COVID Deaths, Excess Deaths, and the Non-Elderly (Revisited)

While we know that COVID primarily affects the elderly, the mortality and other effects on the non-elderly aren’t trivial. I have explored this in several past posts, such as this November 2021 post on Americans in their 30s and 40s. But now we have more complete (though not fully complete) mortality data for 2021, so it’s worth revisiting the question of COVID and the non-elderly again.

For this post, I will primarily focus on the 12-month period from November 2020 through October 2021. While data is available past October 2021 on mortality for most causes, data classified by “intent” (suicides, homicides, traffic accidents, and importantly drug overdoses) is only fully current in the CDC WONDER data through October 2021. This timeframe also conveniently encompasses both the Winter 2020/21 wave and the Delta wave of COVID (though not yet the Omicron wave, which was quite deadly).

First, let’s look at excess mortality using standard age groups. For this calculation, I use the period November 2018 through October 2019 as the baseline. The chart shows the increase in all-cause deaths in percentage terms. It is also adjusted for population growth, though for most age groups this was +/- 1% (the 65+ group was 3% larger than 2 years prior).

A few things jump out here. First notice the massive increase in mortality for the 35-44 age group (much more on this later). Almost 50% more deaths! To put that in raw numbers, deaths increased from about 82,000 to 122,000 for the 35-44 age group, and population growth was only about 1%. And while that is the largest increase, there were huge increases for every age group that includes adults.

Also notice that the 65+ age group certainly saw an increase, but it is the smallest increase among adults! Of course, in raw numbers the 65+ age group had the most excess deaths: about 450,000 of the 680,000 excess deaths during this time period. But since the elderly die at such high rates in every year, the increase was as large in percentage terms.

One related fact that doesn’t show up in the chart: while there were about 680,000 excess deaths during this time frame in the US in total, there were only about 480,000 deaths where COVID-19 was listed as the underlying cause of death. That means we have about 200,000 additional deaths in this 12-month time period to account for, or a 24% increase (population growth overall was only 0.4%).

That’s a lot of other, non-COVID deaths! What were those deaths? Let’s dig into the data.

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Covid-19 Didn’t Break the Supply Chains. You Did.

This is my last post in a series that uses the AS-AD model to describe US consumption during and after the Covid-19 recession. I wrote about US consumption’s broad categories, services, and non-durables. This last one addresses durable consumption.

During the week of thanksgiving in 2020, our thirteen-year-old microwave bit the dust. NBD, I thought. Microwaves are cheap, and I’m willing to spend a little more in order to get one that I think will be of better quality (GE, *cough*-*cough*). So, I filtered through the models on multiple websites and found the right size, brand, and wattage. No matter the retailer, at checkout I learned that regardless of price, I’d be waiting a good two months before my new, entirely standard, and unexceptional microwave oven would arrive. I’d have to wait until the end of January of 2021.

¡Que Ridiculo!

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AS-AD: From Levels to Percent

The aggregate supply & aggregate demand model (AS-AD) is nice because it’s flexible and clear. Often professors will teach it in levels. That is, they teach it with the level of output on one axis, and the price level on the other axis. This presentation is convenient for the equation of exchange, which can be arranged to reflect that aggregate demand (AD) is a hyperbola in (Y, P) space. Graphed below is the AD curve in 2019Q4 and in 2020Q2 using real GDP, NGDP, and the GDP price deflator.

The textbook that I use for Principles of Macroeconomics, instead places inflation (π) on the vertical axis while keeping the level of output on the horizontal axis. The authors motivate the downward slope by asserting that there is a policy reaction function for the Federal Reserve. When people observe high rates of inflation, state the authors, they know that the Fed will increase interest rates and reduce output. Personally, I find this reasoning to be inadequate because it makes a fundamental feature of the AS-AD model – downward sloping demand – contingent on policy context.

