21 ms·

Estimation of total mortality due to COVID-19

272 points by harambae 5y ago

AnotherGoodName 5y ago
In absolute number terms it's more deaths in total in the USA than the Spanish Flu (675k deaths total since it began), HIV (700k deaths total since it began) or any other pandemic. Population has increased so the US did lose a smaller percentage of population but on the other hand Spanish Flu didn't have a vaccine to stop it one year in. Hopefully enough of the population takes the vaccine now to stop this. Note this also means COVID has been the number 1 cause of fatalities in total. The other top killers are heart disease and cancer. Heart disease kills ~660k a year and cancer 600k a year. We're not that much over 1 year now since the first cases in the USA. This means that COVID is absolute top cause of fatalities at the moment. For anyone that may feel the need to mention car crashes, guns or drugs those don't even rank in the top 10 of fatalities in the USA. Something to consider if you see anyone trying to downplay this.
- void_mint 5y ago
  Most of the people trying to downplay covid aren't interested in logic and reasoning, though.
- Herodotus38 5y ago
  Also, during the influenza of 1918 there wasn’t widespread availability of oxygen. If we were still at that level of technology there would be significantly higher mortality. You can see a bit of this play out in India where people are dying who shouldn’t be.
- nostromo 5y ago
  Both HIV and the Spanish Flu killed young people with most of their lives ahead of them. All early loss of life is tragic, but the number of deaths alone isn't the only measure. If you calculate the loss of lifespan, HIV would blow Covid out of the water, because the median age at death would mean ~40 or 50 years of life lost. Covid's median age at death is so high, it's often above a country's life expectancy. It's also worth noting the US population has more than tripled since 1918 and grown by a third since 1990. This isn't meant to downplay Covid's impact, but to make a more nuanced comparison with past pandemics.
- Teknoman117 5y ago
  It was #3 in 2020 even though widespread testing only started in March. Seriously frightening stuff. Imagine if we went from zero heart disease or zero cancer deaths to present numbers in the span of one year... https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm
  - dragontamer 5y ago
    Heart disease and cancer aren't even singular diseases. Hell, even the Flu is a combination of diseases: TypeA, TypeC, etc. etc. Even Flu-TypeA is a combination of different diseases: H3N2 (Bird Flu) and H1N1 (Swine Flu) are both Flu-TypeA. For a singular disease + minor mutations (COVID19 vs B.1.1.7 vs P.1 extremely similar and covered by the same vaccine) to cause such a death count is pretty remarkable.
- mywittyname 5y ago
  >Something to consider if you see anyone trying to downplay this. Most of the downplaying I've seen has revolved around the idea that those who died would have, "died anyway" from some other ailment or that hospitals are finding any reason they can to attribute deaths to covid. So, while you have a great argument, I doubt you'll change any minds because those who disagree flat out reject your premise.
  - whimsicalism 5y ago
    For the former, if someone is actually willing to listen to evidence, you can cite them numbers of average years of life lost per covid death (~15).
    - throwaway0a5e 5y ago
      >you can cite them numbers of average years of life lost per covid death That's practically inviting them to cite back the average life lost from the 1918 flu. If you're trying to counter someone who's downplaying Covid that is probably not something you should invite them to do.
      - AnotherGoodName 5y ago
        That's fine though. If they point out that COVID is merely in the same order of magnitude but not objectively worse than Spanish Flu then the point that COVID should not be downplayed has been won.
      - Revery42 5y ago
        I believe there are a significant amount of these people that won't actually argue that just because the Spanish flu was worse in this way that the Covid pandemic isn't a problem.
      - whimsicalism 5y ago
        As the other poster said, if that's the argument you're resorting to, I would say you've already lost. I've found it is helpful to count by equivalent number of deaths to something that the person has actually experienced, as it is way too easy to brush away deaths that occurred in 1918. For instance, it's as if you took the number of years of life lost in 9/11 and multiplied it by 120.
- arberx 5y ago
  To add to this, looking strictly at deaths, neglects the long term affects and people with severe but none-fatal cases. Not to mention the capacity issues associated with Covid. "cAsE fAtAliTy rAtE iS oNlY 1%" is a horrible metric to base any policy off of.
- tunesmith 5y ago
  I had no idea about HIV deaths, I would have guessed it would be 2x-3x COVID deaths. I don't think that means "HIV had a smaller impact than I thought", I think that means COVID is bigger than I thought. We get desensitized to the numbers. Thanks for the perspective.
  - cronix 5y ago
    HIV is a lot harder to spread than airborne viruses. But, imagine how much worse it would have been if it was airborne.
- throwaway0a5e 5y ago
  We'll have to wait 20+yr for the controversy to simmer down but I bet when you run the numbers using a metric like YPLL (which is the typical metric used for these sorts of comparisons) the difference between Covid and other big pandemic outbreaks over history is going to be more minor.
  - whimsicalism 5y ago
    Very back of hand numbers, but, assuming this article is true (haven't looked into it) 900,000 death * 15 yll/death [0] = 13.5 million YLL vs ~63 million YLL for Spanish Flu and 0.5 million YLL for typical flu season [1] [0]: https://www.nature.com/articles/s41598-021-83040-3 https://www.nature.com/articles/s41598-021-83040-3 [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/
    - username90 5y ago
      Flu seasons before vaccines were much worse than now though, it was like having covid every single year. The Spanish flu was about an order of magnitude worse than the normal flu seasons which is why it was so devastating. > 900,000 death * 15 yll/death [0] = 13.5 million YLL Right, so an average American lost 0.03 years of their life due to covid. I guess some thinks everything they did last year to save that 0.02 or so years was worth it. Basically you save a week by social distancing and locking down for a year.
      - whimsicalism 5y ago
        This is the number of years lost with social distancing. You could make this same argument about anything that causes large amounts of deaths.
        username90 5y ago
        Places that didn't do social distancing didn't lose much more, there is no evidence that social distancing saved more than I estimated here. My estimate was even very generous in your favour since I estimated death without social distancing to be the worst in the world. But we could estimate to be roughly the death rate in Florida, in which case most of the social distancing did basically nothing.
- screye 5y ago
  Remember that life expectancy went from 60 -> 80 over the last century. 80% of the deaths have been from folks aged 65+. So, it is arguable that the Spanish flu would have killed a lot more if the average lifespan was higher.
  - gilbetron 5y ago
    It's an interesting point. Spanish Flu hit younger people, so having more older people might not have affected the numbers much. On the other hand, maybe having so many old people with covid affected which variant traveled around.
  - CodeGlitch 5y ago
    It affected younger people more: https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatality https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatali... > The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old.
- neither_color 5y ago
  I'm not trying to downplay it, I believe the official CDC counts, but some additional considerations are: Is the high total death count related directly to our response(or lack thereof), or to our higher population of people pre-disposed/vulnerable to this virus? For the past few months the focus has been on people ignoring lockdowns, ignoring bans on gatherings, vaccine hesitance etc. but it seems that, based on the co-morbidities, we were an already largely unhealthy population to begin with. We shouldn't downplay the progress we've made while we're at it. 100 million vaccinations is quite an accomplishment. If we're going to beat ourselves up for having the top total deaths(while not being in the top 20 per capita), we should pat ourselves on the back for that one. Getting 100 million people to do anything is hard.
- agumonkey 5y ago
  To be fair, I feel it's been naturally downplayed already. It's really not shocking anybody anymore. There's a weird fuzzy average life that emerged where most people are just waiting for the thing to go away and the casualties have become numbers.
- tomp 5y ago
  > Something to consider if you see anyone trying to downplay this. It's invalid reasoning to use this study to "upplay" the pandemic. It includes deaths due to depressions and delayed medical interventions, which you could argue isn't the result of COVID directly, but the result of lockdowns. So when people use this study to claim "see, this many lives were lost, we were right to institute lockdowns" - that's circular reasoning, part of the reason so many lives were lost is because of lockdowns.
  - treeman79 5y ago
    Number saved due to lockdown Number died due to lock down Personally I lost access to badly needed medical care due to lockdown. Was quite scary. Eventually got Covid. Sucked but nothing compared to what else I’ve been through. So initially was dismissive. However definitely some lasting changes to my clotting levels. I have to be perfect with blood thinners these days, we’re before covid I could fudge with them.
    - txsoftwaredev 5y ago
      "Personally I lost access to badly needed medical care due to lockdown. Was quite scary." My nearly 70 year old mother is in the same boat. She recently dealt with breast cancer treatments (a rare form) and thankfully was given the all clear before covid. She still needed to do follow up visits, more testing etc. but due to covid was told to stay away. Even though she was more comfortable with the risk of getting covid vs. ensuring her cancer is in remission they wouldn't see her.
  - standardUser 5y ago
    If there had been no mitigation efforts the death toll would have skyrocketed as our healthcare systems collapsed.
    - betwixthewires 5y ago
