Cory Franklin and Robert Weinstein
The current COVID-19 situation in the U.S. is both good and bad. The good news is that COVID-19 deaths are at the lowest levels of the three-year pandemic. Given current trends, projections indicate roughly 100,000 COVID-19 deaths for 2023 — less than half of any of the three previous years.
The bad news is that the number of overall excess U.S. deaths — the difference between expected numbers of deaths from all causes and the actual number of deaths observed — is rising at a shocking rate.
COVID-19 is a factor, but the main causes of excess deaths are more social than medical, and the worst aspect is that they are occurring in the younger demographic in which homicides, suicides, vehicular deaths, and drugs are taking a disproportionate toll on what should be the healthiest sector of the population.
Since the pandemic began, excess deaths are up by more than 1.25 million in the U.S., about 15 percent higher than in the pre-pandemic years. This pattern is not limited to the U.S.; excess pandemic deaths are elevated by 5-20 percent in Great Britain, most of Europe, and Australia.
The reason for these excess deaths defies simple explanation; the cause is certainly multifactorial.
Some of this is likely an undercount of COVID-19 deaths. Another factor is delayed deaths caused by past COVID-19 infections. After any acute viral infection like COVID-19 has subsided, patients can suffer long-term medical complications including problems with inflammation and dangerous blood clotting disorders. These late effects of COVID-19 have included increases in fatal heart attacks and strokes.
In the arena of excess deaths, unanticipated effects of lockdowns that resulted in healthcare and societal disruptions have been just as important as COVID-19 itself. Patients have found it more difficult to access care. Appointments with physicians have been delayed; routine surgeries, including biopsies, have been canceled; and even when patients suffer symptoms, many have avoided clinics and hospitals, fearing COVID-19 or just long waits.
While telemedicine has helped many people, suspicious lumps cannot be diagnosed on Zoom. In the U.S., diagnosis rates of six common cancers fell between 16 percent and 42 percent during the early days of the pandemic. These figures probably understate the number of serious conditions that were discovered late or not at all.
Combine this with deaths of despair (suicides and overdoses), vehicular accidents (possibly faster and more reckless driving), and homicides.
Further, add the deaths that were occasioned by the unhealthy lifestyle choices — overeating and excessive drinking — prompted by lockdowns.
While the fairly strict lockdowns of the U.S., Australia, and Western Europe have clearly contributed to excess deaths, Sweden is notable because government pandemic restrictions were not nearly as stringent and there were fewer lockdown deaths. Initially, Sweden was criticized for its more lenient approach to the pandemic, but Sweden has had one of the lowest total excess mortality rates in Europe since the beginning of the pandemic.
The most depressing aspect of this excess death phenomenon is that life expectancy in the U.S. has dropped for the second consecutive year. Current life expectancy in the U.S. is 76.4 years, the lowest figure of the past two decades.
After World War II, American longevity was the envy of the world. Now we have fallen behind Lebanon, Cuba and Czechia.
All this is in the face of improved care for the elderly: The U.S. has comparable survival after age 75 with industrialized countries, better control of cardiovascular risk factors, lower stroke mortality, and higher rates of cancer screening and survival.
The alarming truth is that the decrease in U.S. life expectancy has come at the expense of teenagers, young adults, and those in early middle age. This is not the result of COVID-19; in 2021 alone, more potential years of American life were lost because of drugs (primarily opiates), road deaths, firearm violence, and obesity than years lost from COVID-19 during the entire pandemic.
In “The Tempest,” William Shakespeare cautioned that “what’s past is prologue.” Englishman John Burn-Murdoch, a columnist for the Financial Times, has studied mortality patterns in the U.S. and United Kingdom and warns, “One in 25 American five-year-olds today will not make it to their 40th birthday. No parent should ever have to bury their child, but on average across the US one set of parents from every kindergarten class most likely will.” Surely a clarion call, to which America must respond immediately.
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center.
