There were two articles in JAMA allegedly estimating the excess deaths from the current virus. The first article noted:
Between March 1 and August 1, 2020, 1 336 561 deaths occurred in the US, a 20% increase over expected deaths (1 111 031 [95% CI, 1 110 364 to 1 111 697]). The 10 states with the highest per capita rate of excess deaths were New York, New Jersey, Massachusetts, Louisiana, Arizona, Mississippi, Maryland, Delaware, Rhode Island, and Michigan. The states with the highest per capita rate of excess deaths changed from week to week. The increase in absolute deaths in these states relative to expected values ranged from 22% in Rhode Island and Michigan to 65% in New York. Three states with the highest death rates (New Jersey, New York, and Massachusetts) accounted for 30% of US excess deaths but had the shortest epidemics (ED90 < 10 weeks). States that experienced acute surges in April (and reopened later) had shorter epidemics that returned to baseline in May, whereas states that reopened earlier experienced more protracted increases in excess deaths that extended into the summer.
The second article alleges:
Compared with other countries, the US experienced high COVID-19–associated mortality and excess all-cause mortality into September 2020. After the first peak in early spring, US death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.
Now here are four major concerns:
1. In New Jersey, and one suspects in New York, as we have reported here almost daily, half or more than half of the deaths were in long term care facilities. These were the direct result of sending a few infected patients there as well as not testing care takers. Thus this number of deaths is less a result of the disease than of the lack of moral attention given these facilities by the State.
2. From about March 15 through June 15th in New York City, the Emergency Departments were empty of normal patients with heart attacks, strokes, and other common causes of death. So where did they go? Did more die of these causes for lack of treatment. Who signed the death certificate and what was the cause the virus?
3. Co-morbidities added to the mortality. It was not just age but such things as obesity, Type 2 diabetes, congestive heart failure, and other sever co-morbities may be exacerbated by the virus and treatment for the co-morbidities delayed.
4. Patients with cancers, for example failed to get care during the four month window. Now early prostate cancer is not a problem but melanoma and hematological cancers can spread rapidly and become terminal.
Thus one must adjust the numbers to reflect at least these significant factors. There does not appear to be any attempt no less even recognition of these factors.
We suspect that it is thus too early to make statements of the type in these two articles. post hoc analyses will take a few years after proper data collection and analyses. It is regrettable that we will undoubtedly see these numbers floated in some political campaign most likely. Epidemiological analysis requires detailed study of all the facts. Unfortunately we are not even close to having them.
And unsurprisingly the Press seems to take the results presented at face value without any consideration of the failure to address the few issue above. The real question is: how many deaths from unpreventable COVID-19 alone occurred. Then one must ask; how many deaths resulted from failures in treatment, and then one may have a glimpse at the true facts.
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