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Measuring Mortality

MATTHEW EDLUND, MD, MOH
Guest Columunist
Edlundr@lbknews.com

Death focuses the mind. It also brings forth propaganda.

Consider the death case rate for Covid-19. It has became a matter of comparison, even competition, between governments, letting some crow they’ve done a better job.

South Korea certainly has. It’s widespread testing and nationally coordinated response engaging high use of integrated data makes their numbers relatively believable. Yet China is already proclaiming its response to the pandemic demonstrates the superiority of its political and economic system. It is not just American intelligence officials who believe their statistics doctored. Iran is in a whole separate category, declaring few deaths despite lack of quarantine and adequate medical response.

The affair gets murkier when people realize a “case” is defined differently in different localities. A positive PCR test? Ground glass forms on CAT scan? High fever and dry cough?

The same is true of death statistics. If someone dies in their home of coronavirus but was never diagnosed, are they put on the mortality rolls? (Most times not.) If they die of a heart attack but were also infected, are they included? In the U.S., people often are.

 

How to get around this?

There are plenty of ways. But one of the simplest may be to look at excess deaths (https://www.bbc.com/future/article/20200401-coronavirus-why-death-and-mortality-rates-differ)

In most developed countries, death rates are generally predictable. You know how many folks are expected to die any given month in South Carolina or New York.

And Covid-19 will cause many excess deaths beyond those felled by the virus itself. What about the heart attack victims who can’t get proper care because of overwhelmed hospitals? The murder victims shot who can’t get into the ICU?

Those are obvious examples. Others are important, but not so easy to discern. Increases in domestic violence, alcoholism and drug abuse may appear as people lose jobs and stay shut in. Traffic fatalities may go down. People forced to cook for themselves may eat more or less healthily. Increased depression rates may affect mortality through heart disease, stroke, suicide, even cancer rates. Quarantines may cause some to exercise less.

Use of excess deaths has already started in Italy. As this disaster unfolds, such measures can give health, corporate and economic planners a better idea of what is going on.

The real cost of the virus will have ramifications in virtually every sector of life for years to come. Looking at excess deaths will be just one measure of what will happen.

Yet death is what epidemiologists call a “hard” endpoint. My scientist brother-in-law recently told me he did not expect American death rates to approach the numbers recently predicted.

We’ll see.

Longboat Key News

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