally be occurring absent the pandemic. One would expect, post pandemic, that deaths would drop back to normal numbers, perhaps even dipping below normal numbers because the people who would have died during that period passed away during the pandemic. Did this happen?
This paper answers a different question, “how many excess deaths does the US have compared to other high income countries?”. But it looks like at least by that metric, we are pretty much back where we were pre-covid
I found some other papers suggesting our live expectancy has continued to decrease, but attributing that increased mortality to drug overdose, violence (and firearms), and obesity.
But US covid deaths last winter were estimated to be 33k-52k
And it was ranked the tenth leading cause of mortality last year:
Down from third in 2020. It’s dropped back below things like unintentional injuries (mostly auto accidents), stroke, chronic respiratory disease, diabetes, Alzheimer’s, and kidney disease.
People continue to age and suffer from chronic conditions that make them vulnerable to SARS-CoV-2 and other pneumonic and influenza-like illnesses. But as @puzzlegal notes, overall death rates from infectious illnesses have dropped to pre-pandemic levels, and deaths attributed to COVID-19 are, while significant, below the expected mortality rate if the virus were circulating in the general population at levels exceeding the P&I epidemic threshold. Which is not to say that it is not a concern for hospitals and convalescent facilities as well as anyone with an immunosuppressive condition but not a major risk factor to the overall population unless a substantially more virulent variant shows up. Unfortunately, most of the surveillance activities have been curtailed so we wouldn’t know until it shows up in state hospitalization and mortality data for the states that report that information in a timely and accurate manner.
Stranger
Will covid itself, now that it’s endemic, become part of the new “baseline” deaths and no longer “excess” after a few years? As in, when does it just become one of the many baseline background causes of human deaths, as opposed to an exceptional event?
Unless it suddenly increases in virulence or becomes a partner in bacteriological ‘superinfections’, it already has. Frankly, any hypothetical increase in mortality in the United States is likely to be masked by other socioeconomic impacts of people losing medical coverage or inability to access care for chronic and traumatic conditions as well as the well-known mortality increase of economic recession.
Stranger
I mean, what is the process for determining whether something is considered “excess” vs “the new baseline”? Is it just a rolling 5-year average (or something like that), or does a group of people have to say that and go “well, this disease is baseline, that one is normal…” etc.?
The P&I baseline is developed from past historical data and seasonal estimates but it just provides a kind of alert line as to when a pathogen with epidemic potential may be emerging; obviously a “rolling 5-year average” is both too coarse and too slow for timely prediction so various methods are used to perform geospatial analysis, hospitalization and deaths in expectation of standard morbidity and mortality, virologic surveillance (wastewater, antigen tests) for known pathogens, and surveillance of viral outbreaks in livestock or wild animals with spillover potential. Whenever there is a blip in hospitalization and mortality rates that has common locations or pathology, public health authorities and the Epidemic Intelligence Service investigate.
Obviously, there is some degree of subjectivity when determining what is ‘normal’ and abnormal. In the case of pneumonic and influenza-like illness, a rate that exceeds 1.645 standard deviations about the baseline for expected seasonal mortality is used. Other, more rare diseases might have a higher threshold. Currently, measles outbreaks in the United States are something like 8-9 standard deviations above ‘normal’ because the disease was virtually eliminated by near comprehensive vaccination but despite the anomalous number of infections and deaths (and its high transmissibility) it is not considered likely for epidemic potential because the vast majority of Americans have durable immunity through vaccination or prior exposure.
I was looking for the explanation in the CDC website but there appears to have been significant reorganization and I can’t find the page that used to describe this pretty clearly but here is a paper from the CDC’s Emerging Infections Diseases journal on the topic:
https://wwwnc.cdc.gov/eid/article/26/11/20-0706_article
Stranger
Thank you, Stranger, for the fascinating details!
Thanks everyone for your responses. Not encouraging.
Because the answer is unsatisfying, or because you think SARS-CoV-2 is still circulating at pandemic rates?
Stranger
It is still circulating at near-pandemic levels. It’s just not killing people at the same rate it was when we had a large immunologically naive population. By now, everyone who ever goes out in public has been exposed to covid, through some combination of immunization and infection. And there’s still quite a lot of covid morbidity, both from active infections and from a variety of post-covid conditions. (Although it does appear to be seasonal, and we are currently in a lull between the winter peak and the likely summer peak.)
