A viewpoint article published on 17 December in the Journal of the American Medical Association threatens to set a new standard for saying very little about Covid urgently. COVID-19 as the Leading Cause of Death in the United States establishes clearly that between March and October 2020, Covid did not achieve the status of ‘Leading Cause of Death in the United States. However, it shrieks, ‘The daily US mortality rate for COVID-19 deaths is equivalent to the September 11, 2001, attacks, which claimed 2988 lives, occurring every 1.5 days, or 15 Airbus 320 jetliners, each carrying 150 passengers, crashing every day’.
The table accompanying the article compares deaths attributed to Covid between March and October 2020 with deaths in the same nine-month period in 2018. The table shows that Covid has been one-eighth as deadly for those aged 25-34 as accidental drug overdoses, about half as deadly for those aged 45-54 as heart disease, and around a third as deadly for those aged 55-64 as cancer. Children under 15 die in plane crashes as surely as adults, but they have a one in a million chance of dying from Covid. Although, slightly more Americans aged 85 or older died of Covid than cancer, those deaths together still did not approach the total of the very elderly who died of heart disease.
Although there were no Covid deaths in 2018, the comparison between Covid deaths in 2020 and other causes in 2018 is explained by the fact that 2018 is ‘the most recent year for which detailed cause-of-death data are available’. This reminds us that we do not have reliable data for all causes of death in 2020 and likely never will, given that many deaths with other causes have been recorded as Covid deaths. The formal CDC designation is ‘Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1’, not deaths caused by Covid-19.
As of 18 December, provisional data suggest that 2,800, 974 million people had died in the USA in 2020, and about 10% of those deaths were ‘Covid-related’. This can be compared to the confirmed figures for 2018, when 2,839,205 people died.
It is now well established that the absence of diagnoses of and treatments for a range of conditions and diseases has led to additional non-Covid deaths, although it remains to be calculated whether these will outnumber the number of deaths ‘with confirmed or presumed COVID-19’, or even ‘true’ Covid deaths, caused by the disease or the body’s response to it. Still, the total number of deaths will not have risen between 2018 and 2020, despite the ‘daily 911s’.
The viewpoint authors conclude that ‘The failure of the public and its leaders to take adequate steps to prevent viral transmission has made the nation more vulnerable, allowing COVID-19 to become the leading cause of death in the United States, particularly among those aged 35 years or older. Much of this escalation was preventable, as is true for many deaths to come.’ This is inaccurate and hyperbolic. The finger-pointing is unhelpful and unaccompanied by any recommendation for ameliorating the dire situation it highlights, but fails to support with data.
It is perfectly clear that Covid is a serious threat to public health, a mild to moderate threat to the health of those aged between 15 and 84, and a severe threat to those aged 85 or older. Public health professionals such as the authors of the JAMA ‘viewpoint’ have rarely articulated the true nature of the threat, preferring to make us all responsible and anxious. The public at large, and greater numbers of those aged under 45, have not acted irresponsibly and ‘made the nation more vulnerable’. They are the nation and most have calculated the level of threat the virus poses to them, to their children, to their parents and grandparents, and are acting accordingly. However shrill some scientists may be, ‘the science’ does not support local and national governments imposing draconian restrictions that pose a greater threat than a novel coronavirus to the health and wellbeing of society over this year and the decade to come.