      You say that, and they said it (only 90s kids will remember "fifteen days to slow the spread") but as of right now, it's a truism. Maybe the lockdown worked to ease the stress on the medical system. Maybe only the first 15 days of lockdown did that, or 30. I highly doubt that the entire year of lockdowns saved the medical system, and I would be willing to bet the effectiveness of the lockdowns in preventing a collapse of the medical system ended within the first 3 months. So suppose that's true, 3/4ths of the lockdown and all the mental health and depression related deaths associated with it were unnecessary. I don't know when the lockdowns stopped being effective in protecting the medical system, but I know it wasn't this morning. Some amount of those deaths are attributed to lockdowns that were unnecessary. Also, you can't quantify the hypothetical death toll in that scenario in any real numbers, to say "would have skyrocketed" is unfounded. I could understand "would've been higher" that sounds reasonable.
- maerF0x0 5y ago
  > Something to consider if you see anyone trying to downplay this. I admit I'm the morbid one in the group, memento mori and all. But I think the real stat we should track is years of lost life expectancy. That's the only statistic that makes sense when doing cross disease examinations. Not speaking specifically about covid, but more generally, something which primarily kills young people is much bigger deal than something which primarily kills old people.
  - exporectomy 5y ago
    I wonder if that measure should be used for criminal justice as well. As well as showing that killing an old person is less harmful, it also excludes babies. Both these groups seem to have lives that are worth less even to themselves and so it's (however distasteful) not as bad if they die. We already do that with abortion by valuing an unborn baby's life less.
    - username90 5y ago
      Many places already has laws around infanticide which is much lower than manslaughter. Canada for example sentences mothers to at most 5 years with no minimum for killing their baby.
  - jschwartzi 5y ago
    YLL is a horrifying metric because it values someone who is 20 over someone who is 60. The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young. This kind of statement about the bare utility of a human life is the same statement that underlies a lot of how we have treated the disabled or those on welfare in the past. And it only makes sense if you think about a human life in terms of its economic usefulness as some sort of cog in the economic machine that wears out and can be discarded safely after age 67.
    - orangecat 5y ago
      The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young. It's not about "usefulness", it's that saving the life of a young person produces a larger benefit in terms of expected future years of life. Take the extreme case: if a building is on fire and you can only rescue one person, would you be indifferent between saving the life of a 10 year old child versus a 90 year old with terminal cancer?
- jollybean 5y ago
  It's also greater than all of US military combat deaths for every war combined i.e. Civil War, WW1/2, Korea, Vietnam etc.. And think of how much concern (legitimately so) we have for them.
  - nonameiguess 5y ago
    US Civil War death toll is estimated between 620,000 and 750,000, which is higher than the official Covid toll so far. It was also much more highly concentrated in a small number of states in a country that was far less populated.
    - jollybean 5y ago
      That's not 'combat deaths' though, that's 'total deaths'. In those wars, a huge number of people died from things other than direct combat. Here are the numbers [1] [1] https://en.wikipedia.org/wiki/United_States_military_casualties_of_war https://en.wikipedia.org/wiki/United_States_military_casualt...
ArtTimeInvestor 5y ago
How does it compare to the flu?
Teknoman117 5y ago
This is anecdotal at best, but when my grandfather passed last May from COVID, his death certificate did not record the cause of death as COVID. He tested negative twice after his month long bought with it, but only lived for another few weeks until dying of respiratory failure. We were told that because he was not testing positive at the time of death, his cause of death could not be recorded as COVID. I thought cause of death was whatever disease or injury started the chain of events that lead to one's death, but it felt like serious statistic manipulation. (edit - grammar)
- CalChris 5y ago
  My sister's a doc. Same anecdote. She had a patient who fell at home while severely weakened with COVID. Death certificate did not say COVID.
- bsimpson 5y ago
  Gets manipulated in the other direction too: financial incentives nudge hospitals to assign coronavirus as a cause of death if you had it when you died, even if it wasn't what actually killed you. I don't know if it's as blatant as "died in a car crash of coronavirus," but enough of my medical friends have mentioned it that I believe there's truth to it.
  - vmception 5y ago
    Many tallies in the US were adjusted after this specific criticism over 8 months ago. But I guess the talking point won't be updated, oh well. My main issue with this criticism is that tallies of other illnesses have the same issues. So if an actual flu season said 20,000 people died, it had the same reporting issues and distribution of reporting issues. This means a direct comparison to two ailments with the same distribution of reporting issues gives you an accurate view of the affect. So even without going back and fixing the records - which I'm not sure you or other people even know happened - this means Covid deaths are more accurate and actually proves how it is much much worse. Anybody see the irony there? Given that the point of bringing attention to this would be to downplay the severity or response (or that there is a 100% correlation between the people that subscribe to these talking points and want a dramatically different response or no mitigation response at all), so, thanks for keeping healthcare authorities accountable, I guess.
spamizbad 5y ago
So much for all the conspiracy theories we saw last year claiming deaths attributed to COVID were being wildly inflated. Many people felt the opposite was likely true - and I think history will prove them right.
- deleted 5y ago
  [deleted]
whb07 5y ago
Wonder how they accounted for the gun shot victims and motorcycle crashes who are accounted as covid deaths? Looking at Italian data going back to March/April of 2020, we knew that over 50% of deaths, the patient had 3+ serious diseases and had a median age of 79+. The true death rate is the delta of standard deaths in a “normal” year and the ones recorded now. That and somehow account for some pull-forward that’s clearly happened. If a person was somehow due to die (assume a God exists and it’s already planned) on January 2021 of terminal cancer, but then covid found him and he died Dec 2020, what’s the real cause of death?
- techbio 5y ago
  So, perhaps we see fewer than expected deaths in the next 2-3 years?
- gilbetron 5y ago
  If the same person had died from a stroke in Dec 2020 instead of covid, what's the real cause of death?
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chmod600 5y ago
It looks like Florida is two shades "better" than California in the diagram, which would put the total Florida death rate as better than California. That would be interesting because Florida did almost no lockdown. How could that be?
- bpodgursky 5y ago
  Florida aggressively locked down visitor access to nursing homes pretty early on, which is where the vast majority of deaths happen. Wearing masks on beaches and in restaurants etc may slightly impact the case count but really doesn't impact mortality in the same way that an outbreak in a care home does.
  - nradov 5y ago
    Is there any reliable evidence that wearing masks on beaches even impacts the case count? Data from actual contact tracing seems to indicate that outdoor transmission is close to zero.
    - bpodgursky 5y ago
      Yeah, I didn't feel like getting into that particular battle, but should have been more explicit; wearing masks outdoors has 0 impact on anything.
  - pvarangot 5y ago
    I'm not sure where I read about this but Florida also did better in prisons.
- nostromo 5y ago
  WHO has been consistent about being anti-lockdown during all of Covid. There's limited evidence they work more than a short-term delay tactic and cause tremendous harm.
  - spaetzleesser 5y ago
grumpyautist 5y ago
The organization that published these numbers apparently a. Doesn't know how to use certbot and b. Is primarily funded by organizations who are anything but impartial on the subject
- akamaka 5y ago
  Can you explain in more detail? Who are the biased organizations who funded this publication?
  - grumpyautist 5y ago
    From Wikipedia: IHME receives core grant funding from the Bill & Melinda Gates Foundation[60] and the state of Washington. The US Centers for Disease Control and Prevention (CDC); Inter-American Development Bank; Gavi, the Vaccine Alliance; the National Heart, Lung and Blood Institute; Kingdom of Saudi Arabia Ministry of Health; Medtronic Philanthropy; and the National Institute on Aging have also contributed funding through project grants and contracts. Billions of dollars from organizations that have billions invested in selling vaccines Look into the criticism of organizations such as Gavi.
    - knowaveragejoe 5y ago
      Dismayed to see this kind of conspiracy BS on HN.
      - grumpyautist 5y ago
        What about what I said was "conspiracy bs"? These are the organizations that fund the group. They are invested in vaccine sales, and some of them have very questionable ethics. Again from Wikipedia: "Public-sector workers and academics public health have criticized GAVI, and other global health initiatives (GHIs) with private-sector actors, saying that they have neither the democratic legitimacy nor the capacity to decide on public health agendas. Private donors often find it easier to exert influence through public-private partnerships like GAVI than through the traditional public sector. There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries. Some WHO officials have privately criticized GAVI for infringing and weakening the WHO's mandates" And that is just a small portion of the issues with that organization. GAVI is an organization that promotes sales of the industry's newest vaccines, not promoting vaccination as a whole. "In 2012, the first MSF "The right shot" report criticized GAVI for focussing on funding expensive new vaccines and neglecting to give children cheap old ones. "Twenty percent of the world’s children aren’t even getting the basic vaccines", MSF's vaccine policy adviser said.[11] MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which GAVI is listed as a leader, as flawed for failing to help those 20%, which is some 19 million children.[28]" And this is just complaints against one of the organizations.
timr 5y ago
