Thanks Dr Faust for putting this out there, I certainly agree that NON-ILLNESS (what are officially termed "unnatural") deaths being incorrectly attributed to Covid is, at most, only a tiny problem.
HOWEVER, the issue of OTHER illnesses leading to miscategorized "Covid" deaths is something I've been looking closely at for well over a year now, and that's where we disagree. FYI the article I mentioned working on last week, in this forum, regarding the question of overcounting of Covid deaths, was published this morning in Time magazine (a full year after I first started pitching an earlier version to several major newspapers):
(There probably shouldn’t be a paywall issue, especially if you haven’t read a Time article in a while?)
Fortuitously, only yesterday I happened to hear about a new study out of Denmark, actually the first rigorous study on this question published in a peer reviewed journal, that confirms the (rather large!) overcounting of Covid deaths. Luckily, Time allowed me to include mention of the study at the last moment; it certainly seemed worth delaying the publication by a day…
And yes, I know that Dr. Faust and probably most of you already disagree, perhaps even without reading what I’ve written, but isn’t it healthy to at least occasionally try to see the other side of an argument?
By the way, the authors of that Danish study also looked carefully at the data for excess deaths: It’s very clear, if you just look at the table in their article (which I linked to), that while official “Covid” deaths exploded a year ago, excess deaths hardly even budged…
And Dr. Faust, I hate to request this just one more time, but especially since I cited Dr Wen's articles several times in my piece, can you please forward this message to her?
Thank you,
Daniel Halperin, PhD
Adjunct Full Professor, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
Great write-up, I have no idea how you find the time to work 4 different jobs (physician, professor, editor, father - am I missing any?) while still penning lengthy and well researched pieces on substack (your point-by-point rebuttal to Wen for example).
Your quote last week especially resonated with me: “I will not have suddenly switched political affiliations. I will have stayed on the same team—the one that is data-driven.”
I've been meaning to weigh in on the excess death articles you've penned as I have some alternate perspectives to consider. (Note that I assume we share near identical politics). Lengthy comment (split in 2!), but it's summarizing thoughts spanning your last 5+ pieces so bear with me.
1) Our method of counting of Covid deaths is without precedent. This was the first time when someone died of a heart attack we would go back and run a PCR test to search if they had a viral infection recently [1]. Prior to 2020, when an 85 year old woman deteriorates after a fall, acquires a UTI, then acquires a respiratory infection, and eventually dies of pneumonia, we didn’t search for the exact virus or bacterial infection post mortem [2]. Am I mistaken on this?
I choose these two examples because they represent the first documented Covid deaths, that of Patricia Dowd (57, San Jose) and Marion Krueger (85, Kirtland WA) which were subsequently the first two names in the NYT May 24 issue "US Deaths Near 100.000, an Incalculable Loss".
They also are examples of deaths, which prior to 2020, we would not have sought out via PCR tests whether either had a particular virus. Agree?
2) The media, specifically the left leaning media which, as a liberal I consume, was.... "overzealous"... in their coverage of Covid deaths during 2020. In this same edition of the NYT paper listing the first 100K deaths, just a few names down from Marion Krueger was Jordan Driver Haynes (27, Iowa). I was shocked to see a name so young so googled him only to find out he died of a gunshot. The Times quickly issued a correction, but the damage had been done - the right was quick to pounce on this.
And why shouldn't they? Yes, it is one error among the ~360 names listed in the papers front page, but it was the youngest name and should have triggered some skepticism from one of the dozens of editors that would have seen this before print.
I think it is one of several instances where in their eagerness to frame Covid 19 as a deadly threat to anyone regardless of age and health, they let their biases blind them from rigorous reporting. And the right seized on this opportunity.
To your point, it is only .5%, but I think they have a valid argument - it's not the size of the number, it is the intent. When I scan this list of deaths in the NYT, and see heart attacks, falls, a gun shot - it undermines the premise that we have been undercounting deaths.
All of this leads to the question....
3) At what point do excess deaths just become... deaths? I was thinking about this after Dr Halperin asked a similar question in previous comment the other day. We are entering the 3rd year where the US will have roughly 500K more deaths than expected. If the US has 3.4 million deaths in 2023, are these still "excess" or does this become the new baseline? What explains the roughly 150K excess accidental deaths the last 3 years?
