Has anyone noticed that the nation has been going through a 3-month surge in COVID-19 infections and hospitalizations that is just now beginning to abate? The CDC community levels on July 28 reported over 80% of counties at medium or high risk levels, an all-time high since the CDC began reporting such information back in late February. We’re not out of the woods yet.
Most would agree that the worst outcome from COVID-19 has been the high degree of premature, avoidable death. This consequence felt more tangible than ever this May, when the U.S. surpassed the milestone of 1 million reported COVID-19 deaths.
But the true toll of the pandemic extends beyond deaths with “COVID-19” etched on the certificate.
As of August 23, the CDC estimates that over 238,000 excess deaths have occurred from causes other than COVID-19 since the start of the pandemic in 2020. In order to prevent this high level of excess mortality moving forward, we need to consider what triggered these non-COVID-19 excess deaths and clarify our takeaways from the mortality data since the beginning of the pandemic.
Research suggests the pandemic’s social, economic, and healthcare system disruptions precipitated excess deaths through a variety of mechanisms. Drug overdoses spiked, homicides soared. Patients and providers postponed preventive health and cancer screenings. Medical care diverted to COVID-19 patients delayed treatment of acute conditions such as heart attacks and strokes. Though road traffic decreased during stay-at-home orders in 2020, certain risky behaviors such as driving under the influence and speeding increased among some groups.
Provisional mortality reports prepared weekly by the CDC show the pandemic’s evolving impact on specific age groups. A deep dive into this data provide some surprises.
For those 15 years of age and older, mortality risks were higher in both 2020 and 2021 than the 2015-2019 average. While adults ages 65 and older were particularly vulnerable to COVID-19 from April 2020 through March 2021 (year 1), their mortality risk actually decreased in April 2021 through March 2022 (year 2), likely due to widespread vaccinations and improved treatments.
Moreover, excluding COVID-19 deaths, Americans in the 65 and older group had lower mortality risks in 2021 than in 2015-2019. This decrease can be explained by mortality displacement: COVID-19 deaths in year 1 of the pandemic for these age groups replaced expected deaths in year 2 from other causes.
In contrast, adults ages 25-54 experienced higher all-cause mortality risk in year 2 than year 1. Age group differences in vaccine hesitancy and the predominance of the highly transmissible Delta variant in the second half of 2021 may have contributed to a drop in the median age of hospitalized COVID-19 patients during the second year of the pandemic.
Life expectancy offers another measure of the pandemic’s effect.
In 2020, life expectancy at birth in the U.S. dropped by 1.8 years, the biggest yearly decrease since World War II. This trend continued in 2021 as younger adults suffered worse outcomes from COVID-19, with the net loss in life expectancy now exceeding 2 years. The social and economic value of these years can never be recouped.
While we can’t undo the high level of death and “excess mortality” caused by the pandemic over the last 2 years, there are a few lessons we can learn as we try to move forward.
One key takeaway is that vaccinations have been highly effective in reducing the risk of severe COVID-19 symptoms, hospitalizations, and deaths. As SARS-CoV-2 variants continue to circulate in the U.S., healthcare professionals can help Americans of all ages protect themselves and their loved ones by reminding patients to keep tabs on the latest CDC guidelines on vaccine boosters.
Another lesson learned is that we must work toward a more robust healthcare system. Medical practices must reiterate the essential role of preventive care, especially reaching out to those who remain reluctant to engage with the healthcare system. Expanding access to telehealth services can help but must be accompanied by efforts to support high-speed internet access in underserved areas. Public health leaders and politicians must consider ways to expand and enhance healthcare system capacity and support nursing staff, especially during crisis situations.
The way our nation responds to the ongoing ebb and flow of infections will determine how many additional excess deaths will occur. Analytics can help researchers sift the abundance of data available on the COVID-19 pandemic and distill insights that inform public health policy and personal health decisions. We must all work together to apply these lessons and build a healthier, more resilient society.
Sheldon H. Jacobson, PhD, is a professor in computer science at the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign. As a data scientist, he applies his expertise in data-driven risk-based decision-making to evaluate and inform public policy. Ian G. Ludden is a PhD student in computer science at the University of Illinois Urbana-Champaign. He uses analytical techniques to better understand public challenges ranging from gerrymandering to epidemiology. Janet A. Jokela, MD, MPH, is the executive associate dean in the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign. She is an infectious disease and public health physician.
Disclosures
This work was supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE – 1746047. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.
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