This isn't a "study", it's a statistical model. It reflects the assumptions put into it. To wit: > Our analysis follows four key steps. First, for all locations where weekly or monthly all-cause mortality has been reported since the start of the pandemic, we estimate how much mortality increased compared to the expected death rate....Second, based on a range of studies and consideration of other evidence, we estimate the fraction of excess mortality that is from total COVID-19 deaths as opposed to the five other drivers that influence excess mortality. Third, we build a statistical model that predicts the weekly ratio of total COVID-19 deaths to reported COVID-19 deaths based on covariates and spatial effects. Fourth, we use this statistical relationship to predict the ratio of total to reported COVID-19 deaths in places without data on total COVID-19 deaths and then multiply the reported COVID-19 deaths by this ratio to generate estimates of total COVID-19 deaths for all locations. And, what, you may ask, are the biases of the models' authors with regards to the percentage of excess mortality due to Covid itself? Excellent question: > Deaths that are directly due to COVID-19 are likely underreported in many locations, particularly in settings where COVID-19 testing is in short supply. Most excess mortality is likely misclassified COVID-19 deaths. > Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality. For the reasons presented in this section, we believe that this is likely an underestimate. As someone who has now spent the better part of his life creating statistical models, when you assume something is true, your model is likely to confirm your assumptions. This is why statistical models are worthless without prospective validation. If you haven't shown that your assumptions are correct for the future, you're just making castles in the sky.
- grumpyautist 5y ago
  Yep, and it's a suspect one at best. Personally I wouldn't trust a stastical model from someone who advertises that they own the book "how to lie with statistics" and obviously used it
  - seoaeu 5y ago
    I trust someone who acknowledges that statistics can be used deceptively vastly more than I trust someone who doesn't.
kaczordon 5y ago
Third, we build a statistical model that predicts the weekly ratio of total COVID-19 deaths to reported COVID-19 deaths based on covariates and spatial effects. Given how disastrously wrong most modeling/forecasting(1) has been during this pandemic color me a little bit skeptical that their model is somehow better. Models give wide latitude to fiddle with parameters. (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447267/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447267/
- williamsmj 5y ago
  This group in particular has a terrible record: https://www.vox.com/future-perfect/2020/5/2/21241261/coronavirus-modeling-us-deaths-ihme-pandemic https://www.vox.com/future-perfect/2020/5/2/21241261/coronav...
- dadjoker 5y ago
  Color me completely distrusting. Between the IHME and Neil Ferguson (aka The Master of Disaster because of how horrifically wrong his models have been) models in the UK, they haven't even been close to reality. The IHME was even called out last year by other data modelers at one point for how poorly done their models were.
  - teachingassist 5y ago
    This is a slight re-write of history, by my recollection. Neil Ferguson's earliest models were used to justify no action/herd immunity as the UK's initial strategy. I recall (but can't find) the Imperial College scientists saying they didn't fully consider any other option at first, because they understood that it would be politically unpalatable.
    - thinkingemote 5y ago
      Just goes to show how faulty our recollection is that it changes what we think was history. Best to actually look it up. (hint: you won't find the 'do nothing for herd immunity' as a stategy, but you will find many newspaper articles speculating about it based on out of context quotes) History gives a better record than our impressions from the news of the sensational at the time and our faulty memories.
grawprog 5y ago
>the discrepancy between reported deaths and analyses of death rates compared to expected death rates, sometimes referred to as “excess mortality,” suggests that the total COVID-19 death rate is many multiples larger than official reports. So...not as many people died as we thought were going to so we're now just going to arbitrarily say any excess death was a covid death just to make sure the numbers look like what we think they should? These are the kinds of statistical shenanigans that have been going on all year and people wonder why people question 'the science.'
- mypalmike 5y ago
  Comparison of expected versus actual outcomes is a reliable method to estimate the overall effect of a new input. Can you specifically point out how such analysis constitutes "shenanigans"?
  - exporectomy 5y ago
    It includes deaths caused by the response to covid, such as people avoiding hospital for other diseases and whatever the deathy consequences of lockdowns might be.
    - mypalmike 5y ago
      Of course. This is addressed in the article.
- crazygringo 5y ago
  That's not what they do at all. Just a few sentences later, they break down changes in death rates into 6 categories -- 3 that are increases but also 3 that are decreases. But in any case, it's a pretty reasonable first-order assumption that excess deaths are from COVID, that can then be analyzed in more detail per-population to see if it continues to be plausible, e.g. whether excess deaths were also correlated in time and place with COVID, etc. And isn't this precisely the kind of double-checking of official numbers that is valuable? Official statistics don't always tell the truth -- witness Cuomo specifically undercounting nursing home deaths. The shenanigans we should be concerned with aren't this -- it's shenanigans in official reporting. Thank goodness we live in a democracy with free speech where these kinds of things can be questioned. Challenging findings to produce stronger, more trustworthy final results ultimately increases faith in science, don't you think? It sounds like you're arguing findings should never be challenged, which isn't science at all.
yalogin 5y ago
For me its shocking that we as a population have become so numb to so much death around us. Wonder what it says about society in general. Would be fascinating to read any research reports on that aspect.
- vkou 5y ago
  That's because our media has a gentleman's agreement to not show it to us. If the news were running 24/7 with reels of disaster porn - images of people dying in ICUs, or struggling to breathe and unable to get treatment, we'd have been taking this problem seriously last year. Instead, it's this abstract, sanitized problem that only happens to other people. What you don't see on the TV isn't real.
  - symlinkk 5y ago
    Which is why LiveLeak was so great, you got to see what death actually was.
  - listenallyall 5y ago
    Sure. And the evening news should show every fatal car crash, in multiple angles, slo-mo, so the population would learn about these deathtraps called "automobiles" and we could take that problem seriously too.
hervature 5y ago
As others have pointed out the death toll from COVID is truly astounding. Get your vaccines if you can. That being said, excess mortality is not purely from COVID. There are widely reported drops in treatment for various cancers [1,2,3]. The link between COVID and diabetes is also very complicated and will take years to figure out what happened. The grim bright side is that we've seemed to hit peak excess deaths and may be dipping below and so the 900k number might decrease a little moving forward [4]. [1] - https://www.breastcancer.org/treatment/covid-19-and-breast-cancer-care#breastcancer https://www.breastcancer.org/treatment/covid-19-and-breast-c... [2] - https://ascopubs.org/doi/full/10.1200/CCI.20.00134 https://ascopubs.org/doi/full/10.1200/CCI.20.00134 [3] - https://jamanetwork.com/journals/jamaoncology/fullarticle/2774867?guestAccessKey=8e9733f4-229b-4616-a1fe-169ee2e23abd&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=011421 https://jamanetwork.com/journals/jamaoncology/fullarticle/27... [4] - https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
- pelasaco 5y ago
  Isn't "total mortality due to COVID-19" different than "total mortality from COVID-19"? As I understand the cancer treatments were aborted due COVID-19, therefore, more person died due to COVID-19 but not necessarily from COVID-19... does it make sense?
  - hervature 5y ago
    I think that's exactly the criticism of this paper. They are precisely saying "total mortality due to COVID-19" = "total mortality from COVID-19". From the paper: > for now we assume that total COVID-19 deaths equal excess mortality
  - betwixthewires 5y ago
    Well that's a question of if you think the lockdowns were necessary or not. If you think they were, then of course excess mortality is due to covid. If you think they weren't then that excess mortality was due to unneeded human intervention. Of course the answer is somewhere in between, that is, some degree of lockdowns and therefore the deaths attendant to that were overzealous, and that throws this entire model in the trash.
the_reformation 5y ago
“If there were 315,507 excess deaths due to Covid-19, why is the difference in all-cause deaths between the end of 2020 and the end of 2019 only 61,654? That’s 61,654 more all-cause deaths in 2020 than in 2019, where the increase in all-cause deaths over each of the past ten years has averaged 44,806. That’s a difference of 16,848 from the median in a year with an alleged 315,507 extra Covid-related deaths.”
0xbadcafebee 5y ago
I'm curious to find out the long-term effect from all the organ damage caused by non-lethal COVID-19. Heart damage, lung damage, brain damage, blood clots, chronic fatigue. Wonder if our healthcare costs will reach a new high over the next 30 years.
jccooper 5y ago
An interesting read, but the title here is pretty terrible. It represents one line in a table halfway down the page. The original article title is "Estimation of Total Mortality Due to COVID-19" which is accurate, if dull. I'd perhaps add "worldwide".
kmm 5y ago
According to The Economist[1] and this preprint[2], the US had about 600k excess deaths. What could cause such a massive discrepancy? 1: https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker https://www.economist.com/graphic-detail/coronavirus-excess-... 2: https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v2 https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v...
- fullshark 5y ago
  They claim COVID led to behavioral changes that lowered the expected volume of death, so the naive excess mortality is an undercount: > Overall, the evidence suggests reductions of 615,000 deaths, or potentially more, stemming from behavioral changes at the global level. The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality So basically they lowered the expected number of deaths, then claimed all deaths above expectation are COVID.