4) The rest of the world is having a similar issue. Why? Excess deaths remain elevated regardless of measures taken. In a comment reply on Wednesday you noted: |“The issue of how US compares to Europe I can't comment on because I have not studied Europe closely. Generally though, if you have an older population that's vaccinated, you'll have less excess mortality”|
I have analyzed Europe and what I can find of Asia excess deaths*, some of the challenges I see:
- Why did the Nordic countries have the lowest excess deaths in the world, with Sweden of all places, currently "leading" by having the lowest excess deaths among her neighbors? (I ran this back early December, will re-evaluate soon: https://imgur.com/a/Scz0Ovk )
- Does the Nordic outcome alter the hypothesis that masks, lockdowns, and school closures were critical to fighting Covid 19? While Sweden is largely singled out for going against the mainstream approach, her neighbors also returned kids to school May of 2020 largely unmasked, at a country level had the lowest masking rates in the world, and had among the shortest closures of businesses.
(As Daniel Halperin noted the other day, Sweden also offers a counterfactual to the anti-covid-vax claim that the mRNA shots are causing excess death signal)
Conversely, why have so many countries cited as examples of "doing it right" by closing schools, having very high masking rates, strict contact tracing, high vaccine uptake, etc all have such poor outcomes? Examples:
- South Korea saw excess mortality skyrocket almost +90% this past spring. That exceeds any country except the Northeast US during March/April 2020 https://imgur.com/a/m71NgFD
- Germany, once heralded as a “Master Class in Science” (CNBC, 7/23/20) is on the 3rd straight year of excess mortality being above average, each year higher than the last. 2022 on track for 11% excess mortality.
- Portugal, where headlines proclaimed they “ran out of people to vaccinate” due to their strong compliance, is also completing their third year 12% above average.
- New Zealand, which leveraged its isolation and strict lockdowns to avoid excess deaths, finally reopened after vaccines were made available, yet in 2022 are poised to hit 13% excess mortality
5) Why did excess deaths only "appear" after we started taking action against covid? Could we consider a hypothesis that part of the excess death signal *may* be related to our actions? I feel like this is heretical thinking, but the Sagan part of me wonders if we should scrutinize that hypothesis specifically because it is "heretical". [3]
On one hand, the virus is so potent that a single person can infect 1/3 of a cruise ship in days, a 300 person wedding in a day, or a single conference could create 300,000 cases.
Yet as noted above, the first two recorded deaths occurred in February (and if you read the full story on Marion Krueger it may be her Covid infection happened in mid January), in places far from New York City. If the virus was penetrating nursing homes in the suburbs of Washington already, why are there no excess deaths in that state until November of 2020?
Why were we finding Covid 19 in blood samples and sewage from December 2019 in Iowa, Brazil, Wisconsin, etc but no excess deaths? [4][5]
How does the dominant Covid spread hypothesis account for a complete lack of excess deaths in the US during December 2019 - March 2020 in the US?
6) Let's examine the "heretical" alternative hypothesis. Prior to 2020, if there was a "Swiss Cheese" model of dealing with the flu or other ILI, it went something like this:
- Get adequate sleep
- Reduce stress
- Eat a healthy and balanced diet
- Minimize alcohol consumption
- Exercise regularly
- Wash your hands and practice good hygiene
- Maintain strong relationships (science journalist Marta Zaransky wrote an entire book "Growing Young" loaded with research on this lesser known but data driven hypothesis)
Now, did the measures we took to fight Covid in spring of 2020 follow the pre 2020 guidelines to minimize poor viral outcomes?
Of course not. Each and every one of those, with the exception of "practice hygiene" went the other direction either directly or indirectly of the guidance from Public Health. "2 weeks to flatten the curve" lead to "Netflix and Chill" which lead to higher stress, obesity, alcohol consumption, poorer diets, less exercise, fewer social bonds.
Just as you correctly argue above |"when old people fall, it’s often because of some lurking medical problem."|, I think it is also correct to argue that when the population gets fatter, lazier, and more dependent on alcohol, deaths from viral infections will increase. That feels like an obvious and non-controversial statement.
