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From March to July 2020, more than 225,000 over-deaths occurred in the United States compared to historical standards, about two-thirds directly due to COVID-19. However, new studies show that additional deaths may be indirectly associated with people avoiding emergency medical care during a pandemic.
COVID-19-related deaths depended on the state and stage of the pandemic, as reported in studies by researchers at Virginia Commonwealth University and Yale University. Published online October 12 JAMA..
another Investigation Published online at the same time JAMA I took a more international perspective. Researchers at the University of Pennsylvania and Harvard have found that the United States has higher pandemic excess mortality and higher mortality from all causes than the other 18 countries.
Continued deaths from COVID-19 continue to be the focus of attention, but the time it takes some public health agencies to update numbers can be delayed by weeks or months. there is.
“For the general public, there are two take-away messages: the number of deaths caused by the pandemic exceeded the publicly reported number of COVID-19 deaths by 20%, and the restrictions were reopened or lifted early. By the way, Stephen H. Woolf, MD, the lead author of a US-focused study, Medscape Medical News..
The point for doctors is the big picture. The COVID-19 pandemic may be the cause of death from other conditions. “The surge in COVID-19 was accompanied by an increase in deaths from other causes such as heart disease and heart disease. Alzheimer’s disease Woolf, a professor of family medicine and artificial health at Virginia State University School of Medicine in Richmond, Virginia, and an honorary director and senior adviser to the Center for Social and Health, said.
Investigators have identified 225,530 US excess deaths during the five months from March to July. They report that 67% are directly due to COVID-19.
Deaths associated with COVID-19 included those listed as the underlying cause or cause of the disease. Total mortality in the United States is “significantly consistent” each year, and investigators have calculated an overall 20% increase in mortality.
The survey includes data from the National Center for Health Statistics and the 48 states and District of Columbia. Connecticut and North Carolina were excluded due to lack of data.
Wolf et al. Also found that mortality from two other causes, heart disease and Alzheimer’s disease / dementia, was statistically high.
Changed state
New York, New Jersey, Massachusetts, Louisiana, Arizona, Mississippi, Maryland, Delaware, Rhode Island, and Michigan had the highest per capita excess mortality rates. During the study, the shortest epidemics occurred in three states: New York, New Jersey, and Massachusetts.
Some lessons can be learned by looking at how individual states managed large numbers of people with COVID-19. “I suspected that the states that reopened early were at risk of a pandemic surge, but I was surprised at the consistency that happened and the devastating deaths they suffered,” Wolff said. Stated.
“The goal of our research is not to look in the rear-view mirror and mourn what happened a few months ago, but to learn lessons for the future. Our country is better at controlling the spread of the community. You can’t control this pandemic without strong effort, “Woolf said. “Our research shows that in states that did this well, such as New York and New Jersey, there was a big surge, but the curve bent and returned to baseline within 10 weeks.
“If this can be done as a country, countless lives will be saved.”
Global perspective
The United States experienced high COVID-19-related mortality and high mortality from all causes compared to 18 other countries, as reported in a study by researchers at the University of Pennsylvania and Harvard. Did.
The United States was ranked third among countries with moderate or high mortality rates, with 72 deaths per 100,000. Perhaps not surprising given the status of SARS-CoV-2 infection across the United States, it is not surprising how high mortality is associated with early onset and “insufficient long-term response.” The question remains.
Alyssa Bilinski, MSc, and lead author Ezekiel J. Emanuel, MD, PhD, Chairman of the School of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine in Philadelphia, September 19, 2020. On this day, the United States reported a total of 198,589 COVID-19 deaths.
They calculated that if the US mortality rate was similar to the Australian mortality rate, the US would have experienced 187,661 fewer COVID-19 deaths. Similar to Canada, the death toll in the United States will be 117,622 less.
Mortality in the United States was lower than in six other countries with high COVID-19 mortality in early spring, including Belgium, Spain and the United Kingdom. However, since May 10, the per capita mortality rate in the United States has surpassed others.
From May 10 to September 19, Italy’s mortality rate was 9.1 per 100,000, compared to 36.9 per 100,000.
“After the first peak in early spring, US mortality rates for COVID-19 and all causes remained higher than in countries with high COVID-19 mortality rates,” the researchers say. “This can be the result of several factors, including a weak public health infrastructure and a decentralized and inconsistent US response to pandemics.”
“Motivation and motivation”
Wolf and colleagues estimate that more than 225,000 over-deaths have occurred in recent months. This shows that the number of deaths is 20% higher than expected. Harvey V from the Gordon and Betty Moore Foundation. Fineberg, MD, PhD, editorial To JAMA..
“Importantly, conditions like COVID-19 can contribute to excess mortality, both directly and indirectly,” he writes.
The direct contribution to mortality from infected individuals is simple, but “indirect contributions may be related to the circumstances and choices of the COVID-19 pandemic, for example. stroke I’m too worried about COVID-19 to go to the emergency department, and a potentially reversible condition can be fatal. “
“The general signs of COVID-19 deaths and the pandemic-related excessive deaths presented by Wolf et al. Are sufficiently humiliating and motivating,” Fineberg said.
“Serious human damage”
“The importance of the estimation by Wolf et al., Which suggests that more than 400,000 deaths will occur in 2020 as a whole, is exaggerated as it explains the reduction of some causes of death, such as car accidents. Can’t, but will increase like others Myocardial infarction, ”Howard Boschner, MD, Editor-in-Chief JAMA, And Phil B. Fontanarosa, MD, MBA, Editor-in-Chief JAMA, Another accompanying editorial..
“These deaths reflect a true measure of the human cost of the 2020 pandemic,” they added.
Emmanuel and Biliński’s work is noteworthy in calculating excess COVID-19 and mortality from all causes by September 2020, they say. “After the first peak in early spring, US mortality rates for COVID-19 and all causes remained higher than those in countries with high COVID-19 mortality rates.”
“The 2020 pandemic, where and how we lived, how it changed their lives, and for many, few forget about the serious human suffering it caused. Probably, “writes Boschner and Fontanarosa.
The work by Wolf and colleagues was supported by the National Center for Advancing Translational Sciences, the National Institute on Aging, and the National Institute of Allergy and Infectious Diseases. The work by Biliński and Emmanuel was partially funded by the Colton Foundation. Wolf, Emmanuel, Feinberg, Boschner and Fontanarosa have not revealed any relevant financial relationships.
JAMA.. Published online on October 12, 2020. Bilinsky and Emanuel, OverviewWolf et al. Overview; editorial
Damian McNamara is a Miami-based staff journalist. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and neurology. Follow Damian on Twitter: @MedReporter..
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