standardUser 5y ago
How many more people have died during the pandemic than we would expect to have died based on past trends? The NYT had a tracker (which they stopped updating) that showed the number of excess deaths was not much higher than than confirmed COVID-19 deaths. https://www.nytimes.com/interactive/2021/01/14/us/covid-19-death-toll.html https://www.nytimes.com/interactive/2021/01/14/us/covid-19-d...
option 5y ago
About time we start asking hard questions on the virus origin.
- exporectomy 5y ago
  OK. You can start.
  - option 5y ago
    It is totally a coincidence not worth investigating that the covid outbreak started in a city with the lab that holds the world’s largest collection of bat coronaviruses. for starters let’s have WHO investigate it by a team not led by the guy who was a close collaborator with Wuhan lab.
- AnimalMuppet 5y ago
  As opposed to all the ones that have been asked so far, which were somehow "not hard"?
  - option 5y ago
    yet to see an independent team of experts (as in no previous collaborators, not vetted by ccp, etc) allowed to investigate the lab which holds the world’s largest collection of bat coronaviruses and just happened to be located in Wuhan.
akomtu 5y ago
Basically, it's nothing to worry about. On an average year, about 2.5 million people die in the US, with at least 600k from cancer. Another data point is that something like 2.3 millions sit in the US prisons right now, so if the 900k number makes you terrified, you should be 3x more terrified about ending up in a prison one day and Nx more terrified by cancer, as for each cancer death, there are tens living in misery fighting that cancer.
betwixthewires 5y ago
The study is counting all excess mortality during the pandemic. This is a bad methodology, and I might add possibly a politically motivated one, but that's neither here nor there. There are metrics all over the place showing some regions with no lockdowns having less excess mortality and mortality due to covid. Some of the lockdown measures in some places were counterproductive. Some people say all of them were, some people say none of them were anywhere (which makes no sense really), but the truth is probably somewhere in the middle: at least some measures taken in some places were the wrong call. This is to be expected, we didn't know what the disease was going to do and lots of us panicked. But conflating deaths from covid with deaths from the response and attributing all of them to the same cause is going to necessarily include deaths that would not have happened even in the pandemic if it weren't for the response. And we can quantify that, as an example, look at the disparity in excess mortality and covid death between California and Florida. California had a higher excess mortality and a higher covid death rate. Was that excess death in California due to covid, or due to a botched response? Again, probably a bit of both, but there's no way to pick the two categories apart, and so this entire methodology is not useful to quantify anything.
pmoriarty 5y ago
Compare 900k dead from COVID-19 (so far) to U.S. deaths in: - Vietnam[1]: 58 k - World War Two[2]: 407 k - World War One[3]: 117 k and due to the huge numbers of people in the U.S. who are refusing to get vaccinated, wear masks, or participate in social distancing, the U.S. deaths from COVID-19 are probably far from over. [1] - https://en.wikipedia.org/wiki/Vietnam_war https://en.wikipedia.org/wiki/Vietnam_war [2] - https://en.wikipedia.org/wiki/World_War_II_casualties https://en.wikipedia.org/wiki/World_War_II_casualties [3] - https://en.wikipedia.org/wiki/World_war_one https://en.wikipedia.org/wiki/World_war_one
- auser1443231 5y ago
  900k people did not die from COVID-19. This "model" is predicting deaths related to the response to COVID-19 (deaths to to increase drug usage, missed cancer screenings, etc.). The second paragraph of the linked article clearly states this.
williesleg 5y ago
Thanks Biden.
auser1443231 5y ago
This headline is wildly click-baity and does not reflect the linked "study", however flawed, at all. The headline should be changed. The "study" (really it's just a model) primarily investigated excess mortalities related to our response to COVID-19, NOT COVID-19 itself. The second paragraph states six drivers of all-cause mortality that were taken into consideration: a) the total COVID-19 death rate, that is, all deaths directly related to COVID-19 infection b) the increase in mortality due to needed health care being delayed or deferred during the pandemic c) the increase in mortality due to increases in mental health disorders including depression, increased alcohol use, and increased opioid use d) the reduction in mortality due to decreases in injuries because of general reductions in mobility associated with social distancing mandates e) the reductions in mortality due to reduced transmission of other viruses, most notably influenza, respiratory syncytial virus, and measles f) the reductions in mortality due to some chronic conditions, such as cardiovascular disease and chronic respiratory disease, that occur when frail individuals who would have died from these conditions died earlier from COVID-19 instead. Only 2 of these 6 factors are related to the virus itself; the rest are related to our response. If anything, this model highlights how destructive our response was.
crad 5y ago
Anecdotes obviously don't validate data models, but I do wonder if my personal experience was common. My mother-in-law passed last summer, alone in her apartment. She was sick beforehand, quarantined, and living in a senior living community. When she was discovered the coroner did not come and investigate because it appears of natural causes, based on the observations of the local police officer. Her body was transported directly to the funeral home. I insisted they do a COVID-19 test, which the coroner did at the funeral home. The results came back as positive. Had I not pushed them to actually test, it would have been misreported and her death mis-attributed. It left me wondering if this was common and how many people may have passed in similar circumstances, without family pushing for testing.
toomuchredbull 5y ago
Not to be grim but seems to me that a country that suffered lots of casualties of their oldest, weakest and most infirm and the least economic disaster is probably well suited to be successful in the future.
- worik 5y ago
  You mean "To be grim...."
einpoklum 5y ago
I won't make the unfair comparison to, say, New Zealand, which has no land borders, but let's take Vietnam: * 100M people * Long land borders with Laos, Cambodia, and China * Virus located in state territory in Jan 2020 * Total number of verified cases: 3,137. * Total number of deaths: 35 * Current number of daily new cases: ~50. Multiply the figures by 3.3 or so to normalize with US population. Forget the quibbling over the statistical model. Maybe it's only 600K. Regardless, it's over _20000 times higher_. And even allowing for, I don't know, different susceptibility to the symptoms, or whatever - the US numbers are just insane.
- floxy 5y ago
  Yes, I wonder if the U.S. can or will learn the lesson of Vietnam. https://www.vox.com/22346085/covid-19-vietnam-response-travel-restrictions https://www.vox.com/22346085/covid-19-vietnam-response-trave...
nickthemagicman 5y ago
What everyone is neglecting to talk about is the age effect of mortality with Covid. For people under 55 the chance of fatility is miniscule.. in the range of choking or car accidents. This age group makes up 80% or so of the population. For people over 80 this may be the worst disease since the black plague. Millions upon millions of deaths. This age group makes up approximately 10% of the population. This is an important consideration because the lockdowns effectively trapped mostly working age people who weren't at risk of dying from Covid in the first place. I think that's where a lot of criticism of Covid policies stems from. Should we make national health policy based on a disease that effects a minority of the population? Reference: https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/ https://www.statista.com/statistics/1191568/reported-deaths-...
anoncake 5y ago
US population: 328.2 million. So that's 0.24%. Assuming the average victim would have died another 10 years, that means everyone lost, on average, 0.024 years = 8.8 days.
throwaway7783 5y ago
Heh, the thread is amusing. A few days back there was another thread discussing true mortality rate of COVID in India and a lot of support for how deviation from base rates are a fairly good indicator. When it comes to the US...
WalterBright 5y ago
There are also very debatable definitions of what a Covid death is when there are co-morbidities present. For example, if one dies having both advanced cancer and Covid, which one gets tagged as the cause of death?
worik 5y ago
Awful. So many commenters arguing about the accuracy of the statistical models used to reach the 900,000 dead figure. Missing the terrible, tragic, point. Too many people have died (and too many been disabled - for each death about 10 get "Long Covid") It did not have to be like this. This is/was a tragedy. There have been way too many deaths. Some places did much worse than others - perhaps it is time to start thinking about, and discussing that?
crowf 5y ago
In order to even start calculation the "true" cost, they should also subtract the deaths from school shootings, road accidents, etc. that did not happen this past year.
pyrotactics 5y ago
But so many studies find the exact opposite. Including the CDC! Wake up already. 99.97% survival rate!
dang 5y ago
We changed the title from "True U.S. death toll from Covid is more than 900k, study finds". That was editorialized, which breaks the site guidelines. It was also arguably both misleading and baity, which means that it broke the site guidelines on all three points: "Please use the original title, unless it is misleading or linkbait; don't editorialize." Please don't do that! https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- harambae 5y ago
  Original source was this: https://www.mediaite.com/news/true-u-s-death-toll-from-covid-is-more-than-900000-study-finds/ https://www.mediaite.com/news/true-u-s-death-toll-from-covid... Which is where the title came from. At the last minute I remembered there was an actual scientific paper so I changed the URL to that.
  - dang 5y ago
    That makes sense. We sometimes leave a title up after changing the URL too.
raarts 5y ago
I think calculating weekly expected deaths and drawing conclusions from that is wrong given the seasonality of covid-19 and diseases in general. Excess deaths should be looked at over a long period of time. Seems similar to the difference between weather and climate.

