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# COVID has probably killed, directly and indirectly, more than one million Americans

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When calculating the number of people killed by COVID-19, two quite different general methods are available:

(1) We can simply count the total number of people who have died in the USA since February of last year, whose official cause of death was given as COVID-19. Currently this number is around 780,000 per the CDC.

(2) Alternatively, we can ask, “how many more people have died since then, compared to the number that would have died but for the epidemic?” This is a different question, because it takes into account the secondary effects of the epidemic, both negative and positive, on mortality (An example of a positive effect is that mortality from the flu has fallen drastically).

The latter number can be calculated in a variety of ways, but the most straightforward is to look at what mortality rates were before the epidemic, and then look at them over the course of the epidemic to this point.

If we do that, we find the following:

About 520,000 more people died in the USA in 2020 than we would have expected, if mortality trends had remained constant. 535,000 more people died in the USA in 2020 than in 2019. This compares to the 15,600 increase in total deaths between 2018 and 2019 (The increase in total deaths between the two latter years is a product of the fact that a slightly larger and older population produced a very slightly higher death total, even though age-adjusted mortality rates fell between the two years, as they almost always do).

COVID officially accounted for about 385,000 deaths in the USA in 2020, but it would be inaccurate to say it accounted directly for that many excess deaths, because somewhere in the neighborhood of 5% to 10% of the people who died from COVID would have died anyway absent the epidemic (This is because of the extreme mortality rates from the disease in the very oldest cohorts of the population, who of course have relatively high mortality rates even when there’s no global pandemic happening).

Transferring the same math to 2021, we find that as of mid-November the USA had seen around 947,000 excess deaths since February of the previous year, of which about 700,000 were excess COVID deaths, statistically speaking (again this is somewhat lower than the total number of COVID deaths per se), while about 250,000 were excess deaths from other causes. The latter is a gigantic number all by itself, which suggests strongly that we really have no good grasp yet on just how devastating the secondary effects of the pandemic have been.

Since those numbers are now nearly a month old, it’s safe to say that we’ve seen more than one million excess deaths in America over the course of the COVID-19 epidemic, if we measure excess deaths by the straightforward method of calculating how many people have died, and comparing it to the number of people we would have expected to die if typical pre-pandemic mortality trends had held.

All the data in this post are taken from the CDC, which uses a number of different methods for calculating excess mortality during the pandemic.

In any case, no matter what method one uses there’s no question that the mortality toll in the USA from COVID-19 is a lot higher than the already-staggering official death count, for reasons that researchers will spend many years exploring.