COVID’s Bigger Picture

Throughout the fog of the pandemic, which hit communities of color hardest, the dashboard of daily COVID indicators has throttled our existence and the range of our activities as we did our best to carry on.

But it only tells part of the story.

Now, more than a year into our tribulation, researchers are getting a rearview mirror look back at where COVID hit hardest and left the deepest scars. That information is critical for us to be able to identify where we remain vulnerable often because of legacy deficiencies in the local health care systems that are particularly pronounced in communities of color.

If America is to get well, which is the first step to escaping the undertow of this pandemic and preparing for staving off the next, we have to uplift these places where regular access to quality healthcare was a socio-economic preexisting condition that helped drive the local body count.

It’s important to remember that for decades our government ignored the warnings from public health experts that the U.S. was not properly prepared for the pandemic we are living through now.

In his book “The Great Influenza”, first published in 2004, John M. Barry presaged the COVID crisis describing how “hospitals, like every other industry, have gotten more efficient by cutting costs, which means virtually no excess capacity—on a per capita basis the United States has far fewer hospital beds than a few decades ago.”

He continued. “Indeed, during a routine influenza season, usage of respirators rises to nearly 100 percent; in a pandemic, most people who needed a mechanical respirator would not get one.”

As we have learned first-hand over the last several months, because the healthcare system was overwhelmed, getting accurate cause of death data was itself a work in progress. No doubt, cases of COVID may have been missed. In others, individuals may have died at home or succumbed to a chronic illness that was written off as COVID when it was not.

The one constant comparative data point is death itself from any and all causes.  Like births, deaths are something we track with some precision. So, one way that medical researchers can get a sense of the scale of the impact of something like COVID is to compare the total number of deaths from all causes during the pandemic and compare it with the same data point over several prior years.

Such an “excess death” analysis will capture the collateral impact of overwhelmed healthcare systems that were under resourced long before COVID. It will include the people that died as a consequence of opting not to go to the hospital for an unrelated condition for fear of catching COVID. While that’s not a COVID death per se, it tells us something about what happens when we permit healthcare to operate without any margin or redundancy in what is a form of rationing.

According to a recently published study in the Journal of the American Medical Association, which looked at the rate of excess deaths from March 1, 2020 to Jan. 2, 2021 there were 522,368 “excess deaths” as gauged against 2014 to 2019. 

At the start of this year, COVID deaths were reported at just over 350,186. By comparing the “excess rate” of death with the COVID reported data, linked to its location, we can get some sense of where the public health system had the hardest time holding up under the once in a century strain of a mass death event.

The study, produced by researchers with the Virginia Commonwealth University School of Medicine in Richmond and the Yale School of Public Health, calculated that COVID accounted for 72.4 % of the excess mortality. The balance may have been “either immediate or delayed mortality from undocumented COVID-19 infection, or non–COVID-19 deaths secondary to the pandemic, such as from delayed care or behavioral health crises.”  

While nationally there was a 23 percent increase in excess mortality during the pandemic, New York State, which lost close to 50,000 to COVID, saw the nation’s highest spike, with a 38 percent jump in excess deaths. Yet, Mississippi and New Jersey actually exceeded New York State, on a per capita basis, according to the researchers.

It would seem we need to know more about why New Jersey’s “excess mortality” ranked so high.

In an editorial that was published with the study, Dr. Alan M. Garber wrote of the importance of grasping the bigger picture, beyond the daily COVID dashboard because “there is no more visible or alarming manifestation of the toll of the COVID-19 pandemic than the deaths it has caused.”

“The missteps in responding to an outbreak that not only could be, but largely was, predicted should not give governments confidence that they are prepared for threats that are more speculative and possibly further in the future,” wrote Garber. “Failure to anticipate the scale of the potential damage from such future catastrophes will only exacerbate the tendency to downplay their importance, making it less likely that governments will prepare adequately. That is why understanding the toll of a pandemic is an important step in the right direction.”

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