272 points by harambae 5y ago

In absolute number terms it's more deaths in total in the USA than the Spanish Flu (675k deaths total since it began), HIV (700k deaths total since it began) or any other pandemic. Population has increased so the US did lose a smaller percentage of population but on the other hand Spanish Flu didn't have a vaccine to stop it one year in. Hopefully enough of the population takes the vaccine now to stop this. Note this also means COVID has been the number 1 cause of fatalities in total. The other top killers are heart disease and cancer. Heart disease kills ~660k a year and cancer 600k a year. We're not that much over 1 year now since the first cases in the USA. This means that COVID is absolute top cause of fatalities at the moment. For anyone that may feel the need to mention car crashes, guns or drugs those don't even rank in the top 10 of fatalities in the USA. Something to consider if you see anyone trying to downplay this.

void_mint 5y ago
Most of the people trying to downplay covid aren't interested in logic and reasoning, though.
Herodotus38 5y ago
Also, during the influenza of 1918 there wasn’t widespread availability of oxygen. If we were still at that level of technology there would be significantly higher mortality. You can see a bit of this play out in India where people are dying who shouldn’t be.
nostromo 5y ago
Both HIV and the Spanish Flu killed young people with most of their lives ahead of them. All early loss of life is tragic, but the number of deaths alone isn't the only measure. If you calculate the loss of lifespan, HIV would blow Covid out of the water, because the median age at death would mean ~40 or 50 years of life lost. Covid's median age at death is so high, it's often above a country's life expectancy. It's also worth noting the US population has more than tripled since 1918 and grown by a third since 1990. This isn't meant to downplay Covid's impact, but to make a more nuanced comparison with past pandemics.
Teknoman117 5y ago
It was #3 in 2020 even though widespread testing only started in March. Seriously frightening stuff. Imagine if we went from zero heart disease or zero cancer deaths to present numbers in the span of one year... https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm
- dragontamer 5y ago
  Heart disease and cancer aren't even singular diseases. Hell, even the Flu is a combination of diseases: TypeA, TypeC, etc. etc. Even Flu-TypeA is a combination of different diseases: H3N2 (Bird Flu) and H1N1 (Swine Flu) are both Flu-TypeA. For a singular disease + minor mutations (COVID19 vs B.1.1.7 vs P.1 extremely similar and covered by the same vaccine) to cause such a death count is pretty remarkable.
mywittyname 5y ago
>Something to consider if you see anyone trying to downplay this. Most of the downplaying I've seen has revolved around the idea that those who died would have, "died anyway" from some other ailment or that hospitals are finding any reason they can to attribute deaths to covid. So, while you have a great argument, I doubt you'll change any minds because those who disagree flat out reject your premise.
- whimsicalism 5y ago
  For the former, if someone is actually willing to listen to evidence, you can cite them numbers of average years of life lost per covid death (~15).
  - throwaway0a5e 5y ago
    >you can cite them numbers of average years of life lost per covid death That's practically inviting them to cite back the average life lost from the 1918 flu. If you're trying to counter someone who's downplaying Covid that is probably not something you should invite them to do.
    - AnotherGoodName 5y ago
      That's fine though. If they point out that COVID is merely in the same order of magnitude but not objectively worse than Spanish Flu then the point that COVID should not be downplayed has been won.
    - Revery42 5y ago
      I believe there are a significant amount of these people that won't actually argue that just because the Spanish flu was worse in this way that the Covid pandemic isn't a problem.
    - whimsicalism 5y ago
      As the other poster said, if that's the argument you're resorting to, I would say you've already lost. I've found it is helpful to count by equivalent number of deaths to something that the person has actually experienced, as it is way too easy to brush away deaths that occurred in 1918. For instance, it's as if you took the number of years of life lost in 9/11 and multiplied it by 120.
arberx 5y ago
To add to this, looking strictly at deaths, neglects the long term affects and people with severe but none-fatal cases. Not to mention the capacity issues associated with Covid. "cAsE fAtAliTy rAtE iS oNlY 1%" is a horrible metric to base any policy off of.
tunesmith 5y ago
I had no idea about HIV deaths, I would have guessed it would be 2x-3x COVID deaths. I don't think that means "HIV had a smaller impact than I thought", I think that means COVID is bigger than I thought. We get desensitized to the numbers. Thanks for the perspective.
- cronix 5y ago
  HIV is a lot harder to spread than airborne viruses. But, imagine how much worse it would have been if it was airborne.
throwaway0a5e 5y ago
We'll have to wait 20+yr for the controversy to simmer down but I bet when you run the numbers using a metric like YPLL (which is the typical metric used for these sorts of comparisons) the difference between Covid and other big pandemic outbreaks over history is going to be more minor.
- whimsicalism 5y ago
  Very back of hand numbers, but, assuming this article is true (haven't looked into it) 900,000 death * 15 yll/death [0] = 13.5 million YLL vs ~63 million YLL for Spanish Flu and 0.5 million YLL for typical flu season [1] [0]: https://www.nature.com/articles/s41598-021-83040-3 https://www.nature.com/articles/s41598-021-83040-3 [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/
  - username90 5y ago
    Flu seasons before vaccines were much worse than now though, it was like having covid every single year. The Spanish flu was about an order of magnitude worse than the normal flu seasons which is why it was so devastating. > 900,000 death * 15 yll/death [0] = 13.5 million YLL Right, so an average American lost 0.03 years of their life due to covid. I guess some thinks everything they did last year to save that 0.02 or so years was worth it. Basically you save a week by social distancing and locking down for a year.
    - whimsicalism 5y ago
      This is the number of years lost with social distancing. You could make this same argument about anything that causes large amounts of deaths.
      - username90 5y ago
        Places that didn't do social distancing didn't lose much more, there is no evidence that social distancing saved more than I estimated here. My estimate was even very generous in your favour since I estimated death without social distancing to be the worst in the world. But we could estimate to be roughly the death rate in Florida, in which case most of the social distancing did basically nothing.
screye 5y ago
Remember that life expectancy went from 60 -> 80 over the last century. 80% of the deaths have been from folks aged 65+. So, it is arguable that the Spanish flu would have killed a lot more if the average lifespan was higher.
- gilbetron 5y ago
  It's an interesting point. Spanish Flu hit younger people, so having more older people might not have affected the numbers much. On the other hand, maybe having so many old people with covid affected which variant traveled around.
- CodeGlitch 5y ago
  It affected younger people more: https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatality https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatali... > The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old.
neither_color 5y ago
I'm not trying to downplay it, I believe the official CDC counts, but some additional considerations are: Is the high total death count related directly to our response(or lack thereof), or to our higher population of people pre-disposed/vulnerable to this virus? For the past few months the focus has been on people ignoring lockdowns, ignoring bans on gatherings, vaccine hesitance etc. but it seems that, based on the co-morbidities, we were an already largely unhealthy population to begin with. We shouldn't downplay the progress we've made while we're at it. 100 million vaccinations is quite an accomplishment. If we're going to beat ourselves up for having the top total deaths(while not being in the top 20 per capita), we should pat ourselves on the back for that one. Getting 100 million people to do anything is hard.
agumonkey 5y ago
To be fair, I feel it's been naturally downplayed already. It's really not shocking anybody anymore. There's a weird fuzzy average life that emerged where most people are just waiting for the thing to go away and the casualties have become numbers.
tomp 5y ago
> Something to consider if you see anyone trying to downplay this. It's invalid reasoning to use this study to "upplay" the pandemic. It includes deaths due to depressions and delayed medical interventions, which you could argue isn't the result of COVID directly, but the result of lockdowns. So when people use this study to claim "see, this many lives were lost, we were right to institute lockdowns" - that's circular reasoning, part of the reason so many lives were lost is because of lockdowns.
- treeman79 5y ago
  Number saved due to lockdown Number died due to lock down Personally I lost access to badly needed medical care due to lockdown. Was quite scary. Eventually got Covid. Sucked but nothing compared to what else I’ve been through. So initially was dismissive. However definitely some lasting changes to my clotting levels. I have to be perfect with blood thinners these days, we’re before covid I could fudge with them.
  - txsoftwaredev 5y ago
    "Personally I lost access to badly needed medical care due to lockdown. Was quite scary." My nearly 70 year old mother is in the same boat. She recently dealt with breast cancer treatments (a rare form) and thankfully was given the all clear before covid. She still needed to do follow up visits, more testing etc. but due to covid was told to stay away. Even though she was more comfortable with the risk of getting covid vs. ensuring her cancer is in remission they wouldn't see her.
- standardUser 5y ago
  If there had been no mitigation efforts the death toll would have skyrocketed as our healthcare systems collapsed.
  - betwixthewires 5y ago
    You say that, and they said it (only 90s kids will remember "fifteen days to slow the spread") but as of right now, it's a truism. Maybe the lockdown worked to ease the stress on the medical system. Maybe only the first 15 days of lockdown did that, or 30. I highly doubt that the entire year of lockdowns saved the medical system, and I would be willing to bet the effectiveness of the lockdowns in preventing a collapse of the medical system ended within the first 3 months. So suppose that's true, 3/4ths of the lockdown and all the mental health and depression related deaths associated with it were unnecessary. I don't know when the lockdowns stopped being effective in protecting the medical system, but I know it wasn't this morning. Some amount of those deaths are attributed to lockdowns that were unnecessary. Also, you can't quantify the hypothetical death toll in that scenario in any real numbers, to say "would have skyrocketed" is unfounded. I could understand "would've been higher" that sounds reasonable.
maerF0x0 5y ago
> Something to consider if you see anyone trying to downplay this. I admit I'm the morbid one in the group, memento mori and all. But I think the real stat we should track is years of lost life expectancy. That's the only statistic that makes sense when doing cross disease examinations. Not speaking specifically about covid, but more generally, something which primarily kills young people is much bigger deal than something which primarily kills old people.
- exporectomy 5y ago
  I wonder if that measure should be used for criminal justice as well. As well as showing that killing an old person is less harmful, it also excludes babies. Both these groups seem to have lives that are worth less even to themselves and so it's (however distasteful) not as bad if they die. We already do that with abortion by valuing an unborn baby's life less.
  - username90 5y ago
    Many places already has laws around infanticide which is much lower than manslaughter. Canada for example sentences mothers to at most 5 years with no minimum for killing their baby.
- jschwartzi 5y ago
  YLL is a horrifying metric because it values someone who is 20 over someone who is 60. The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young. This kind of statement about the bare utility of a human life is the same statement that underlies a lot of how we have treated the disabled or those on welfare in the past. And it only makes sense if you think about a human life in terms of its economic usefulness as some sort of cog in the economic machine that wears out and can be discarded safely after age 67.
  - orangecat 5y ago
    The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young. It's not about "usefulness", it's that saving the life of a young person produces a larger benefit in terms of expected future years of life. Take the extreme case: if a building is on fire and you can only rescue one person, would you be indifferent between saving the life of a 10 year old child versus a 90 year old with terminal cancer?
jollybean 5y ago
It's also greater than all of US military combat deaths for every war combined i.e. Civil War, WW1/2, Korea, Vietnam etc.. And think of how much concern (legitimately so) we have for them.
- nonameiguess 5y ago
  US Civil War death toll is estimated between 620,000 and 750,000, which is higher than the official Covid toll so far. It was also much more highly concentrated in a small number of states in a country that was far less populated.
  - jollybean 5y ago
    That's not 'combat deaths' though, that's 'total deaths'. In those wars, a huge number of people died from things other than direct combat. Here are the numbers [1] [1] https://en.wikipedia.org/wiki/United_States_military_casualties_of_war https://en.wikipedia.org/wiki/United_States_military_casualt...

