#15,511
Yesterday the CDC's MMWR released two new COVID-19 reports, both of which speak to the severity and impact of the the coronavirus pandemic in the United States. The first we'll look at deals with excess mortality in the United States since late January, and finds nearly 300,000 more deaths have occurred than would have been expected over the past 8 months.
As we've discussed previously (see here, here & here), counting individual deaths due to a specific cause is rarely practical. Death certificates don't necessarily reflect the true cause of death, and unless foul play is suspected, autopsies and post mortem laboratory testing is a luxury normally reserved for TV procedural dramas.
The CDC's recently published Burden Of The 2019-2020 Flu Season estimated the number of flu related deaths as 22,000, but that was averaged from a range of 17,970 - 29,053.
But we do have pretty accurate actuarial data that can tell us how many deaths are expected in a given location, over a given period of time. When that number exceeds expectations, that is considered excess mortality, and indicative of an unexpected catalyst.
When combined with enhanced hospital surveillance, as reported in the second MMWR report (below), it becomes easier to ascribe the cause of this excess mortality to a specific cause.
Both reports are lengthy, and detailed, and so I've only included the summaries. Follow the links to read them in their entirety.
Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity — United States, January 26–October 3, 2020
Early Release / October 20, 2020 / 69
Lauren M. Rossen, PhD1; Amy M. Branum, PhD1; Farida B. Ahmad, MPH1; Paul Sutton, PhD1; Robert N. Anderson, PhD1 (View author affiliations)View suggested citation
Summary
What is already known about this topic?
As of October 15, 216,025 deaths from COVID-19 have been reported in the United States; however, this might underestimate the total impact of the pandemic on mortality.
What is added by this report?
Overall, an estimated 299,028 excess deaths occurred from late January through October 3, 2020, with 198,081 (66%) excess deaths attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino persons.
What are the implications for public health practice?
These results inform efforts to prevent mortality directly or indirectly associated with the COVID-19 pandemic, such as efforts to minimize disruptions to health care.
(Continue . . . )
In this second report, in-hospital risks of death and complications from COVID-19 and influenza are compared using electronic health records (EHRs) from 3,948 COVID patients (March 1–May 31, 2020) and 5,453 patients hospitalized with influenza (October 1, 2018–February 1, 2020).
This analysis showed that hospitalized COVID cases were 5 times more likely to die than hospitalized flu patients, and 17 times more likely to develop respiratory and nonrespiratory complications.
And as we've seen reported repeatedly in the past (see CMS: Black Medicare Patients Nearly 4 Times As Likely To Be Hospitalized With COVID-19 & Race, Ethnicity, and COVID-19-related Deaths in New York City), the risk of developing severe COVID complications was higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients.
Risk for In-Hospital Complications Associated with COVID-19 and Influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020
Early Release / October 20, 2020 / 69
Jordan Cates, PhD1,2; Cynthia Lucero-Obusan, MD3; Rebecca M. Dahl, MPH1; Patricia Schirmer, MD3; Shikha Garg, MD1,4; Gina Oda, MS3; Aron J. Hall, DVM1; Gayle Langley, MD1; Fiona P. Havers, MD1; Mark Holodniy, MD3,5; Cristina V. Cardemil, MD1,4 (View author affiliations)View suggested citation
Summary
What is already known about this topic?
Patients hospitalized with COVID-19 are reported to be at risk for respiratory and nonrespiratory complications.
What is added by this report?
Hospitalized patients with COVID-19 in the Veterans Health Administration had a more than five times higher risk for in-hospital death and increased risk for 17 respiratory and nonrespiratory complications than did hospitalized patients with influenza. The risks for sepsis and respiratory, neurologic, and renal complications of COVID-19 were higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients.
What are the implications for public health practice?
Compared with influenza, COVID-19 is associated with increased risk for most respiratory and nonrespiratory complications. Certain racial and ethnic minority groups are disproportionally affected by COVID-19.
Lowered humidities, and increased indoor contacts, have been shown to greatly aid transmission of the virus, and both become bigger factors during the winter.
Add in holiday gatherings, reopened schools, and growing pandemic fatigue, and the next 16 to 20 weeks could prove quite challenging. Even more so, should seasonal influenza get added to the mix.
