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United States leads 19 countries in COVID-19, all-cause death rate

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Two research letters published today in JAMA estimate excessive deaths from COVID-19 and other causes in different countries since the start of the pandemic, one finding a higher coronavirus death rate in the United States. United States than in 18 other countries since early May, and the other showing that the overall death rate in the United States rose 20% from March to August, with 67% of excess deaths attributable to the virus.

Decentralized and inconsistent response

In the first study, researchers at Harvard and the University of Pennsylvania compared COVID-19 death rates in the United States through September 19 with those of 18 other countries with more than 5 million people and at least $ 25,000 in gross domestic product per capita. They also compared death rates from any cause in 14 countries with data available up to July 25.

As of September 19, the United States had recorded 198,589 COVID-19-related deaths, for a death rate of 0.06%, higher than countries with low and moderate coronavirus death rates but similar to those with low and moderate coronavirus death rates. high mortality. For example, the death rate in Australia, considered a low-mortality country, was 0.003%, while Canada, a moderate-mortality country, had a death rate of 0.02%.

At the end of the high mortality spectrum, Italy’s COVID-19 death rate was 0.06%, while Belgium’s was 0.09% throughout the pandemic. But, since May 10, the rate of the United States exceeds that of all the other countries studied.

If the coronavirus death rate in the United States were similar to that of Australia, it would have had 187,661 fewer COVID-19 deaths (94% of reported deaths) and, compared to Canada, it would have had 117,622 deaths from less (59%).

Before May 10, the United States had a lower coronavirus death rate than other high-mortality countries, but after that date the other six high-mortality countries (Belgium, France, Netherlands, Spain, Sweden and United Kingdom)) had lower death rates than in the United States. For example, the death rate in Italy from May 10 to September 19 was 0.01%, compared to 0.04% in the United States.

If death rates in the United States were similar to those in most high-mortality countries as of May 10, it would have had 44,210 to 104,177 fewer deaths (22% to 52%); if the start date had been changed to June 7, he would have had 28% to 43% fewer deaths.

Trends in COVID-19 deaths and excess all-cause deaths were similar in the 14 countries where all-cause death rates were available. Countries with moderate coronavirus death rates have seen only small increases in deaths from any cause, but those with high coronavirus death rates have also seen all-cause death rates in high excess (for example, 0.1% in Spain and 0.07% in the United States). But since May 10, the United States has had the highest all-cause death rate of any high-death country.

The authors concluded that deaths from COVID-19 and excess deaths from any cause in the United States were likely due to a poor response to the pandemic rather than an early surge in coronavirus cases before prevention methods. and treatment of the virus are improved.

“Compared to other countries, the United States experienced high COVID-19 associated mortality and excess all-cause mortality in September 2020,” the authors wrote. “After the first peak in early spring, death rates in the United States from COVID-19 and all causes remained higher than even in countries with high COVID-19 mortality. This may be due to several factors, including

weak public health infrastructure and a decentralized and inconsistent US response to the pandemic. “

Underrecognition, disturbance

In the second study, researchers at Virginia Commonwealth University and Yale analyzed demographics and data on COVID-19 and all-cause deaths for 48 U.S. states and Washington, DC, from the National Center for Health Statistics and from the US Census Bureau.

From March 1 to August 1, 1,336,561 people died in the United States, 225,530 (20%) more than the 1,111,031 deaths that would have been expected based on historical data. Of the 225,530 excess deaths, 150,541 (67%) were attributed to the coronavirus.

Additional deaths attributed to heart disease also increased significantly in the weeks ending March 21 and April 11, corresponding to flare-ups of cases, while deaths from Alzheimer’s disease / dementia increased by two. times during this period and between the weeks ending June 6 and July 25, the latter corresponding to surges in the Sun Belt states.

“The high death toll in the Sun Belt states shows us the serious consequences of how some states have responded to the pandemic and are sounding the alarm not to repeat this mistake in the future,” the author said. principal: Steven Woolf, MD, Virginia Commonwealth University (VCU). in a college press release. “We cannot causally prove that the early reopening of these states led to the summer flare-ups. But it seems very likely,” he said.

States with the highest excess death rates, which ranged from 22% in Rhode Island to 65% in Michigan and New York, also included Arizona, Delaware, Louisiana, Maryland, Massachusetts, Mississippi and New Jersey.

While 30% of the excess deaths were in Massachusetts, New Jersey and New York, these states also had the shortest initial outbreaks, at less than 10 weeks. States that experienced a surge in April and reopened later saw excess death rates return to normal in May, while those that reopened earlier saw an increase in additional deaths throughout the year. summer.

The study was an update of an analysis of excess deaths in March and April, published in JAMA on July 1, which found that 65% of excess deaths during this period were attributed to COVID-19 and that the deaths due to causes other than coronaviruses such as Alzheimer’s disease, diabetes and heart disease have jumped in the five states with the most deaths from COVID-19.

“Excessive deaths attributed to causes other than COVID-19 could reflect deaths from an infection not recognized or documented by [COVID-19] or deaths among uninfected patients resulting from disturbances produced by the pandemic, ”the authors wrote.

Woolf warns that long-term data could show the pandemic has had a wider effect on death rates, including cancer patients who have experienced disruptions in their chemotherapy program and women whose mammograms have been delayed. “And death is just a measure of health,” he said. in the VCU version.

“Many people who survive this pandemic will live with complications from chronic diseases for life. Imagine someone who developed the warning signs of a stroke, but was afraid to call 9-1-1 for fear of contracting the virus. This person could have a stroke. this leaves them with permanent neurological deficits for the rest of their lives. “

‘Mortifying and motivating’

In an op-ed for the same journal, Harvey Fineberg, MD, PhD, of the Gordon and Betty Moore Foundation in Palo Alto, Calif., Said that although the number of excess deaths cited in the second study is likely only a rough estimate that will change over time, “a general indication of the death toll from COVID-19 and additional pandemic-related deaths, as presented by Woolf et al, is sufficiently mortifying and motivating.”

“When a pandemic reaches the health, social and economic ladder of COVID-19, regardless of the precise number of deaths that have occurred on a certain date, an intense, persistent, multidimensional and coherent response must be on the agenda. and an urgent priority for the nation, ”he wrote.

In another editorial by the same journal, JAMA editor-in-chief Howard Bauchner, MD, and editor-in-chief Phil Fontanarosa, MD, MBA, said the results of the second study suggest that more than 400,000 excess deaths will have occurred by the end of 2020., the importance of which “cannot be overstated, as it explains what could be a decrease in certain causes of death, such as road accidents, but an increase in others, such as myocardial infarction ”.

“These deaths reflect a true measure of the human cost of the great pandemic of 2020,” they wrote. “These deaths far exceed the death toll in the United States in some armed conflicts, such as the Korean War and the Vietnam War, and deaths from the 2009 H1N1 (swine flu) pandemic, and are close to the number deaths from World War II.

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