The most recent numbers from the National Center for Health Statistics show that there were about 527,000 more fatalities in 2020 than 2019, an 18.6% increase.1
As you can see from the chart above, the average year-over-year increase has been ~35,000 or 1.3%. The largest increase over the last five years was just under 3% in 2017. So, the 2020 increase is more than six times greater than anything we have seen in recent years. You would probably have to go back to the Asian Flu pandemic in 1957 to find anything comparable to this kind of one-year increase.
Interestingly, however, the CDC only attributes about 380,000 of the excess deaths to COVID. In other words, we have an increase of about 145,000 for which we do not have an explanation.
There are two which are likely. First, there were probably some fatalities, especially in the first months of the pandemic, that were related to COVID but written off to the regular flu or pneumonia. Second, we know that our attempts to control the pandemic caused some collateral damage. Suicides and family violence are both up for the year. There are also many anecdotal accounts of patients dying from other causes because they feared going to a hospital for treatment. I doubt that we will ever be able to segregate the causes into neat categories but as traditional actuarial numbers begin to come in for 2020, we should get a better idea of the causes associated with these fatalities.
“Mortality Displacement” & “Years of Life Lost”
While the death toll from COVID in 2020 was gut-wrenchingly high, there are two factors which are likely to ultimately mitigate the toll.
The first is mortality displacement. Mortality displacement is an epidemiological/demographic concept that describes the phenomenon where an extraordinary event delays or accelerates fatalities that would otherwise have occurred in another time period.
Because the vast majority of COVID victims have been elderly and ill, there likely has been a significant displacement of fatalities that would have otherwise occurred in 2021 into 2020. This is particularly likely in that 40-50% of the fatalities that occurred in nursing homes. The average life expectancy in a skilled nursing facility is less than two years.
Also, as you can see from the chart, there was a very small increase in 2019 from 2018. Therefore, we probably went into 2020 with a larger highly vulnerable cohort than normal. However, we will not be able to judge the degree to which mortality displacement has affected total fatalities until we have the final numbers for 2021, which will be about a year from now.
Second, epidemiologists and actuaries distinguish between “lives lost” and “years of life lost.” Years of life lost is a calculation which compares the age of the decedent to their life expectancy. Again, because COVID fatalities have been very concentrated among the elderly, its toll in terms of years of life lost has been relatively less than other pandemics. Most pandemics, and especially flu pandemics, tend to have high fatality rate among children, as well as the elderly. Thankfully, COVID almost entirely spared children. So, when the “years of life lost” is calculated and compared to previous years, the increase will be well below the 18% absolute increase in fatalities.
To give you some sense of the scale of the years of life lost factor, this study estimated that by early January, COVID had caused just over 20 million years of life lost in eighty-one countries for which data was available. While that seems like an astonishing large number, that is about equal to the number of years lived by the world’s population every day. Also, it is considerably less than some other leading causes of death. For example, nearly 4 million people die from drinking unsanitary water annually, most of whom are children. So, the years of life lost to unsanitary water was many times more than COVID in 2020. And lives lost to unsanitary water supply will continue to occur every year. By the way, that problem could be solved for a fraction of what has been spent on the attempts to contain COVID.
It is very unfortunate and disappointing that COVID became so politicized and was so sensationalized by the media. Both clouded our ability to think about COVID in a nuanced way and I fear ultimately made the outcome worse. I think that a case can be made that our inability to focus on the actual fatality risk led to poor decisions in our mitigation approach. I will be writing more on this topic soon.
Note 1 – There are a number of social media posts circulating showing a small increase in fatalities in 2020. These numbers were pulled from the NCHS site in early January. However, the NCHS collects its fatality from state death certificates filed with it. It generally takes a little over two months until most of the certificates have been received and files. The totals I am using in this post were downloaded on March 23. The total number will continue to increase slightly as late certificates are filed. However, this should represent more than 99% of the final number.