At the same time, I do think that it can be useful to put inflation on the vertical axis. Afterall, individuals are forward looking. We expect positive inflation because that’s what has happened previously, and we tend to be correct. So, I tell my students that “for our purposes”, placing inflation on the vertical axis is fine. I tell them that, when they take intermediate macro, they’ll want to express both axes as rates of change. I usually say this, and then go about my business of teaching principles.

But, what does it look like when we do graph in percent-change space?

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Are the COVID Vaccines Effective at Preventing Death?

A recent analysis by the Kaiser Family Foundation of CDC data suggests that about 234,000 COVID deaths in the US could have been prevented if everyone was vaccinated. That’s about 25% of all COVID deaths throughout the pandemic, and about 60% of COVID deaths since June 2021 (roughly the time when most older adults in most states had had a chance to be vaccinated).

The first way to think of that death rate is tragic, given that so many lives could have been saved. Rather than being the high-income nation with the highest COVID death rate, the US could have been more in line with countries like Italy, the UK, and France. The US actually had a lower COVID death rate than Italy and the UK when the vaccine roll-out began, and today we could be at about France’s level with better vaccination rates.

But there’s a flipside to the KFF numbers. If 60% of COVID deaths since June 2021 were preventable, that means 40% weren’t preventable. Furthermore, the same data show that about 40% of COVID deaths in January and February 2022 were fully vaccinated or had boosters. That sounds like the vaccines might not work very well! So what does this all mean? Let’s dig into the data from the CDC a little bit.

The first, and most important thing, to recognize is that most American adults are vaccinated (about 78%), so unless vaccines are 100% effective (and they aren’t, despite some public officials overenthusiastic pronouncements early in the vaccine rollout), there are still going to be a lot of COVID deaths among the vaccinated. If 100% of the population was vaccinated, 100% of the deaths would be among the vaccinated. The key question is whether vaccines lower the chance of death.

And they do. Let’s see why.

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How to Get People Vaccinated for 93 Cents

We’ve talked a lot about vaccines on this blog, including both the benefits of vaccines and how to get people vaccinated. For example, last month I posted about Robert Barro’s estimate on the number of additional vaccines needed to save 1 life. Barro put it at about 250 vaccines. Using some reasonable assumptions, I further suggested that each person vaccinated has a social value of about $20,000. That’s a lot!

But how do we convince people to get vaccinated? Lotteries? Pay them? In addition to just paying them (the economist’s preferred method), another good old capitalist method is advertising (the marketer’s preferred method). And a new working paper tries just that, running pro-vaccine ads on YouTube with a very specific spokesman: Donald Trump.

Running ads on YouTube is pretty cheap. For $100,000, the researchers were able to reach 6 million unique users. And because they randomized who saw the ads across counties, they are able to make a strong claim that any increase in vaccinations was caused by the ads. They argue that this ad campaign led to about 104,000 more people getting vaccinated, or less than $1 per person (the actual budget was $96,000, which is how they get 93 cents per vaccine — other specifications suggest 99 cents or $1.01, but all of their estimates are around a buck).

Considering, again, my rough estimate that each additional vaccinated person is worth $20,000 to society (in terms of lives saved), this is a massive return on investment. Of course, we know that everything runs into diminishing returns at some point (they also targeted areas that lagged in vaccine uptake). Would spending $1,000,000 on YouTube ads featuring Trump lead to 1 million additional people getting vaccinated? Probably not quite. But it might lead to a half million. And a half million more vaccinated people could potentially save 2,000 lives (using Barro’s estimate).

I dare you to find a cheaper way to save 2,000 lives.

Dressed for Recess(ion)

In my previous post, I decomposed consumer expenditures to figure out which service sectors experienced the largest supply-side disruptions due to Covid-19. I illustrated that transportation & recreation services were the only consumer service to experience substantial and persistent supply shocks. Health, food, and accommodation services also experienced supply shocks, but quickly rebounded. Housing, utility, and financial services experienced no supply disruptions whatsoever.

What about non-durables?