ArtTimeInvestor 5y ago

How does it compare to the flu?

Teknoman117 5y ago

This is anecdotal at best, but when my grandfather passed last May from COVID, his death certificate did not record the cause of death as COVID. He tested negative twice after his month long bought with it, but only lived for another few weeks until dying of respiratory failure. We were told that because he was not testing positive at the time of death, his cause of death could not be recorded as COVID. I thought cause of death was whatever disease or injury started the chain of events that lead to one's death, but it felt like serious statistic manipulation. (edit - grammar)

CalChris 5y ago
My sister's a doc. Same anecdote. She had a patient who fell at home while severely weakened with COVID. Death certificate did not say COVID.
bsimpson 5y ago
Gets manipulated in the other direction too: financial incentives nudge hospitals to assign coronavirus as a cause of death if you had it when you died, even if it wasn't what actually killed you. I don't know if it's as blatant as "died in a car crash of coronavirus," but enough of my medical friends have mentioned it that I believe there's truth to it.
- vmception 5y ago
  Many tallies in the US were adjusted after this specific criticism over 8 months ago. But I guess the talking point won't be updated, oh well. My main issue with this criticism is that tallies of other illnesses have the same issues. So if an actual flu season said 20,000 people died, it had the same reporting issues and distribution of reporting issues. This means a direct comparison to two ailments with the same distribution of reporting issues gives you an accurate view of the affect. So even without going back and fixing the records - which I'm not sure you or other people even know happened - this means Covid deaths are more accurate and actually proves how it is much much worse. Anybody see the irony there? Given that the point of bringing attention to this would be to downplay the severity or response (or that there is a 100% correlation between the people that subscribe to these talking points and want a dramatically different response or no mitigation response at all), so, thanks for keeping healthcare authorities accountable, I guess.

spamizbad 5y ago

So much for all the conspiracy theories we saw last year claiming deaths attributed to COVID were being wildly inflated. Many people felt the opposite was likely true - and I think history will prove them right.

deleted 5y ago
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whb07 5y ago

Wonder how they accounted for the gun shot victims and motorcycle crashes who are accounted as covid deaths? Looking at Italian data going back to March/April of 2020, we knew that over 50% of deaths, the patient had 3+ serious diseases and had a median age of 79+. The true death rate is the delta of standard deaths in a “normal” year and the ones recorded now. That and somehow account for some pull-forward that’s clearly happened. If a person was somehow due to die (assume a God exists and it’s already planned) on January 2021 of terminal cancer, but then covid found him and he died Dec 2020, what’s the real cause of death?

techbio 5y ago
So, perhaps we see fewer than expected deaths in the next 2-3 years?
gilbetron 5y ago
If the same person had died from a stroke in Dec 2020 instead of covid, what's the real cause of death?

deleted 5y ago

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chmod600 5y ago

It looks like Florida is two shades "better" than California in the diagram, which would put the total Florida death rate as better than California. That would be interesting because Florida did almost no lockdown. How could that be?

bpodgursky 5y ago
Florida aggressively locked down visitor access to nursing homes pretty early on, which is where the vast majority of deaths happen. Wearing masks on beaches and in restaurants etc may slightly impact the case count but really doesn't impact mortality in the same way that an outbreak in a care home does.
- nradov 5y ago
  Is there any reliable evidence that wearing masks on beaches even impacts the case count? Data from actual contact tracing seems to indicate that outdoor transmission is close to zero.
  - bpodgursky 5y ago
    Yeah, I didn't feel like getting into that particular battle, but should have been more explicit; wearing masks outdoors has 0 impact on anything.
- pvarangot 5y ago
  I'm not sure where I read about this but Florida also did better in prisons.
nostromo 5y ago
WHO has been consistent about being anti-lockdown during all of Covid. There's limited evidence they work more than a short-term delay tactic and cause tremendous harm.
- spaetzleesser 5y ago

grumpyautist 5y ago

The organization that published these numbers apparently a. Doesn't know how to use certbot and b. Is primarily funded by organizations who are anything but impartial on the subject

akamaka 5y ago
Can you explain in more detail? Who are the biased organizations who funded this publication?
- grumpyautist 5y ago
  From Wikipedia: IHME receives core grant funding from the Bill & Melinda Gates Foundation[60] and the state of Washington. The US Centers for Disease Control and Prevention (CDC); Inter-American Development Bank; Gavi, the Vaccine Alliance; the National Heart, Lung and Blood Institute; Kingdom of Saudi Arabia Ministry of Health; Medtronic Philanthropy; and the National Institute on Aging have also contributed funding through project grants and contracts. Billions of dollars from organizations that have billions invested in selling vaccines Look into the criticism of organizations such as Gavi.
  - knowaveragejoe 5y ago
    Dismayed to see this kind of conspiracy BS on HN.
    - grumpyautist 5y ago
      What about what I said was "conspiracy bs"? These are the organizations that fund the group. They are invested in vaccine sales, and some of them have very questionable ethics. Again from Wikipedia: "Public-sector workers and academics public health have criticized GAVI, and other global health initiatives (GHIs) with private-sector actors, saying that they have neither the democratic legitimacy nor the capacity to decide on public health agendas. Private donors often find it easier to exert influence through public-private partnerships like GAVI than through the traditional public sector. There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries. Some WHO officials have privately criticized GAVI for infringing and weakening the WHO's mandates" And that is just a small portion of the issues with that organization. GAVI is an organization that promotes sales of the industry's newest vaccines, not promoting vaccination as a whole. "In 2012, the first MSF "The right shot" report criticized GAVI for focussing on funding expensive new vaccines and neglecting to give children cheap old ones. "Twenty percent of the world’s children aren’t even getting the basic vaccines", MSF's vaccine policy adviser said.[11] MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which GAVI is listed as a leader, as flawed for failing to help those 20%, which is some 19 million children.[28]" And this is just complaints against one of the organizations.

