Look, anyone who thinks that an enormous amount of health, economic and social damage isn’t being done by the excessive governmental responses to the epidemic is just in denial. The evidence keeps piling up. The most horrifying stories are the the new estimates that tens of millions of people are in the process of starving to death in poorer countries. But we have evidence from developed countries as well.
Let’s start with a study from the CDC itself. (CDC Article) The researchers studied the delay or avoidance of medical care because of CV-19 concerns. The study is based on a survey of adults over age 18. 41% said they had avoided medical care because of CV-19. 12% said they had avoided urgent or emergency care and 31.5% avoided routine care. Avoidance of care was significantly higher among persons who had two or more of certain common medical conditions, which is particularly concerning, and among those with disabilities and minorities. Interestingly, people with health insurance were more likely to avoid care than those without it. And younger people also had higher rates of deferral of care. We should be clear, this isn’t occurring because of “the virus”, it is occurring because the media and politicians have given an erroneous picture of the balance of risks to the population and have done so in a hysterical, fear inducing manner.
A new paper from the National Bureau of Economic Research summarizes the potential effects of the governmental responses to CV-19. (NBER Paper) The paper gives a lengthy examination of past health and economic shocks and what the evidence is about long-run health and economic effects. As you might expect, one lesson is that the poor are affected the most. There is clear evidence from the 1918 flu epidemic and other health and recessionary shocks that long-term economic well-being is affected. There is also evidence of health detriments.
This study from NEJM discusses the incidence of heart attack during the epidemic. (NEJM Article) The study was done in the Kaiser health system and compared heart attack hospitalizations earlier this year to prior years, finding a 48% decline. Now perhaps that is due to fewer heart attacks, but if you look at actual heart disease deaths you would see the same number or an increase, and you would likely see that more deaths in this category are occurring at home.
There are a lot of references to “excess” deaths during the epidemic. Partly this is to identify how much CV-19 may have caused deaths above the normal average. Some are trying to argue that if excess deaths are more than actual deaths attributed to CV-19, we must be missing some diagnoses. Others attribute the difference to lockdown-induced deaths, whether from suicide, drug and alcohol overdoses or missed care. As I have noted before, you really have to go cause by cause to understand the impact. This article is by researchers who lean toward the every excess death is a CV-19 death approach. (ACP Article) They make the laughable statement that especially early in the epidemic death certificate certifiers weren’t counting every CV-19 death. We have seen an epidemic of revised and back-dated death certificates from weeks and months ago. We see that anyone who ever had a positive CV test is being treated as a CV death, including over 5000 people who died in accidents, suicides or by things like homicide or poisonings. But I digress. The authors use a “natural disaster” approach to CV-19 to say there are “indirect” deaths which should be attributed to it. What the authors fail to distinguish is a death in which CV-19 actually played a meaningful causative role and deaths caused by the governmental reactions to the epidemic. The latter category has nothing to do with the virus, it has everything to do with the complete failure of officials to recognize the likelihood of people missing care or being terrorized into suicide, or drug and alcohol abuse. Those are lockdown deaths, not CV-19 deaths.
Here is another paper on the excess deaths topic. (Medrxiv Paper) Again, average mortality in prior years was compared with that existing during the epidemic. There was an “excess” and about 25% of the excess did not appear tied to CV-19, with many of these deaths occurring in the home. Without quantifying it, the authors note that some of the unexplained excess deaths may be unrecognized CV-19 deaths and some may be due to avoidance of health care.
An article in the Journal of the American Medical Association also deals with deaths during the epidemic. (JAMA Article) This author does a good job acknowledging all the considerations involved in a truly balanced response to the mortality and health effects of the disease itself as well as the governmental responses. The author in a very reserved way, suggests that the health consequences of the responses is likely to be worse than the impact of the disease and those consequences deserve more attention.