Here’s a rational way to approach the data on COVID-related deaths.

A good piece on excess mortality data with further links can be found here.

Transcript Below!

Hey everybody, Dr. Z, it’s Sunday June 26th. All right, quick COVID update. Many people have asked me, hey, could we be over-counting deaths from COVID? Because, on the coroner’s death certificate, you list COVID if it’s any suspicion of it, if it’s been tested for and you die of something else it doesn’t matter, you’re still seeing COVID, so could we be over-counting since we’re testing a lot more now, and could this be leading to an overreaction and an over dramatization of how dangerous this pandemic really is?

Well, I think let’s look at that, because these are valid questions. Death certificates in general, in the best of times, are kind of sketchy, and again, if you die with COVID-19 of something else, it’s still gonna be listed on the death certificate and counted in the total tallies. Also we are testing extensively as opposed to in the beginning, so could we just be, again, over diagnosing it?

People dying of different things, sure! It’s entirely possible, so how do we tease this out and how do I think about this as a doctor and how should you critically evaluate these ideas? Because, listen, put all ideas on the table, argue them, a lot of them are politicized and all that, so that’s fine though. Politicize it all you want, and then look at the data rationally. And here’s how you look at this.

Yes, it’s entirely possible that we’re over-counting deaths. It’s also possible that we’re under counting them, and that despite all of this, there are a lot of people that aren’t tested who die of the disease at home quietly and it’s called something else. That’s totally possible. In fact, prevalence data, using antibodies, really indicates that there’s been a ton of infection, probably 10 times or more, in the community than what we’ve been able to test for.

So already we know we’re kinda maybe under counting the number of cases, but are we under counting or over-counting fatalities? Well, there’s a clean way to look at this. Because we know this data is garbage. It’s really not great data. So, what can we do? Well there’s something called excess death rate. What does that mean? It means look at the entire death rate for an area, in this case let’s say the United States. And compare that death rate during a period of time to previous years during the same period of time. Why does the period of time matter? Well, because, in the winter you may have more deaths from influenza, there may be different periods, so you have to compare apples to apples, and you can do that year over year over year. And we have this data. Other countries have this data too. Not everybody does, so you can’t do it for the whole world, but you can do it for places that have it, like here.

So what do we find when we look at that data? Well, and I’m gonna link to all this stuff in the show notes on, so you can check my references there. There was a JAMA article that looked at the period from March 1st through the end of May, May 30th, and that’s three solid months in the center of the pandemic when things were locking down and there was a lot of drama, right? We’re not looking at June and July when things have been picking up again.

What did they find? They found roughly 122,000 excess deaths in the US during that time, compared to previous years. So that’s a lot of excess deaths. And so we go, okay, well, how many of those were actually labeled as COVID-19, in other words what was the COVID-19 death rate at that time? Well, guess what. The COVID-19 death count over that period of time was 30% less than the total number of excess deaths, in other words deaths you wouldn’t have expected to happen that year. That’s a lot of deaths.

So what does that mean? Well this is where we have to put on our thinking cap and our reasoning cap and think of the different possibilities, because we can’t know the answer for sure, since the testing and accuracy of our data isn’t great, but we do know there was 30% more deaths that we shouldn’t have expected during this time.

Well, okay, option one, is that these deaths were actually COVID-19. Directly related, that we did not test for, that died maybe at home, or that we misdiagnosed. So we’ve missed 30% of the deaths, which means, it’s 30% more damaging than what we were estimating. Now this has obviously impacts on what our policies are, et cetera. Okay, so that’s possibility 1 on one extreme.

Another possibility is that what we’re seeing is the effect of the pandemic on death rates that is not directly due to infection with COVID-19. Let me explain what I mean. During this period of time, we shut down our economy, we generated a ton of fear in the population of hospitals, healthcare workers, in general. And what happened? We saw plummeting rates of ER visits for heart attacks, strokes, very very very serious illness. Now, do we have any reason to believe, in a period when excess deaths were 122,000 or something, that there were less heart attacks and strokes? Especially since we know that this virus can actually also cause heart attacks and strokes, and be misdiagnosed, which would fall us into that first bucket we talked about, but let’s say that didn’t happen. People could be avoiding the hospital and dying, in a way that is recorded as, you know, heart attack, stroke, or nothing, ’cause we never get an autopsy, most of the time. We don’t get autopsies, we don’t know what people died of. Cardiac arrest, we have no idea. And that’s directly due to the fact that this virus exists in the world right now causing the havoc that it’s causing on our response.

So, the response to the virus, of fear, actually could have cost those excess lives. So that is a very real possibility. We know people are avoiding the doctor’s, we know they’re avoiding regular screening, we know they’re avoiding vaccination for their children. All these things were happening, especially during that early time period. And so, the excess death rate could partially be explained by that.

The third possibility is that there’s something else going on that’s killing Americans that we don’t understand. Little far fetched. If anything, what we could see is a delay. There’s always a lag in death reporting. Could it be that we’re seeing more substance abuse? Depression, mental illness, suicide? We’re not seeing those numbers yet, but could that excess death rate be foreshadowing some of that, when we actually get data? And diseases of despair due to economic turmoil, isolation, again, all the mental and social fabric disruption that’s happened, and economic disruption that’s happened from our response to the virus. Entirely possible.

So, this is kind of the spectrum. So well, what’s going on in other countries? Well, it turns out in the UK, their excess death rate is higher than their tested positive COVID death rate by 20%. In Spain, it’s 40% higher than their tested death rate, meaning there is a ton of excess death that isn’t accounted for. Do you think that they’re actually testing everybody and getting a correct diagnosis? No, I suspect, it really feels like there’s more COVID causing havoc, and the incidental havoc.

Now, here’s a twist that makes it even more uncomfortable. During this period, traffic deaths and homicides dropped quite a bit. Because we’re locked down. So, despite the drop in traffic deaths and homicides, which are major killers, the excess death rate was still really high. So it tells you, any speculation that we’re over-counting the deaths from COVID-19, is really far fetched. And it’s much more likely that we’re under counting COVID-19 deaths. Either the direct deaths, or the results of our response to the pandemic. The fear, the economic shutdown, the societal disruption. And I think as we get more data, it’s gonna become clear what’s going on.

So, I think the punchline of this video is, looking at excess deaths, and applying it to the question, are we over or under counting COVID-19 deaths, leads us to a pretty clear answer, in terms of, yes I think we’re under counting the deaths. We’re certainly not over-counting them. And then what you do with that information becomes important.

Well, does it mean that we shut everything down again? Well, would that then lead to a trade-off in increasing the deaths of economic despair, substance abuse, isolation? Do we wear masks, social distance, wash our hands, continue to test, get the data, science the crap out of it, open the economy? Think about what to do about schools, which is so important, for economic and mental health, and our education and our future. And use this data to then empower our decisions rationally, instead of in such a politically charged way, which, everybody is guilty of doing at this point. Everybody, even the most rational scientist, is politicizing this because of the fact that they’re humans.

So let’s try click by click by click to do better. All right guys, I love you, share this video, and we out. Peace.

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