Total consumption spending is the largest category of spending in our economy and is composed of services, durable goods, and non-durables. Services are the largest portion and durable goods compose the smallest portion. So, while there were plenty of stories during the Covid-19 pandemic about months-long delivery times for durables, they did not constitute the typical experience for most consumption.

Even though it’s not the largest category, many people think of non-durables when they think of consumption. Below is the break-down of non-durable spending in 2019. The largest singular category of non-durable spending was for food and beverages, followed by pharmaceuticals & medical products, clothing & shoes, and gasoline and other energy goods. Clearly, the larger the proportion that each of these items composes of an individual household budget, the more significant the welfare implications of price changes.

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$5,000 Worth of Vaccines Saves One Life

I’ve written about the social benefits (in terms of the value of lives saved) of COVID mitigation measures, such as wearing face masks, before. But at this juncture in the pandemic (and really for the past 12 months), the key mitigation measure has been vaccines. How much does it cost to save one life through increased vaccination?

Robert Barro has a new rough estimate: about $5,000. In other words, he finds that it takes about 250 additionally vaccinated people in a state to save one life, and the vaccines cost about $20 to produce (marginal cost). So, about $5,000.

Barro gets this number (specifically, that 250 new vaccinated people saves one life) by using cross-state regressions on COVID vaccination rates and COVID death rates. Of course, there are plenty of potential issues with cross-state regressions. It’s not a randomized control trial! But Barro does a reasonable job of trying to control for most of these problems.

Another way to restate these numbers: if we assume that the VSL of an elderly life is somewhere around $5 million, then the social benefit from each person getting vaccinated is around $20,000. In other words from a public policy perspective, it would have made sense to pay each person up to $20,000 to get vaccinated!

Or thought of one more way: each $20 vaccine is worth about $20,000 to society. That’s an astonishing rate of return. And we’re not even including the value of opening up the economy earlier (from both a political and behavioral perspective) than an alternative world without the vaccines.

This Time was Way Different

The financial crisis recession that started in late 2007 was very different from the 2020 pandemic recession. Even now, 15 years later, we don’t all agree on the causes of the 2007 recession. Maybe it was due to the housing crisis, maybe due to the policy of allowing NGDP to fall, or maybe due to financial contagion. I watched Vernon Smith give a lecture in 2012 in which he explained that it was a housing crisis. Scott Sumner believes that a housing sectoral decline would have occurred, and that the economy-wide deep recession and subsequent slow recovery was caused by poor monetary policy.

Everyone agrees, however, that the 2007 recession was fundamentally different from the 2020 recession. The latter, many believe, reflected a supply shock or a technology shock. Performing social activities, including work, in close proximity to others became much less safe. As a result, we traded off productivity for safety.

The policy responses to each of the two were also different. In 2020, monetary policy was far more targeted in its interventions and the fiscal stimulus was much bigger. I’ll save the policy response differences for another post. In this post, I want to display a few graphs that broadly reflect the speed and magnitude of the recoveries. Because the recessions had different causes, I use broad measures that are applicable to both.

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Half of Deliberately Exposed Unvaccinated Volunteers in UK Study Did Not Get COVID; Why?

A British study by Ben Killingley and 31 co-authors recently appeared in pre-print form, where 36 (heroic) healthy young adult volunteers were deliberately exposed to the Covid virus by nasal drops. These volunteers then went into quarantine for 14 days, and logged their symptoms and were subjected to various tests for a total of 28 days.


Of the 36 subjects, only 18 (53%) became infected with the virus, as determined by PCR testing (the gold standard for Covid tests) and by direct counting of viral loads in mucus cells by FFA.

The study found that viral shedding (as estimated by mucus viral loads) begins within two days of exposure and rapidly reaches high levels, then declines. Viable virus is still detectible up to 12 days post-inoculation. This result supports the practice of people quarantining for at least 10 days after they first exhibit symptoms of infection. There were significant higher viral loads in the nose than in the throat,  which supports the practice of wearing masks that cover the nose as well as the mouth.


