IMAGE: In March and April of 2020, mortality rates from (clockwise from top left) heart disease, diabetes, Alzheimer’s disease and stroke spiked in states that also had the most COVID-19 deaths:… view more
Credit: (Courtesy of JAMA)
RICHMOND, Va. (July 1, 2020) — Since COVID-19’s spread to the United States earlier this year, death rates in the U.S. have risen significantly. But deaths attributed to COVID-19 only account for about two-thirds of the increase in March and April, according to a study published Wednesday in the Journal of the American Medical Association.
Researchers at Virginia Commonwealth University and Yale University found that, from March 1 to April 25, the U.S. saw 87,001 excess deaths — or deaths above the number that would be expected based on averages from the previous five years. The study, “Excess Deaths from COVID-19 and Other Causes, March-April 2020,” showed that only 65% of the excess deaths that occurred in March and April were attributed to COVID-19, meaning more than one-third were linked to other causes.
In 14 states, including two of the most populated — California and Texas — more than half of the excess deaths were tied to an underlying cause other than COVID-19, said lead author Steven Woolf, M.D., director emeritus of VCU’s Center on Society and Health.
This data, Woolf said, suggests the COVID-19 death counts reported to the public underestimate the true death toll of the pandemic in the U.S.
“There are several potential reasons for this under-count,” said Woolf, a professor in the Department of Family Medicine and Population Health at VCU School of Medicine. “Some of it may reflect under-reporting; it takes awhile for some of these data to come in. Some cases might involve patients with COVID-19 who died from related complications, such as heart disease, and those complications may have been listed as the cause of death rather than COVID-19.
“But a third possibility, the one we’re quite concerned about, is indirect mortality — deaths caused by the response to the pandemic,” Woolf said. “People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship or emotional distress.”
Woolf and his team found that deaths from causes other than COVID-19 rose sharply in the states that had the most COVID-19 deaths in March and April. Those states were Massachusetts, Michigan, New Jersey, New York — particularly New York City — and Pennsylvania. At COVID-19’s peak for March and April (the week ending April 11), diabetes deaths in those five states rose 96% above the expected number of deaths when compared to the weekly averages in January and February of 2020. Deaths from heart disease (89%), Alzheimer’s disease (64%) and stroke (35%) in those states also spiked.
New York City’s death rates alone rose a staggering 398% from heart disease and 356% from diabetes, the study stated.
Woolf said he and his team suspect that some of these were indirect deaths from the pandemic that occurred among people with acute emergencies, such as a heart attack or stroke, who may have been afraid to go to a hospital for fear of getting the virus. Those who did seek emergency care, particularly in the areas hardest hit by the virus, may not have been able to get the treatment they needed, such as ventilator support, if the hospital was overwhelmed by the surge.
Others may have died from a chronic health condition, such as diabetes or cancer, that was exacerbated by the effects of the pandemic, said Woolf, VCU’s C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity. Still others may have struggled to deal with the consequences of job loss or social isolation.
“We can’t forget about mental health,” Woolf said. “A number of people struggling with depression, addiction and very difficult economic conditions caused by lockdowns may have become increasingly desperate, and some may have died by suicide. People addicted to opioids and other drugs may have overdosed. All told, what we’re seeing is a death count well beyond what we would normally expect for this time of year, and it’s only partially explained by COVID-19.”
Woolf and his co-authors, Derek Chapman, Ph.D., Roy Sabo, Ph.D., and Latoya Hill of VCU, and Daniel M. Weinberger, Ph.D., of Yale University, state that further investigation is needed to determine just how many deaths were from COVID-19 and how many were indirect deaths “caused by disruptions in society that diminished or delayed access to health care and the social determinants of health (e.g., jobs, income, food security).”
Woolf, also a family physician, said this paper’s results underscore the need for health systems and public officials to make sure services are available not only for COVID-19 but for other health problems. His study showed what happened in the states that were overwhelmed by cases in March and April. Woolf worries that the same spikes in excess deaths may now be occurring in other states that are being overwhelmed.
“The findings from our VCU researchers’ study confirm an alarming trend across the U.S., where community members experiencing a health emergency are staying home — a decision that can have long-term, and sometimes fatal, consequences,” said Peter Buckley, M.D., interim CEO of VCU Health System and interim senior vice president of VCU Health Sciences. “Health systems nationwide need to let patients know it is safe and important to seek care in a health emergency, whether it’s through telehealth or in person.”
Woolf, who serves in a community engagement role with the C. Kenneth and Dianne Wright Center for Clinical and Translational Research, said resources should be available for those facing unemployment, loss of income and food and housing insecurity, including help with the mental health challenges, such as depression, anxiety or addiction, that these hardships could present.
“Public officials need to be thinking about behavioral health care and ramping up their services for those patients in need,” Woolf said. “The absence of systems to deal with these kinds of other health issues will only increase this number of excess deaths.”
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The research team from VCU and Yale received funding for this study from the National Center for Advancing Translational Sciences and the National Institute of Allergy and Infectious Diseases. Both entities are part of the National Institutes of Health.
About VCU and VCU Health
Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located in downtown Richmond, VCU enrolls more than 31,000 students in 217 degree and certificate programs in the arts, sciences and humanities. Thirty-eight of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 11 schools and three colleges. The VCU Health brand represents the VCU health sciences academic programs, the VCU Massey Cancer Center and the VCU Health System, which comprises VCU Medical Center (the only academic medical center in the region), Community Memorial Hospital, Children’s Hospital of Richmond at VCU, MCV Physicians and Virginia Premier Health Plan. For more, please visit http://www.vcu.edu and vcuhealth.org.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
