Excess mortality rates in the U.S. remain high, despite a steady decline since mid-December.
This article was originally published on October 27, 2020. It has been updated to show up-to-date figures.
Excess mortality rates in the U.S. remain high, despite a steady decline since mid-December. The excess deaths are attributed to COVID-19 and its new variants, which have pushed the reported weekly mortality rates well above the pre-pandemic numbers.
The most current data from the Centers for Disease Control and Prevention (CDC) (for the week ending January 2) indicates that 11% to 15% more deaths occurred than would be expected without the pandemic.
That’s down notably from this winter’s worst point – the week ending December 12, 2020. That week marked a post-Thanksgiving peak that was the third-most deadly week of the past 12 months, with an excess mortality rate estimated at 29% to 33%. It was exceeded only by the death tolls from April.
Since then, mortality rates have declined steadily for all age groups, but are still above normal.
Figures for the week ending January 9 were below the expected mortality curve, with 60,178 deaths expected and only 57,792 predicted. However, the CDC cautions that only 60% of death records are submitted to the CDC’s National Center for Health Statistics within 10 days of the date of death. Therefore, that figure is expected to rise. More current data was not available.
COVID-19 is an insidious disease that, as we continue to learn more, is seen to affect multiple organs, including the brain, in addition to respiratory, pulmonary, and coronary systems.
According to the CDC, 343,131 of the 3,329,907 deaths in the U.S. as of January 21 were attributed to COVID-19. Pneumonia, with or without COVID, accounted for nearly 10% of all deaths, and pneumonia that occurred with COVID accounted for nearly 5% of the deaths. Influenza, with or without COVID, accounted for about 0.3% (8,726) of the deaths.
As expected, incidence rates for each of these parameters corresponded with increasing age, except for infants younger than one year. Although children in that age group, like the general population, are more likely to die of other causes, COVID, without or without pneumonia or influenza, accounted for higher mortality (30 COVID-19-related deaths) among infants than among the age 1- to- 4-year-old cohort (21 COVID-19-related deaths). For contrast, the 5- to-14-year-old group accounted for 58 COVID-related deaths. The figure jumped to 528 for 15- to 24-year-olds.
As in earlier reports, men remained more likely than women to contract COVID-19. Differences between the immune responses of men and women are the accepted cause.
A report in Nature noted that men diagnosed with COVID have higher circulating levels of innate immune cytokines (notably IL 8 and IL 18), and female COVID patients had more robust T cell activation.
Oddly, although a poor T cell activation was linked to worse disease outcomes in men, that wasn’t the case in women. “By contrast, higher levels of innate immune cytokines were associated with worse disease progression in female patients, but not in male patients,” the report noted.
However, women aren’t home free when it comes to COVID-19. A report published January 13 in Nature Medicine noted that while men are more susceptible to acute COVID-19, women are more susceptible to long-haul symptoms.
News reports from throughout the U.S. show that one year after the first patients were treated, many still COVID-19 long-haulers are not back to normal. For perspective, the Long Haul COVID Fighters Facebook group has more than 6,000 members, and the Covid-19 Long Haulers Awareness and Education Group has some 14,000 followers.
The vast majority of deaths, including COVID-19-related deaths, occurred in an inpatient, healthcare setting. Here’s the breakdown for COVID-19 from January 1, 2020 to January 16, 2021:
- Healthcare inpatient: 221,809
- Nursing home or long-term care facility: 76,394
- Home: 20,616
- Healthcare outpatient or emergency room: 11,413
- Hospice:9,925
- Other: 6,501
- Healthcare setting, dead on arrival: 304
- Unknown: 169
When COVID-19-related deaths are assessed by race, the deaths equate to the group’s percentage of the population for non-Hispanic Whites (about 60%), Hispanics (just over 18%), and Hawaiian and Pacific Islanders (less than 1%). Native Americans and Alaskan natives accounted for of 1.1% of the deaths, however, despite representing just 0.7% of the U.S. population. In contrast, Asians had fewer deaths (3.6%) than their percentage of the population (5.8%).
Blacks, though, have a higher percentage of COVID deaths than their presence in the population would suggest. The CDC reported 15.9% of COVID-19-related deaths occurred among Blacks, although they comprise 12.5% of the U.S. population.
When these figures are weighted to account for differences in age distribution among the various races, the figures change dramatically.
In that analysis, Hispanics and non-Hispanic Blacks die of COVID-19 at greater percentages than their representation among the U.S. population, at 38% and 25% respectively. Native Americans and Alaskan natives exhibited a mortality rate of 3%, despite a population representation of 0.7%.
A recent study in JAMA Network Open tracked trends in hospitalization and mortality resulting from COVID-19 in New York City. The 9,722-patient review showed that Black and Hispanic patients were more likely – and Asian patients were less likely – to test positive for COVID-19 than Caucasian patients. Once hospitalized, Black patients were less likely to have severe cases or to die than other patients.
That conclusion, however, was made after data was adjusted for comorbidity and “neighborhood characteristics.” As the authors pointed out, “This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.”
