800,000 Deaths? Or 1 Million Deaths?

According to the Johns Hopkins COVID tracker, the US has now surpassed 800,000 COVID deaths during the pandemic. The CDC COVID tracker is almost to 800,000 too. But is this number right? Confusion about COVID deaths and total deaths has been rampant throughout the pandemic, especially when comparing across countries.

One method that many have suggested is excess deaths, which is generally defined as the number of deaths in a country above-and-beyond what we would expect given pre-pandemic mortality levels. It’s a very rough attempt at creating a counterfactual of what mortality would have looked like without the pandemic. Of course, you can never know for sure what the counterfactual would look like. Would overdoses in the US have increased anyway? Hard to say, though they had been on the rise for years even before the pandemic.

So don’t treat excess deaths as a true counterfactual, but just a very rough estimate. I wrote about excess deaths in the US way back in January 2021 (feels like a lifetime ago!), and at the time for 2020 it looked like the US had about 3 million total deaths (in the first 48 weeks of 2020), which was about 357,000 deaths more than expected (again, based on historical levels of the past few years), or about 13.6% above normal.

But once we had complete data for 2020, deaths were even higher: about 19% above expected, or somewhere around 500,000 excess deaths. This compares with the official COVID death count of about 385,000 in 2020 for the US.

What happens if we update those numbers with the most recent available mortality data for 2021? Keep in mind that data reporting is always delayed, so I’ll just use data through October 2021. The following chart shows both confirmed COVID deaths and total excess mortality, cumulative since the beginning of 2020.

As we can see in the chart, there are a lot more excess deaths than confirmed COVID deaths. There were already over 1 million excess deaths through the end of October 2021 in the US, cumulative since January 2020. This compares with about 766,000 confirmed COVID deaths. That’s a big gap!

We could spend a lot of time trying to understand this gap of 250,000 deaths. Is this under-reporting of COVID deaths? Is it deaths caused by government restrictions? Is it caused by the overwhelming of the health system?

I won’t be able to answer any of those questions today. Instead, let’s ask a different question: is the potential US undercount of COVID deaths unusual?

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COVID Deaths and Middle Age

We have known for a long time (basically since the start of the pandemic) that COVID primarily affects the elderly. Infection fatality rates are hard to calculate (since not all infections are reported), but most of the data suggest that the elderly are much more likely to die from COVID than other age groups.

For some, this has become one of the most important aspects of the pandemic. For example, Don Boudreaux emphasizes the age distribution of deaths many times in a recent episode of Econtalk, and he uses this point to argue that we addressed the pandemic incorrectly (to say the least). Boudreaux specifies that COVID is only deadly for those 70 and older. And while I won’t rehash the argument here, please also see my exchange with Bryan Caplan, where he argues that elderly lives are worth a lot less than younger lives (I disagree).

At first blush, the data seems to bear that out. The CDC reports that almost 80% of COVID-involved deaths were among those aged 65 and older (I will use the CDC’s definition of COVID-involved deaths throughout this post). In other words, of the currently reported almost 600,000 COVID deaths in the US, about 475,000 were 65 and older. Throw in the 50-64 age group, and you’ve now got 570,000 of the deaths (95% of the total).

But is this the right way to think about it? Remember, the elderly always account for a large share of deaths, around 75% in recent years. So it shouldn’t surprise us that most deaths from just about any disease are concentrated among the elderly.

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