The deadly lies of the American right wing

Per the CDC’s latest calculations, we’ve now seen approximately 1,045,000 excess deaths over the course of the two years of the COVID pandemic in America.

Note that this is a conservative estimate. It’s conservative because for technical reasons the CDC is using six years of pre-pandemic mortality data to estimate excess deaths during the pandemic. Doing so means that the CDC is using an average age-adjusted mortality rate (AAMR) as a baseline for calculating excess deaths that is almost certainly too high. This is because AAMR almost always declines, and indeed for the last century it has always declined to the extent the final year in an eight-year series — which is what 2021 is in this particular analysis — features a lower AAMR than the average AAMR during that eight-year series.

If you take the average decline in AAMR over the course of this century and extrapolate it to the last two years, that produces an excess death calculation that’s about 10% higher than the CDC’s current estimate, i.e. around 1,150,000 excess deaths.

Note also that per the CDC’s calculations, “only” about 823,000 of the 1,045,000 excess death total is attributable to COVID, with another 212,000 excess deaths being attributable to other causes. (By the CDC’s calculation about 10% of all COVID deaths over the course of the pandemic are at this point not counted as excess deaths, because that’s the number of people who have died from COVID that the agency estimates would have died by now from some other cause).

212,000 is a massive number all by itself. That number would probably be reduced significantly if all deaths caused by COVID were being coded appropriately as such. Nevertheless there’s compelling evidence that most of the excess mortality seen among young adults over the past two years hasn’t been due to COVID, diagnosed or not, but to other causes, and in particular to sharp rises in unintentional accidents, including drug overdoses and car crashes.

This Atlantic article lays out a good statistical case for the extent to which COVID deaths per se continue to be driven by unvaccinated older adults, and to a lesser extent partially vaccinated older adults.

The following chart illustrates both how amazingly effective the COVID vaccines continue to be, and how boosting elderly adults generates very significant dividends, as the initial immunity provided by vaccination fades:

The article’s author, Sarah Zhang, argues that we’ve had a nationwide failure to deploy vaccinations where they will be most helpful, i.e., among the elderly:

Consider the current Omicron wave, which has been far deadlier in the U.S. than in other highly vaccinated and boosted countries. The U.S. has reached 80 percent of its pre-vaccine peak in daily deaths, compared with only 20 to 30 percent of peaks reached in other countries. America has not only a lower overall vaccination rate but lower coverage in the elderly. England, for example, has achieved 96 percent full-vaccination coverage in people over 65. In the U.S., this number is 88.5 percent, with big geographic variations that range from 79 percent in Arkansas to 95 percent in Vermont.

These percentages may all look high, but they represent very different levels of remaining risk. “People see 90 and 95 percent as not very much” of a difference, says Adam Kucharski, an infectious-disease modeler at the London School of Hygiene and Tropical Medicine. He prefers to invert the number. “Think of it as: There’s 5 percent unprotected or 10 percent unprotected.” That doubles the pool of people over 65 who are at high risk for hospitalization and death. In a massive epidemic wave like that of Omicron, hospitalizations and deaths can scale up very quickly.

Moreover, the U.S. does lag quite far behind other wealthy countries in boosters for people over age 65. England has boosted 92 percent of its elderly population, while the U.S. is at 65 percent. Even highly vaccinated Vermont is at only 78 percent of seniors boosted. Boosters are necessary because waning immunity and new variants have eroded the spectacular effectiveness seen in 2020’s vaccine trials: Six months-plus after vaccination, two mRNA doses mitigate hospitalizations due to Omicron by only 57 percent across all ages. A booster gets that back up to 90 percent. This extra protection is especially crucial for the elderly because their immune systems tend to mount less robust initial responses to the vaccines. The effects of a third dose may eventually wane too; if any group will need regular boosters in the future, it is again older people—and not just the most elderly.

From a policy perspective, there seems to be some low-hanging fruit to pick here:

How could the U.S. maximize vaccine and booster uptake in older Americans? I put this question to several health-policy experts with the more modest threshold of age 65. This seemed more achievable, given the even lower uptake among middle-aged Americans, but also because nearly everyone over 65 is already on government health care—Medicare. England and Denmark have achieved such high vaccination rates in no small part because they have centralized national health-care systems. Health care in America is incredibly fragmented, but Medicare at least reaches most people over 65. In December, in fact, the Biden administration announced that it would mail all 63 million people on Medicare a letter encouraging COVID boosters—“the first time in more than 4 years” that Medicare had sent such a universal notice, the White House touted. At the same time, the agency that oversees Medicare, the Centers for Medicare & Medicaid Services (CMS), laid out a suite of other outreach efforts promoting COVID boosters.

CMS could add more direct incentives, experts say. Most Americans on Medicare are on traditional Medicare, which is a fee-for-service program that pays the bills but does not closely manage a patient’s care. CMS does have levers to influence health-care providers, though. It could, for instance, incentivize them by making the COVID vaccination and booster rates among patients a “quality measure” that helps determine how much providers are reimbursed. Medicare already does this with pneumococcal vaccines for pneumonia, says Mark McClellan, a former CMS administrator who is now a health-policy professor at Duke University.

In the comment thread to my post this morning about age, vaccination status, and COVID risk, Denverite argues that Zhang’s article illustrates how this isn’t just a problem of Republican propaganda, given that even blue states are having a lot of trouble vaccinating and boosting people in nursing homes, as Zhang emphasizes:

Nursing homes are another potential focus of COVID vaccination. Residents are at particularly high risk for COVID, not just because of age and underlying health conditions but because they live in close quarters. Yet vaccination rates in nursing homes are not any better than in the overall elderly population: 87 percent of residents are fully vaccinated, and only 69 percent are boosted. In general, vaccination rates tend to be lower in for-profit and chain facilities, in those with high staff turnover, and in communities with low vaccination rates, according to a study published last fall. Understaffing and “organizational dysfunction” probably explain why boosters have not been prioritized, says Michael Barnett, one of the study’s authors and a health-policy professor at Harvard. Nursing homes on average turn over more than 100 percent of their staff every year. When staying fully staffed is such a big challenge, simply keeping residents “fed and giving them their meds and helping them use the bathroom—just basic daily stuff is already an overwhelming task,” Barnett told me. “Giving vaccines is a one-time intervention that doesn’t necessarily take that many person hours to figure out. But somebody has to coordinate it and organize it.”

Here I want to make a more general point: Pretty much everything that’s seriously wrong with America is a consequence of right wing ideology, and the propaganda networks that disseminate that ideology.

Why, for instance, can’t we do something as simple as vaccinate and boost people in nursing homes at a higher rate, given how many lives doing so would obviously save? We can’t we have, in other words, a somewhat less irrational health care system?

Here’s why:

(1) Because of right wing lies about vaccines.

(2) Because of right wing lies about science.

(3) Because of right wing lies about the government.

(4) Because of right wing lies about “socialized medicine.”

(5) Because of right wing lies about how freedom means the freedom to die from COVID in a nursing home.

And on and on and on.

The key point to remember is that there are two views of the world: the right wing view and the left wing view. The left wing view is sometimes mistaken about this or that issue, or this or that detail, or this or that policy.

The right wing view is always wrong about everything without exception.

The history of the modern world is a now centuries-long and ongoing demonstration of these statements, which are obviously true and just as obviously not utterable in words of one syllable, because that would violate the cardinal rule of modern American political life, which is that the lies and delusions of the American right wing must always and everywhere be indulged, no matter how many people those lies and delusions continue to kill, maim, and impoverish on a daily and indeed minute to minute basis.