Estimates of excess mortality are notably higher than the official number.

The United States reached the tragic milestone of 1 million deaths from COVID-19 on Thursday, according to the White House, but researchers say the true number of deaths from the pandemic, including people who died from collateral damage from the pandemic, is actually much older.

Beyond the death toll from COVID-19, the pandemic has also wreaked havoc on everyday life.

Doctor appointments were missed, cancer treatments were postponed. People were afraid to go to the hospital and some didn’t want to be a burden on the overburdened medical system. There were not enough hospital beds and elective surgical procedures were delayed. Some medical providers left the field or retired early because they couldn’t take it anymore, worsening existing health care staffing shortages.

All of these situations contributed to what the researchers called excess mortality. In other words, the reported deaths from COVID-19 only represent part of the story.

Using estimates of excess mortality, a recent analysis in The Lancet found that at the end of last year, the number of people who died in the United States due to the pandemic was nearly 40% higher than the official death toll from COVID. US of 820,000.

There are many reasons why excess deaths are higher than reported death counts.

“Health care systems do not list COVID-19 as a cause of death without a positive SARS-CoV-2 test. Therefore, it is unlikely that deaths that occurred earlier in the pandemic, before testing was available, or in places with limited testing capabilities, deaths due to COVID-19 were included in the official count,” he said. lead researcher Dr. Haidong Wang, an associate professor of health metrics sciences at the University of Washington in Seattle.

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There is also no global consensus on when the death of a person infected with COVID should be reported as a COVID death.

“There can be a gray area when it comes to coding a death and attributing it to COVID, particularly when someone may have been infected weeks or months earlier,” said John Brownstein, Ph.D., an epidemiologist and chief innovation officer at Boston Children’s. Hospital. He is also a medical contributor to ABC News.

For decades, epidemiologists have used excess mortality to understand the impact of various infectious diseases. It also provides numerical data on the number of people who died due to conditions caused by the pandemic that may be different from baseline conditions.

“For example, excess mortality includes deaths due to late diagnosis from missed screening appointments, difficulty accessing primary care, and long wait times in the emergency department,” Brownstein said.

In many countries, excess deaths are estimated to be much higher than recorded COVID. The recent Lancet study suggests that around 18.2 million excess deaths occurred worldwide between January 1, 2020 and December 31, 2021 as a result of the COVID pandemic, three times the count of COVID deaths estimated by Johns Hopkins University.

“Now that excess mortality data has been collected, more studies are needed to assess why different states and countries were better or worse off and what can be done to improve health systems,” Wang said.

A recent report produced by The Poor People’s Campaign, in collaboration with the United Nations Sustainable Development Solutions Network, found that COVID disproportionately affected the poorest communities in the United States, highlighting the deadly consequences of poverty, economic insecurity and systemic racism.

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Doctors say that as we reach this sobering milestone, it’s more important than ever for Americans to visit their primary care doctor for a regular checkup, check in with loved ones who might be struggling, and refocus on developing healthy habits.

Jess Dawson, MD, a master’s of public health candidate at the Johns Hopkins Bloomberg School of Public Health, is a contributor to the ABC News Medical Unit.

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