The U.S. is on pace to record 400,000 more deaths for 2020 than it did in 2019, driven by the coronavirus and problems that go beyond the virus but were rekindled by the pandemic, from disrupted care for other diseases to mounting drug overdoses.
Preliminary data show 3.2 million people died in 2020 compared to about 2.8 million the prior year. And while deaths tend to rise with the aging population each year, a nearly 15% increase is highly unusual and driven by the new virus that had killed over 335,000 people by New Year’s Eve and 350,000 by the first week of January.
Unfortunately, COVID-19 doesn’t appear to have replaced deaths from other causes.
In fact, many of those causes rose amid the crisis instead of being displaced, including 40,000 more Alzheimer’s disease deaths and nearly 15,000 more diabetes deaths than statistically predicted since Feb. 1, according to the Centers for Disease Control and Prevention.
Deaths from circulatory diseases like heart failure and hypertension are also up.
The excess deaths story is likely due to “a combination of undiagnosed COVID deaths, including sudden deaths, and some people neglecting their health care — but more the former,” said Peter Hotez, the dean of the National School of Tropical Medicine at the Baylor College of Medicine.
Experts say mislabeled COVID-19 deaths were likely more common early in the pandemic, when testing was hard to find.
The year-to-year jump in mortality is the largest since 1918, when deaths rose a whopping 46% due to the combination of World War I and the flu pandemic, according to the Associated Press.
Over a century later, it is the coronavirus from Wuhan, China, that is sending the numbers off the charts.
The first deaths were recorded in February on the West Coast. The virus exploded in the Northeast last spring before subsiding amid nationwide lockdown orders, before cresting again in the Sun Belt and slamming the Midwest later in the year.
In the new year, the virus is widespread and killing over 2,500 people per day, on average, in the U.S.
Federal data show the disease targeted the elderly, with roughly a third of COVID-19 deaths in the U.S. occurring in those 85 or older, and less than 5% occurring in those younger than 50.
Males tend to account for a greater share of deaths, at 54% versus 46%, according to partial death data from the CDC. Black Americans account for roughly 12% of the U.S. population but nearly 17% of deaths, while Hispanics saw a bigger proportion of cases (nearly 22%) than their share of the population (about 18%) but a lower share of deaths (13.5%).
The U.S. case-fatality rate, or share of people who test positive for the virus that then die, is improving and down to 1.6%. That puts the country on better footing than Mexico (nearly 9%), Italy (3.5%) and the U.K. (2.8%).
Yet the virus is so widespread in the U.S. that detected cases that don’t prove deadly provide a bigger denominator and drive the case-fatality ratio, while the actual death toll continues to climb rapidly.
The U.S. is recording over 107 deaths per 100,000 people, putting it in better stead than the U.K. (113) and on par with Spain (108) but far worse than Germany (42), India (11) and South Korea (2).
Transmission remains elevated, with an average of over 200,000 reported cases per day. The situation worsened after Thanksgiving and then again after Christmas, prompting governors and other countries to issue a series of lockdown measures to control the spread.
The CDC said it doesn’t have data yet on whether car-crash fatalities are down, due to fewer people driving, nor has it tallied suicide data yet.
All year, the Trump administration and some experts have worried about a jump in deaths from despair due to the lack of social interaction. Suicide calls are up slightly compared to earlier years, and gun sales have increased — firearms are used in most suicides — prompting fears that the trend moved in the wrong direction, according to November report by the Brookings Institution.
“Everyone’s been concerned generally about depression and feeling down because of the isolation,” said William Schaffner, an infectious-diseases specialist at Vanderbilt University. “That’s opened up recently — people are traveling and gathering in groups — contrary to recommendations —so some of that may have been ameliorated and we’ll have to look at that over time.”
Officials are definitely worried about drug overdoses, however.
Over 81,000 fatal overdoses occurred in the 12 months ending in May, the highest number ever recorded. The rate was accelerating before the coronavirus hit, but the CDC thinks the pandemic exacerbated the problem.
“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC Director Robert Redfield said in mid-December. “As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”
Experts say social distancing from the pandemic probably worsened the U.S. opioids crisis. For instance, people would have a better chance of survival if someone is nearby to call the paramedics, according to a December working paper from Casey Mulligan, an economics professor at the University of Chicago.
And while supply disruptions might have raised prices and limited the availability of heroin, he wrote, “the market may respond by mixing heroin with more fentanyl and other additives that make each consumption episode more dangerous.”
Also, the pandemic is blocking access to treatment and other help.
“COVID makes face to face indoor interactions more dangerous, which has made accessing professionally provided treatment and peer-led mutual help groups more difficult,” said Keith Humphreys, a Stanford University professor who tracks the opioids problem. “This lowers the number of actively addicted people who will stop using and increases the number of people in early recovery who relapse.”