Thanks. I will say that I'm fortunate in that I am 50% clinical which leaves time for the other jobs. The academic work I do is not as much as you'd think--mainly I teach students and residents while I'm seeing patients, though I give the occasional lecture or teach procedures to students. Editing is also not terribly busy since the "eic" position for medpage is more like "chief medical advisor." The big time investments outside of the clinical work is this newsletter and my research which is actually unpaid for now. As you know, to keep this balance working, I'll need more paid subscribers (thank you for being one!) but for the short-term, it's doable.
1. Correct re: zealous counting. I think given our tech, we should be testing tons of people for lots of things. Even now, when someone drops dead at home, they often just get assigned to heart disease, even though we have no clue if that is why. (Autopsy is rare and we don't know what triggered the event). Maybe rhinovirus kills a few thousand people per year, and metapneumo virus kills 6,000. Of all these "little viruses," I'd like to know which ones matter. Clearly Covid was in a class by itself for a few years, but eventually it could end up being among the pack. But unless we do more surveillance, we won't know.
Wow long comment and I have to get to work. But re: excess deaths, you're asking a profound question which is the following. At the end of the emergency phase of the pandemic, will baseline mortality be different than prior? Lower because of pull forward? If so, for how long? Same as before pandemic (herd safety/immunity from worst consequences which would basically mean that we are back to "normal")? Higher than before pandemic? (in which case, SARS2 is just added to the gang of quiet but real threats that we sorta tolerate). That's a huge question and it is one that i've been pondering closely in the last few weeks and will write about.
Last thing: NZ has some excess mortality which shows that Covid will eventually kill some. But the fact that they are at 13% (if you say; I have not looked), is not the worst outcome if it turns out to be the case that they never face 30-300% (or 700% in NY!) rates that other places had to deal with because Covid erupted before vaccination campaigns. NZ is an amazing case in so many ways. They showed it can be done. The question then is...was it worth it? I'd like to think so, but it takes more analysis than me just saying it was worth it. so...to be continued
You are way too humble. My wife is a vascular surgeon here in Cleveland so I know just how demanding and time consuming even "50% clinical" can be.
Yes, it's a long comment, but it's a combination of half-started replies to your earlier pieces - apologize for being a "time burglar", but time permitting give the second half some consideration.
If you, Ben, or some of other data minded colleagues get a chance, the mortality worldwide is fascinating and offers lots of challenges to consider. What happened in South Korea this past spring as I noted earlier, with average deaths jumping from 5,800/week to 10,500/week is one of the many unexplained datapoints that doesn't seem to fit within the current hypothesis.
Dumped the data from mortality.org to a google spreadsheet if interested. (Imported from excel so the pivot tables don't work, but you can create own using "Raw Data" tab. Just filter for Sex = "B" for both so don't double dip, and use "D_Total" for total deaths)
7) Suppose we traveled back to 2018 or so, and we hypothetically sketch out some models for what happens with changes to behavior and inputs. Imagine that in 2009, instead of halting testing for H1N1 flu and not asking the public to make any changes in behaviors, we instead employed the approach used for Covid 19. Would more or less people have died if we just did 2 of the changes:
- Prevented the roughly 2 million people in nursing homes from having visitors for several months
- Indirectly caused obesity to significantly increase [6]
Now I might be quite wrong, but I suspect you would have modeled higher excess deaths as an outcome as we add these sorts of changes in behavior. No?
Public Health, specifically when issued from government authorities, is notoriously slow to respond to new data or consider that they have made mistakes. This is the nature of politics. How long did politicians who promoted the War on Vietnam, The War on Drugs, or The War on Terror cling to their failed hypothesis? How many came out and admitted when the evidence was in that their policies lead to worser outcomes?
I'm pragmatic. I don't expect very many of the public health scientists who backed policies which may have made outcomes worse to admit error, if there was one. I don't expect them to channel their inner William Farr and concede that the evidence doesn't completely match their hypothesis - even as evidence comes in. (Complete side note, I wonder if William Farr had been promoting Miasma and the impact on altitude for Cholera on Twitter and CNN, instead of just to his buddies at the London Statistical Society, would that have made him less likely to realize and admit his error?)
