Several weeks ago, Governor Baker instituted new recommendations to control the spread of COVID-19. He continues to encourage keeping businesses open and schools operating in-person. Keeping businesses and schools open have a clear scientific basis. In addition, since June 13, 2020 through November 7, 2020 Massachusetts all cause mortality has been either the same or at times even lower than it has been for the past seven years (since 2013) during the same time period. This means that for any one currently living in Massachusetts that the probability of dying from any cause has been equal to or lower than during the previous seven years. Does this sound like a strange statistic given all that you have heard about the increased death rates due to COVID-19 during the past six months? Given this fact, why are so many individuals more afraid of dying from COVID-19 than any other cause? The answer is that numbers reported without proper adjustments, missing critical denominators or taken out of context altogether lend themselves to false interpretation.
In the graph, the gold line is the threshold that shows the numbers of excess deaths for 2020 (above the line). Between mid-March and mid-June of 2020 the excess deaths from COVID-19 occurred primarily in long-term care facilities. The blue portion of each daily bar signifies deaths with a COVID-19 positive test result — not necessarily the primary cause of death. If you click on a bar you will see the number of deaths for that date, along with the percent of excess deaths.
In addition, unlike other epidemics such as the smallpox, 2018 H1N1 (Spanish Flu), measles, mumps, rubella, chickenpox and infantile paralysis (polio that proportionally killed younger individuals), the fatality rates for individuals with COVID-19 parallel more closely deaths rates from all cause mortality, increasing exponentially with age. The average age of COVID-19 is 82 years, 3.4 years older than the life expectancy of the average individual in the United States of 78.6 years. Life expectancy varies by race and ethnicity in the United States, with Hispanic females and Hispanic males showing the highest life expectancies by gender; however, the exponential trends with age are consistent across all race and ethnic categories.
Death is an irrefutable health outcome, unlike deaths and hospitalizations attributed to a particular cause that are subject to many factors, including upcoding cause of hospital admission potentially to maximize financial reimbursements during difficult financial times. Moreover, dying with COVID-19 is quite different than dying from COVID-19, and when reporting deaths, this distinction is not being made. As such, excess deaths from all causes is one of the only unbiased health outcomes to track validly the impact of COVID-19 and mitigation strategies. Based upon excess deaths as a major health outcome, Massachusetts has done an excellent job since the peak mortality day on April 25, 2020 in reducing mortality.
The next big test, will be to watch the excess death rate over the next several weeks through January as “cases” (not necessarily incidence rates) have increased. If excess deaths do not go above the threshold despite the nearly 10-fold increase in the number of cases since mid summer, then the vulnerable are being protected. It should be noted that the increase in cases does not necessarily reflect the increase in incidence when the number of individuals tested has also increased since August 2020 nearly 10-fold. For example, to a very large extent the number of cases have increased because increased testing now provides more individuals in the denominator. Back on August 1, 2020 there were 290 confirmed COVID-19 cases out of 12,595 individuals tested. That is 2.2%. On November 24, there were 2,721 cases out of 110,280 individuals or 2.5%. This along with the fact that there are still no excess deaths, support the assumptions that incidence has remained the same, while detection due to testing has increased dramatically.
Resources continue to be needed to keep the elderly, long-term care facilities and congregate assisted living facilities protected. We included the the excess death interactive infographic below so you can monitor progress in Massachusetts.
For more tables and statistics on COVID-19 go to the CDC website that has an extremely comprehensive set of statistics of COVIC-19.