timr 5y ago

This isn't a "study", it's a statistical model. It reflects the assumptions put into it. To wit: > Our analysis follows four key steps. First, for all locations where weekly or monthly all-cause mortality has been reported since the start of the pandemic, we estimate how much mortality increased compared to the expected death rate....Second, based on a range of studies and consideration of other evidence, we estimate the fraction of excess mortality that is from total COVID-19 deaths as opposed to the five other drivers that influence excess mortality. Third, we build a statistical model that predicts the weekly ratio of total COVID-19 deaths to reported COVID-19 deaths based on covariates and spatial effects. Fourth, we use this statistical relationship to predict the ratio of total to reported COVID-19 deaths in places without data on total COVID-19 deaths and then multiply the reported COVID-19 deaths by this ratio to generate estimates of total COVID-19 deaths for all locations. And, what, you may ask, are the biases of the models' authors with regards to the percentage of excess mortality due to Covid itself? Excellent question: > Deaths that are directly due to COVID-19 are likely underreported in many locations, particularly in settings where COVID-19 testing is in short supply. Most excess mortality is likely misclassified COVID-19 deaths. > Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality. For the reasons presented in this section, we believe that this is likely an underestimate. As someone who has now spent the better part of his life creating statistical models, when you assume something is true, your model is likely to confirm your assumptions. This is why statistical models are worthless without prospective validation. If you haven't shown that your assumptions are correct for the future, you're just making castles in the sky.

grumpyautist 5y ago
Yep, and it's a suspect one at best. Personally I wouldn't trust a stastical model from someone who advertises that they own the book "how to lie with statistics" and obviously used it
- seoaeu 5y ago
  I trust someone who acknowledges that statistics can be used deceptively vastly more than I trust someone who doesn't.

kaczordon 5y ago

Third, we build a statistical model that predicts the weekly ratio of total COVID-19 deaths to reported COVID-19 deaths based on covariates and spatial effects. Given how disastrously wrong most modeling/forecasting(1) has been during this pandemic color me a little bit skeptical that their model is somehow better. Models give wide latitude to fiddle with parameters. (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447267/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447267/

williamsmj 5y ago
This group in particular has a terrible record: https://www.vox.com/future-perfect/2020/5/2/21241261/coronavirus-modeling-us-deaths-ihme-pandemic https://www.vox.com/future-perfect/2020/5/2/21241261/coronav...
dadjoker 5y ago
Color me completely distrusting. Between the IHME and Neil Ferguson (aka The Master of Disaster because of how horrifically wrong his models have been) models in the UK, they haven't even been close to reality. The IHME was even called out last year by other data modelers at one point for how poorly done their models were.
- teachingassist 5y ago
  This is a slight re-write of history, by my recollection. Neil Ferguson's earliest models were used to justify no action/herd immunity as the UK's initial strategy. I recall (but can't find) the Imperial College scientists saying they didn't fully consider any other option at first, because they understood that it would be politically unpalatable.
  - thinkingemote 5y ago
    Just goes to show how faulty our recollection is that it changes what we think was history. Best to actually look it up. (hint: you won't find the 'do nothing for herd immunity' as a stategy, but you will find many newspaper articles speculating about it based on out of context quotes) History gives a better record than our impressions from the news of the sensational at the time and our faulty memories.

grawprog 5y ago

>the discrepancy between reported deaths and analyses of death rates compared to expected death rates, sometimes referred to as “excess mortality,” suggests that the total COVID-19 death rate is many multiples larger than official reports. So...not as many people died as we thought were going to so we're now just going to arbitrarily say any excess death was a covid death just to make sure the numbers look like what we think they should? These are the kinds of statistical shenanigans that have been going on all year and people wonder why people question 'the science.'

mypalmike 5y ago
Comparison of expected versus actual outcomes is a reliable method to estimate the overall effect of a new input. Can you specifically point out how such analysis constitutes "shenanigans"?
- exporectomy 5y ago
  It includes deaths caused by the response to covid, such as people avoiding hospital for other diseases and whatever the deathy consequences of lockdowns might be.
  - mypalmike 5y ago
    Of course. This is addressed in the article.
crazygringo 5y ago
That's not what they do at all. Just a few sentences later, they break down changes in death rates into 6 categories -- 3 that are increases but also 3 that are decreases. But in any case, it's a pretty reasonable first-order assumption that excess deaths are from COVID, that can then be analyzed in more detail per-population to see if it continues to be plausible, e.g. whether excess deaths were also correlated in time and place with COVID, etc. And isn't this precisely the kind of double-checking of official numbers that is valuable? Official statistics don't always tell the truth -- witness Cuomo specifically undercounting nursing home deaths. The shenanigans we should be concerned with aren't this -- it's shenanigans in official reporting. Thank goodness we live in a democracy with free speech where these kinds of things can be questioned. Challenging findings to produce stronger, more trustworthy final results ultimately increases faith in science, don't you think? It sounds like you're arguing findings should never be challenged, which isn't science at all.

yalogin 5y ago

For me its shocking that we as a population have become so numb to so much death around us. Wonder what it says about society in general. Would be fascinating to read any research reports on that aspect.

vkou 5y ago
That's because our media has a gentleman's agreement to not show it to us. If the news were running 24/7 with reels of disaster porn - images of people dying in ICUs, or struggling to breathe and unable to get treatment, we'd have been taking this problem seriously last year. Instead, it's this abstract, sanitized problem that only happens to other people. What you don't see on the TV isn't real.
- symlinkk 5y ago
  Which is why LiveLeak was so great, you got to see what death actually was.
- listenallyall 5y ago
  Sure. And the evening news should show every fatal car crash, in multiple angles, slo-mo, so the population would learn about these deathtraps called "automobiles" and we could take that problem seriously too.

hervature 5y ago

As others have pointed out the death toll from COVID is truly astounding. Get your vaccines if you can. That being said, excess mortality is not purely from COVID. There are widely reported drops in treatment for various cancers [1,2,3]. The link between COVID and diabetes is also very complicated and will take years to figure out what happened. The grim bright side is that we've seemed to hit peak excess deaths and may be dipping below and so the 900k number might decrease a little moving forward [4]. [1] - https://www.breastcancer.org/treatment/covid-19-and-breast-cancer-care#breastcancer https://www.breastcancer.org/treatment/covid-19-and-breast-c... [2] - https://ascopubs.org/doi/full/10.1200/CCI.20.00134 https://ascopubs.org/doi/full/10.1200/CCI.20.00134 [3] - https://jamanetwork.com/journals/jamaoncology/fullarticle/2774867?guestAccessKey=8e9733f4-229b-4616-a1fe-169ee2e23abd&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=011421 https://jamanetwork.com/journals/jamaoncology/fullarticle/27... [4] - https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

pelasaco 5y ago
Isn't "total mortality due to COVID-19" different than "total mortality from COVID-19"? As I understand the cancer treatments were aborted due COVID-19, therefore, more person died due to COVID-19 but not necessarily from COVID-19... does it make sense?
- hervature 5y ago
  I think that's exactly the criticism of this paper. They are precisely saying "total mortality due to COVID-19" = "total mortality from COVID-19". From the paper: > for now we assume that total COVID-19 deaths equal excess mortality
- betwixthewires 5y ago
  Well that's a question of if you think the lockdowns were necessary or not. If you think they were, then of course excess mortality is due to covid. If you think they weren't then that excess mortality was due to unneeded human intervention. Of course the answer is somewhere in between, that is, some degree of lockdowns and therefore the deaths attendant to that were overzealous, and that throws this entire model in the trash.

the_reformation 5y ago

“If there were 315,507 excess deaths due to Covid-19, why is the difference in all-cause deaths between the end of 2020 and the end of 2019 only 61,654? That’s 61,654 more all-cause deaths in 2020 than in 2019, where the increase in all-cause deaths over each of the past ten years has averaged 44,806. That’s a difference of 16,848 from the median in a year with an alleged 315,507 extra Covid-related deaths.”