At the very least, as a starting point, there were 40,000 more than expected accidental deaths in 2020. That rose to 55,000 in 2021. Early to tell but 2022, but projections are for 60,000. That's 155,000 excess deaths in 3 years, and while only 10% of the excess mortality issue, I suspect the age adjusted "Years of Life Lost" exceed "Years of Life Lost" from Covid underlying cause of death.
We should acknowledge that our approach and policies to fighting covid may be responsible for that increase.
_____________________________________
TL;DR: The inclusion of accidental deaths in Covid figures doesn't negate the death toll of covid, but it does expose that our counting methods are unique to Covid and have not been employed in measuring mortaliaty from other ILI until 2020.
This leads to the question of why excess deaths remain elevated across the world, despite measures to contain, mitigate, and vaccinate.
An agnostic look at the data reveals some conflicts to the current hypothesis and warrants a disinterested consideration of whether our approach can be linked to some of the harm.
While this may seem heretical, we have to remember that the history of medicine is punctuated by instances where scrutiny lead to worse health outcomes, especially early in our understanding.
____________________________________________
* You or Ben could check my findings at mortality.org. Go to "Data > STMF > then click the links in "STMF output file (xlsx or pooled csv): weekly death counts.". Clean, easy to use data which I have cross referenced to the US CDC, Korean CDC, and Swedish CDC (equivalents). The team there is also fairly good at responding to questions.
[3] "Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition" Carl Sagan, The Demon-Haunted World
This doesn't address the main critique of those who don't believe covid killed as many as reported - that doctors check off Covid as a cause when it is not. Excess mortality numbers are the only case against as far as i know. And i'd still like to know when we get into the negative on excess mortality since so many very old people died a year or two early due to Covid.
Yeah it's an ancillary point. And to you other question, yes, in the 85+ category, we've seen that at times (pull forward). But never in a sustained way in most places. I keep meaning to get those data out.
Just a quick note to thank former US Surgeon General Dr. Jerome Adams for tweeting out today's Inside Medicine.
https://twitter.com/jeromeadamsmd/status/1617566641293869109?s=10
Thanks Dr Faust for putting this out there, I certainly agree that NON-ILLNESS (what are officially termed "unnatural") deaths being incorrectly attributed to Covid is, at most, only a tiny problem.
HOWEVER, the issue of OTHER illnesses leading to miscategorized "Covid" deaths is something I've been looking closely at for well over a year now, and that's where we disagree. FYI the article I mentioned working on last week, in this forum, regarding the question of overcounting of Covid deaths, was published this morning in Time magazine (a full year after I first started pitching an earlier version to several major newspapers):
https://time.com/6249841/covid-19-no-longer-a-public-health-emergency/
(There probably shouldn’t be a paywall issue, especially if you haven’t read a Time article in a while?)
Fortuitously, only yesterday I happened to hear about a new study out of Denmark, actually the first rigorous study on this question published in a peer reviewed journal, that confirms the (rather large!) overcounting of Covid deaths. Luckily, Time allowed me to include mention of the study at the last moment; it certainly seemed worth delaying the publication by a day…
And yes, I know that Dr. Faust and probably most of you already disagree, perhaps even without reading what I’ve written, but isn’t it healthy to at least occasionally try to see the other side of an argument?
By the way, the authors of that Danish study also looked carefully at the data for excess deaths: It’s very clear, if you just look at the table in their article (which I linked to), that while official “Covid” deaths exploded a year ago, excess deaths hardly even budged…
And Dr. Faust, I hate to request this just one more time, but especially since I cited Dr Wen's articles several times in my piece, can you please forward this message to her?
Thank you,
Daniel Halperin, PhD
Adjunct Full Professor, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
danielhalperin.web.unc.edu ; www.amazon.com/Facing-COVID-Without-Panic-Epidemiologist-ebook/dp/B08D25GQX6
Great write-up, I have no idea how you find the time to work 4 different jobs (physician, professor, editor, father - am I missing any?) while still penning lengthy and well researched pieces on substack (your point-by-point rebuttal to Wen for example).
Your quote last week especially resonated with me: “I will not have suddenly switched political affiliations. I will have stayed on the same team—the one that is data-driven.”
I've been meaning to weigh in on the excess death articles you've penned as I have some alternate perspectives to consider. (Note that I assume we share near identical politics). Lengthy comment (split in 2!), but it's summarizing thoughts spanning your last 5+ pieces so bear with me.