The cheap, fast, LFA rapid antigen test method (used in home tests) performed fairly well. Because it is less sensitive, it did not it did not yield positive results for infected individuals until an average of four days after infection, or about two days after viral shedding may have begun. But from four days onward, the LFA method was sensitive and reasonably accurate which supports the ongoing use of these quick, cheap tests.

These direct inclusions from the paper are helpful, but not earthshaking. The elephant in the room, which the paper did not seem to directly address, is why nearly half of the people who were exposed did NOT become infected. This raises all kinds of issues about what mechanisms the human body may have to naturally fight off COVID or similar viral infections. Gaining insight on this could lead to breakthroughs in preventing or mitigating this pernicious virus.

An article by Eileen O’Reilly at Axios probes these questions. There is nothing conclusive out there, but four ideas that are under investigation are:

1. Cross-immunity from the four endemic human coronaviruses is one hypothesis. Those other coronaviruses cause many of the colds people catch and could prime B-cell and T-cell response to this new coronavirus in some people.

2. Multiple genetic variations may make someone’s immune system more or less susceptible to the virus.  Some 20 different genes have been identified which affect the likelihood of severe infection, and a genetic predisposition to not getting infected is seen in other diseases where people have one or multiple factors that interfere with the virus binding to cells or being transported within.

3. Mucosal immunity may play an underrecognized role in mounting a defense.

This suggests nasal vaccines might have a chance at stopping a virus before it invades the whole body.

4. Where the virus settled on the human body, how large the particle was, the amount and length of exposure, how good the ventilation was and other environmental circumstances may also play a role.

These considerations support continuing with the usual recommendations of social distancing, wearing facemasks, and ventilating buildings, especially when caseloads are peaking. Also, the doses administered to the volunteers in the study were considered quite small by clinical standards. It was surprising that such a low dose was effective as it was in causing full-blown infections; and the particular strain used in the experiment was not necessarily one of the more recent highly virulent variants. After reading these results,  it is more understandable to me why so many reasonably careful friends and family members of mine (nearly all vaccinated, fortunately) have come down with (presumably) omicron COVID in the past two months. Just a little dab will do ya.

Are Car Accidents Getting Labeled as “COVID Deaths”?

Of all the increases in mortality in 2020, one that is notable is motor vehicle accidents. There were 43,045 deaths from motor vehicle accidents, according to the final CDC data. This means motor vehicle accident was listed on the death certificate, even if it was not determined to be the “underlying cause,” though for 98% of these deaths the accident was listed as the underlying cause.

The increase from past years was large. Compared with 2019, there were over 3,000 more motor vehicle deaths, though such as increase is not unheard of: 2015 and 2016 each saw increases of around 2,500. Even so, the crude death rate from motor vehicle accidents in 2020 was the highest it has been since 2008.

If that weren’t bad enough, another theory emerged in 2020 and continues to be suggested today: that car crashes are being labeled as “COVID deaths,” artificially inflating the COVID death count. While one can find this claim made almost daily by anonymous Twitter users, one of the most prominent statements was on Fox News in December 2020. Host Raymond Arroyo said that car accidents were being counted as COVID deaths, and that due to errors like this COVID deaths could be inflated by as much as 40 percent. Senator Marco Rubio made a similar claim on Twitter in December 2021, though he was talking about hospitalizations, not deaths.

Back in 2020, many doctors and medical professionals tried to debunk the “car accidents being labeled as COVID deaths” claim, but the problem was we didn’t have complete data. Anonymous anecdotes were cited, but medical professionals tried to reassure the public this wasn’t the case or at least wasn’t widespread.

But now, we have the data! That is, the complete CDC mortality data for 2020 available through the CDC WONDER database.

What does this data show us? Short answer: there aren’t that many car accidents being labeled as COVID deaths. At most, it’s about 0.03% of COVID deaths.

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