As the Centers for Disease Control has dutifully disclosed COVID-19 mortality and news organizations parroted it, missing from the landscape has been all the OTHER mortality. Throughout the SARS-CoV-2 spread, death has marched on in all the forms with which western civilizations have come familiar; heart disease, stroke, diabetes and hypertension. While Covid-19 has clearly been bad for folks with those conditions, it appears to have been bad for health generally.
In 2020 while most people expected stay/work from home orders to be temporary not a years long event, Covid-19 was strongly associated with excess deaths. In 2021, things took a turn for the worse, ironically, after the introduction of the vaccines. Initially both excess deaths and Covid-19 deaths plummeted. Around MMWR week 11, the relationship between the two broke down. During the deadly Delta wave the correlation was revived only to be disrupted late in the year despite the onset of the Omicron variant. (Caveat: 2021 data is still provision and later weeks especially need to mature.)
We need to see how the late 2021-2022 data fills out but here are a couple of hypothesis to consider:
- Stay/work-at-home orders have eliminated much of the structures of life that, as Jimmy Buffet said, helps "keep it between the navigational beacons." Alcohol consumption when you don't drive anywhere becomes easier. Weight gain less important when wearing sweat pants. Exercise limited because of closed gyms and in some extreme examples, restrictions on outdoor activity, offered an excuse if not a prohibition. Simple, inconspicuously healthy activities like walking from the car to the office or from the office to lunch also disappeared. This sloth-like existence may not have mattered if it lasted but a few months in 2020. Instead, after over the course of nearly two years in many places, it became a life-style. A very unhealth lifestyle.
- Vaccinations appeared with such speed and were implemented at such unprecedented scale, we have no idea at this point what role they may have played in excess deaths. The warning system has been overwhelmed by VAERS submissions and research has only recently begun to emerge that addresses concerns about cardiovascular responses. It isn't a conspiracy. The vaccination approval and clinical uptake has been dramatically accelerated with little time to digest the implications or research on what negative outcomes we do know about. However, the breakdown in the relationship between excess deaths in the spring of 2021 when vaccinations became available for the young and in late 2021 were mandates were implemented is hard to ignore.
- Delayed care (more of theory than a hypothesis), notwithstanding UNH's comments from last week, has had and will continue to have an effect. We see many of the signs we saw in the post-ACA ramp in 2014-2016. I ran through some of those data points in a call yesterday. Replay here.
The implications if just one of these is an excess death accelerant. For all three it means the American health care system has a daunting task before it and, as of right now, not a lot of policy appreciation for the road ahead.
Let me know your thoughts.
Emily Evans
Managing Director – Health Policy
Twitter
LinkedIn