1) Our method of counting of Covid deaths is without precedent. This was the first time when someone died of a heart attack we would go back and run a PCR test to search if they had a viral infection recently [1]. Prior to 2020, when an 85 year old woman deteriorates after a fall, acquires a UTI, then acquires a respiratory infection, and eventually dies of pneumonia, we didn’t search for the exact virus or bacterial infection post mortem [2]. Am I mistaken on this?
I choose these two examples because they represent the first documented Covid deaths, that of Patricia Dowd (57, San Jose) and Marion Krueger (85, Kirtland WA) which were subsequently the first two names in the NYT May 24 issue "US Deaths Near 100.000, an Incalculable Loss".
They also are examples of deaths, which prior to 2020, we would not have sought out via PCR tests whether either had a particular virus. Agree?
2) The media, specifically the left leaning media which, as a liberal I consume, was.... "overzealous"... in their coverage of Covid deaths during 2020. In this same edition of the NYT paper listing the first 100K deaths, just a few names down from Marion Krueger was Jordan Driver Haynes (27, Iowa). I was shocked to see a name so young so googled him only to find out he died of a gunshot. The Times quickly issued a correction, but the damage had been done - the right was quick to pounce on this.
And why shouldn't they? Yes, it is one error among the ~360 names listed in the papers front page, but it was the youngest name and should have triggered some skepticism from one of the dozens of editors that would have seen this before print.
I think it is one of several instances where in their eagerness to frame Covid 19 as a deadly threat to anyone regardless of age and health, they let their biases blind them from rigorous reporting. And the right seized on this opportunity.
To your point, it is only .5%, but I think they have a valid argument - it's not the size of the number, it is the intent. When I scan this list of deaths in the NYT, and see heart attacks, falls, a gun shot - it undermines the premise that we have been undercounting deaths.
All of this leads to the question....
3) At what point do excess deaths just become... deaths? I was thinking about this after Dr Halperin asked a similar question in previous comment the other day. We are entering the 3rd year where the US will have roughly 500K more deaths than expected. If the US has 3.4 million deaths in 2023, are these still "excess" or does this become the new baseline? What explains the roughly 150K excess accidental deaths the last 3 years?
4) The rest of the world is having a similar issue. Why? Excess deaths remain elevated regardless of measures taken. In a comment reply on Wednesday you noted: |“The issue of how US compares to Europe I can't comment on because I have not studied Europe closely. Generally though, if you have an older population that's vaccinated, you'll have less excess mortality”|
I have analyzed Europe and what I can find of Asia excess deaths*, some of the challenges I see:
- Why did the Nordic countries have the lowest excess deaths in the world, with Sweden of all places, currently "leading" by having the lowest excess deaths among her neighbors? (I ran this back early December, will re-evaluate soon: https://imgur.com/a/Scz0Ovk )
- Does the Nordic outcome alter the hypothesis that masks, lockdowns, and school closures were critical to fighting Covid 19? While Sweden is largely singled out for going against the mainstream approach, her neighbors also returned kids to school May of 2020 largely unmasked, at a country level had the lowest masking rates in the world, and had among the shortest closures of businesses.
(As Daniel Halperin noted the other day, Sweden also offers a counterfactual to the anti-covid-vax claim that the mRNA shots are causing excess death signal)
Conversely, why have so many countries cited as examples of "doing it right" by closing schools, having very high masking rates, strict contact tracing, high vaccine uptake, etc all have such poor outcomes? Examples:
- South Korea saw excess mortality skyrocket almost +90% this past spring. That exceeds any country except the Northeast US during March/April 2020 https://imgur.com/a/m71NgFD
- Germany, once heralded as a “Master Class in Science” (CNBC, 7/23/20) is on the 3rd straight year of excess mortality being above average, each year higher than the last. 2022 on track for 11% excess mortality.
- Portugal, where headlines proclaimed they “ran out of people to vaccinate” due to their strong compliance, is also completing their third year 12% above average.