0xbadcafebee 5y ago

I'm curious to find out the long-term effect from all the organ damage caused by non-lethal COVID-19. Heart damage, lung damage, brain damage, blood clots, chronic fatigue. Wonder if our healthcare costs will reach a new high over the next 30 years.

jccooper 5y ago

An interesting read, but the title here is pretty terrible. It represents one line in a table halfway down the page. The original article title is "Estimation of Total Mortality Due to COVID-19" which is accurate, if dull. I'd perhaps add "worldwide".

kmm 5y ago

According to The Economist[1] and this preprint[2], the US had about 600k excess deaths. What could cause such a massive discrepancy? 1: https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker https://www.economist.com/graphic-detail/coronavirus-excess-... 2: https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v2 https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v...

fullshark 5y ago
They claim COVID led to behavioral changes that lowered the expected volume of death, so the naive excess mortality is an undercount: > Overall, the evidence suggests reductions of 615,000 deaths, or potentially more, stemming from behavioral changes at the global level. The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality So basically they lowered the expected number of deaths, then claimed all deaths above expectation are COVID.

standardUser 5y ago

How many more people have died during the pandemic than we would expect to have died based on past trends? The NYT had a tracker (which they stopped updating) that showed the number of excess deaths was not much higher than than confirmed COVID-19 deaths. https://www.nytimes.com/interactive/2021/01/14/us/covid-19-death-toll.html https://www.nytimes.com/interactive/2021/01/14/us/covid-19-d...

option 5y ago

About time we start asking hard questions on the virus origin.

exporectomy 5y ago
OK. You can start.
- option 5y ago
  It is totally a coincidence not worth investigating that the covid outbreak started in a city with the lab that holds the world’s largest collection of bat coronaviruses. for starters let’s have WHO investigate it by a team not led by the guy who was a close collaborator with Wuhan lab.
AnimalMuppet 5y ago
As opposed to all the ones that have been asked so far, which were somehow "not hard"?
- option 5y ago
  yet to see an independent team of experts (as in no previous collaborators, not vetted by ccp, etc) allowed to investigate the lab which holds the world’s largest collection of bat coronaviruses and just happened to be located in Wuhan.

akomtu 5y ago

Basically, it's nothing to worry about. On an average year, about 2.5 million people die in the US, with at least 600k from cancer. Another data point is that something like 2.3 millions sit in the US prisons right now, so if the 900k number makes you terrified, you should be 3x more terrified about ending up in a prison one day and Nx more terrified by cancer, as for each cancer death, there are tens living in misery fighting that cancer.

betwixthewires 5y ago

The study is counting all excess mortality during the pandemic. This is a bad methodology, and I might add possibly a politically motivated one, but that's neither here nor there. There are metrics all over the place showing some regions with no lockdowns having less excess mortality and mortality due to covid. Some of the lockdown measures in some places were counterproductive. Some people say all of them were, some people say none of them were anywhere (which makes no sense really), but the truth is probably somewhere in the middle: at least some measures taken in some places were the wrong call. This is to be expected, we didn't know what the disease was going to do and lots of us panicked. But conflating deaths from covid with deaths from the response and attributing all of them to the same cause is going to necessarily include deaths that would not have happened even in the pandemic if it weren't for the response. And we can quantify that, as an example, look at the disparity in excess mortality and covid death between California and Florida. California had a higher excess mortality and a higher covid death rate. Was that excess death in California due to covid, or due to a botched response? Again, probably a bit of both, but there's no way to pick the two categories apart, and so this entire methodology is not useful to quantify anything.

pmoriarty 5y ago

Compare 900k dead from COVID-19 (so far) to U.S. deaths in: - Vietnam[1]: 58 k - World War Two[2]: 407 k - World War One[3]: 117 k and due to the huge numbers of people in the U.S. who are refusing to get vaccinated, wear masks, or participate in social distancing, the U.S. deaths from COVID-19 are probably far from over. [1] - https://en.wikipedia.org/wiki/Vietnam_war https://en.wikipedia.org/wiki/Vietnam_war [2] - https://en.wikipedia.org/wiki/World_War_II_casualties https://en.wikipedia.org/wiki/World_War_II_casualties [3] - https://en.wikipedia.org/wiki/World_war_one https://en.wikipedia.org/wiki/World_war_one

auser1443231 5y ago
900k people did not die from COVID-19. This "model" is predicting deaths related to the response to COVID-19 (deaths to to increase drug usage, missed cancer screenings, etc.). The second paragraph of the linked article clearly states this.

williesleg 5y ago

Thanks Biden.

auser1443231 5y ago

This headline is wildly click-baity and does not reflect the linked "study", however flawed, at all. The headline should be changed. The "study" (really it's just a model) primarily investigated excess mortalities related to our response to COVID-19, NOT COVID-19 itself. The second paragraph states six drivers of all-cause mortality that were taken into consideration: a) the total COVID-19 death rate, that is, all deaths directly related to COVID-19 infection b) the increase in mortality due to needed health care being delayed or deferred during the pandemic c) the increase in mortality due to increases in mental health disorders including depression, increased alcohol use, and increased opioid use d) the reduction in mortality due to decreases in injuries because of general reductions in mobility associated with social distancing mandates e) the reductions in mortality due to reduced transmission of other viruses, most notably influenza, respiratory syncytial virus, and measles f) the reductions in mortality due to some chronic conditions, such as cardiovascular disease and chronic respiratory disease, that occur when frail individuals who would have died from these conditions died earlier from COVID-19 instead. Only 2 of these 6 factors are related to the virus itself; the rest are related to our response. If anything, this model highlights how destructive our response was.

crad 5y ago

Anecdotes obviously don't validate data models, but I do wonder if my personal experience was common. My mother-in-law passed last summer, alone in her apartment. She was sick beforehand, quarantined, and living in a senior living community. When she was discovered the coroner did not come and investigate because it appears of natural causes, based on the observations of the local police officer. Her body was transported directly to the funeral home. I insisted they do a COVID-19 test, which the coroner did at the funeral home. The results came back as positive. Had I not pushed them to actually test, it would have been misreported and her death mis-attributed. It left me wondering if this was common and how many people may have passed in similar circumstances, without family pushing for testing.

toomuchredbull 5y ago

Not to be grim but seems to me that a country that suffered lots of casualties of their oldest, weakest and most infirm and the least economic disaster is probably well suited to be successful in the future.

worik 5y ago
You mean "To be grim...."

einpoklum 5y ago

I won't make the unfair comparison to, say, New Zealand, which has no land borders, but let's take Vietnam: * 100M people * Long land borders with Laos, Cambodia, and China * Virus located in state territory in Jan 2020 * Total number of verified cases: 3,137. * Total number of deaths: 35 * Current number of daily new cases: ~50. Multiply the figures by 3.3 or so to normalize with US population. Forget the quibbling over the statistical model. Maybe it's only 600K. Regardless, it's over _20000 times higher_. And even allowing for, I don't know, different susceptibility to the symptoms, or whatever - the US numbers are just insane.

floxy 5y ago
Yes, I wonder if the U.S. can or will learn the lesson of Vietnam. https://www.vox.com/22346085/covid-19-vietnam-response-travel-restrictions https://www.vox.com/22346085/covid-19-vietnam-response-trave...

nickthemagicman 5y ago

What everyone is neglecting to talk about is the age effect of mortality with Covid. For people under 55 the chance of fatility is miniscule.. in the range of choking or car accidents. This age group makes up 80% or so of the population. For people over 80 this may be the worst disease since the black plague. Millions upon millions of deaths. This age group makes up approximately 10% of the population. This is an important consideration because the lockdowns effectively trapped mostly working age people who weren't at risk of dying from Covid in the first place. I think that's where a lot of criticism of Covid policies stems from. Should we make national health policy based on a disease that effects a minority of the population? Reference: https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/ https://www.statista.com/statistics/1191568/reported-deaths-...

anoncake 5y ago

US population: 328.2 million. So that's 0.24%. Assuming the average victim would have died another 10 years, that means everyone lost, on average, 0.024 years = 8.8 days.

throwaway7783 5y ago

Heh, the thread is amusing. A few days back there was another thread discussing true mortality rate of COVID in India and a lot of support for how deviation from base rates are a fairly good indicator. When it comes to the US...

WalterBright 5y ago

There are also very debatable definitions of what a Covid death is when there are co-morbidities present. For example, if one dies having both advanced cancer and Covid, which one gets tagged as the cause of death?

worik 5y ago

Awful. So many commenters arguing about the accuracy of the statistical models used to reach the 900,000 dead figure. Missing the terrible, tragic, point. Too many people have died (and too many been disabled - for each death about 10 get "Long Covid") It did not have to be like this. This is/was a tragedy. There have been way too many deaths. Some places did much worse than others - perhaps it is time to start thinking about, and discussing that?

crowf 5y ago

In order to even start calculation the "true" cost, they should also subtract the deaths from school shootings, road accidents, etc. that did not happen this past year.

pyrotactics 5y ago

But so many studies find the exact opposite. Including the CDC! Wake up already. 99.97% survival rate!

dang 5y ago

We changed the title from "True U.S. death toll from Covid is more than 900k, study finds". That was editorialized, which breaks the site guidelines. It was also arguably both misleading and baity, which means that it broke the site guidelines on all three points: "Please use the original title, unless it is misleading or linkbait; don't editorialize." Please don't do that! https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

harambae 5y ago
Original source was this: https://www.mediaite.com/news/true-u-s-death-toll-from-covid-is-more-than-900000-study-finds/ https://www.mediaite.com/news/true-u-s-death-toll-from-covid... Which is where the title came from. At the last minute I remembered there was an actual scientific paper so I changed the URL to that.
- dang 5y ago
  That makes sense. We sometimes leave a title up after changing the URL too.

raarts 5y ago

I think calculating weekly expected deaths and drawing conclusions from that is wrong given the seasonality of covid-19 and diseases in general. Excess deaths should be looked at over a long period of time. Seems similar to the difference between weather and climate.