Counting Deaths

Monty Python Holy Grail

I have written before about the value of knowing the cause of death to a community. Obituaries used to be reported in the newspaper, not paid personal notes as they are now. The cause of death was usually included in the reporter-written, editor reviewed piece. But the business of reporting the news has changed, and now obituaries, written and paid for by the family, rarely include cause of death.

Then I was referring to the “opioid epidemic”, since the wave of deaths from that cause seemed to sneak up on the general public. I argued before that public awareness of the growing numbers might have raised an alarm and changed some things earlier in that “epidemic”.

But now we are in the middle of a different epidemic, and the number of deaths attributed to Covid-19 are reported daily on the news. But the accuracy, the validity of these numbers is easy to question. We all know the inaccuracy of the testing. Are we undercounting Covid-19 deaths? Probably.

There is a way to get around this issue of squishy test accuracy. It has to do with measuring “excess deaths”. This is calculated by comparing the average number of deaths from all causes in a region for the previous three years to the current reporting period.

The CDC updates this information regularly, but there is a significant lag in reporting time. As of May 11th, the CDC listed 49,000 Covid-19 deaths, while most news reports put the US total at almost 82,000. Currently, according to the CDC, the United States has only 95% of the expected deaths for the period February 1st 2020 through May 9th. No big deal, huh? Don’t forget the lag time.

So, if you don’t have confidence in the accuracy of testing to give the cause of death, “excess deaths” might be a better figure. Maybe it tells you if you are being hit by a train, or just panicking when you hear a whistle. But a long lag time before you respond to a warning whistle can be fatal. Most regions are right near baseline. Idaho has only 16 Covid-19 reported deaths (to date) and our number of total deaths for the period February 1st to may 11th is right at 93% of the previous three-year average.

Further, Idaho has very timely reporting to the CDC. On average, it only takes 8 calendar days from death for Idaho to submit data to the CDC. That ranks us at 10th nationally for how well this small branch (Department of Vital Statistics) of Idaho government is doing its job.

So, what’s the big deal, why not open up the doors of businesses or go to a baseball game? We’re safe here in Idaho, right?

But some states are well above average for this period: New York State at 123% and New York City at 224%.

This sort of comparison has been done for countries too. In almost all cases, the number of excess deaths above baseline is significantly greater than the number of reported deaths from Covid-19. This supports that we just don’t have accurate testing.

Maybe more people are dying for other reasons in this “excess death” category. I have heard it argued by folks wanting to reopen our state that the excess deaths (in other states) could be attributed to people not accessing care due to the shutdown. Many ongoing treatments have been suspended and elective procedures have been postponed. Hospitals are bemoaning this loss of revenue. Health care workers are unemployed. Interesting argument, since I would have thought that most such believers agreed with Raul Labrador’s statement: “Nobody dies from lack of access to healthcare”.

I respect our governor’s caution in response to the train whistle. Some places have been hit by the train. Let’s be safe.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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