Iirc, last winter, covid killed more Americans than the flu. So mortality from acute respiratory infections has more than doubled since the before times. But it’s not going away, and i would treat that as the new normal.
(I’m an actuary. Not a life actuary, but this kind of thing is in my wheelhouse.)
It looks like flu may be trending to out-kill COVID this year.
There are waves of COVID (which aren’t consistently over winter, unlike flu), but the peaks seem to decrease each time. Hopefully that trend continues.
Those are good graphs! Also, it looks like this will be a really bad year for flu. Sadly, the CDC is not monitoring bird flu, and i hear they’ve stopped testing for it in many cases. But… That might have something to do with rising flu numbers.
Well, it is difficult to get a solid estimate of how fast it is circulating or what the R0 of the current circulating variants are because of the very limited reporting of non-hospital infections. It certainly has not gone away (as much as many people would like protest that it has), and will obviously remain endemic in the human population for the foreseeable future. That it is still listed as #10 on the causes of death certainly indicates that it is a public health concern if not at the level that it was in 2020-22, and we should be encouraging people to get regular inoculations because the effectiveness of acquired immunity clearly wanes and the virus mutates in the spike protein. The seasonality of SARS-CoV-2 isn’t really well established as we’ve seen spikes at nearly all times of the year, unlike influenza which has a clear seasonal trend and ‘migrates’ from the Northern to Southern hemisphere coincident with the winter season. COVID-19 did have higher mortality than influenza but that isn’t a zero sum game; influenza mortality naturally wanes depending upon what strains are circulating and how extensive vaccination is in vulnerable and vector populations, and it may be that COVID-19 takes out someone who might have otherwise died from influenza A (or some other infection), so you actually have to look at the patterns of infection (again, difficult without extensive tracking data).
I do have a friend who studies coronaviruses (although not specifically the bat-hosted alpha- and betacoronaviruses) who still believes that there is significant potential for SARS-CoV-2 to become significantly more virulent along the lines of SARS-CoV(-1) or MERS-CoV, but since we are in the process of defunding research and demonizing viruses (she’s probably losing her lab in the next few months), I guess we don’t have anything to worry about in the future, right?
I’ve said this before but as surprising and distressing as COVID-19 was, it was a love tap compared to a really virulent pathogen like an H5N9 or some pathogenic but low transmissibility strain like H1N1 recombining with an already human-adapted InfA strain. If SARS-CoV(-1) had broken out before the WHO and CDC could contact trace and contain it we could have had a Contagion scenario.
What are the y-axes on those graphs? Those aren’t mortality rates.
Stranger
Percentage of all US deaths. Data is from here:
Yup. That was really scary. I remember telling my mom that covid 19 wasn’t going to seriously endanger humanity because it looked like it mostly didn’t kill kids or adults of child-bearing age.
The significance of COVID-19 being 1.5% of deaths versus 2.0% for influenza is almost certainly not statistically significant especially given the uncertainty about SARS-CoV-2 infection rates and the wild gyrations of infection spikes. It is clear that we’re not seeing the high mortality peaks the we say through mid-2022 but it is still way higher on average than influenza, and you can also see ‘off-season’ peaks compared to the generally consistent seasonality of influenza. What I see from that graph is that SARS-CoV-2 is causing somewhat less mortality over time but still generating higher mortality even as its slumps than influenza is except at peak levels. Looking at the more current CDC tracker it looks like COVID-19 mortality is way down since April but so is influenza despite having had a later and more aggressive than normal 2024-5 influenza season.
Stranger
If the current bird flu goes in the wrong direction, we could have a lot more flu mortality than covid mortality this year or next. But… that will be a bad thing.
And we may not get much warning. I believe the CDC isn’t monitoring bird flu, and is discouraging testing in some cases.
It just endangered our (moral) humanity as people started rejecting science and accusing medical personnel and epidemiologists of making it up and then attacking people for wearing respirator masks. I’ve never has a particularly optimistic view of the moral character of most people but even a modest crisis like this seemed to really bring out the absolute worst in a lot of people, including those opining that we should accelerate the contagion in order to rid society of dead weight. Ugh.
Not only curtailing monitoring but actively aiding the spread of the pathogen:
Good thing this mutant isn’t in charge of anything import, right?
Stranger
What the actual fuck!