- New Zealand, which leveraged its isolation and strict lockdowns to avoid excess deaths, finally reopened after vaccines were made available, yet in 2022 are poised to hit 13% excess mortality
5) Why did excess deaths only "appear" after we started taking action against covid? Could we consider a hypothesis that part of the excess death signal *may* be related to our actions? I feel like this is heretical thinking, but the Sagan part of me wonders if we should scrutinize that hypothesis specifically because it is "heretical". [3]
On one hand, the virus is so potent that a single person can infect 1/3 of a cruise ship in days, a 300 person wedding in a day, or a single conference could create 300,000 cases.
Yet as noted above, the first two recorded deaths occurred in February (and if you read the full story on Marion Krueger it may be her Covid infection happened in mid January), in places far from New York City. If the virus was penetrating nursing homes in the suburbs of Washington already, why are there no excess deaths in that state until November of 2020?
Why were we finding Covid 19 in blood samples and sewage from December 2019 in Iowa, Brazil, Wisconsin, etc but no excess deaths? [4][5]
How does the dominant Covid spread hypothesis account for a complete lack of excess deaths in the US during December 2019 - March 2020 in the US?
6) Let's examine the "heretical" alternative hypothesis. Prior to 2020, if there was a "Swiss Cheese" model of dealing with the flu or other ILI, it went something like this:
- Get adequate sleep
- Reduce stress
- Eat a healthy and balanced diet
- Minimize alcohol consumption
- Exercise regularly
- Wash your hands and practice good hygiene
- Maintain strong relationships (science journalist Marta Zaransky wrote an entire book "Growing Young" loaded with research on this lesser known but data driven hypothesis)
Now, did the measures we took to fight Covid in spring of 2020 follow the pre 2020 guidelines to minimize poor viral outcomes?
Of course not. Each and every one of those, with the exception of "practice hygiene" went the other direction either directly or indirectly of the guidance from Public Health. "2 weeks to flatten the curve" lead to "Netflix and Chill" which lead to higher stress, obesity, alcohol consumption, poorer diets, less exercise, fewer social bonds.
Just as you correctly argue above |"when old people fall, it’s often because of some lurking medical problem."|, I think it is also correct to argue that when the population gets fatter, lazier, and more dependent on alcohol, deaths from viral infections will increase. That feels like an obvious and non-controversial statement.
Thanks. I will say that I'm fortunate in that I am 50% clinical which leaves time for the other jobs. The academic work I do is not as much as you'd think--mainly I teach students and residents while I'm seeing patients, though I give the occasional lecture or teach procedures to students. Editing is also not terribly busy since the "eic" position for medpage is more like "chief medical advisor." The big time investments outside of the clinical work is this newsletter and my research which is actually unpaid for now. As you know, to keep this balance working, I'll need more paid subscribers (thank you for being one!) but for the short-term, it's doable.
1. Correct re: zealous counting. I think given our tech, we should be testing tons of people for lots of things. Even now, when someone drops dead at home, they often just get assigned to heart disease, even though we have no clue if that is why. (Autopsy is rare and we don't know what triggered the event). Maybe rhinovirus kills a few thousand people per year, and metapneumo virus kills 6,000. Of all these "little viruses," I'd like to know which ones matter. Clearly Covid was in a class by itself for a few years, but eventually it could end up being among the pack. But unless we do more surveillance, we won't know.
Wow long comment and I have to get to work. But re: excess deaths, you're asking a profound question which is the following. At the end of the emergency phase of the pandemic, will baseline mortality be different than prior? Lower because of pull forward? If so, for how long? Same as before pandemic (herd safety/immunity from worst consequences which would basically mean that we are back to "normal")? Higher than before pandemic? (in which case, SARS2 is just added to the gang of quiet but real threats that we sorta tolerate). That's a huge question and it is one that i've been pondering closely in the last few weeks and will write about.
Last thing: NZ has some excess mortality which shows that Covid will eventually kill some. But the fact that they are at 13% (if you say; I have not looked), is not the worst outcome if it turns out to be the case that they never face 30-300% (or 700% in NY!) rates that other places had to deal with because Covid erupted before vaccination campaigns. NZ is an amazing case in so many ways. They showed it can be done. The question then is...was it worth it? I'd like to think so, but it takes more analysis than me just saying it was worth it. so...to be continued
You are way too humble. My wife is a vascular surgeon here in Cleveland so I know just how demanding and time consuming even "50% clinical" can be.
Yes, it's a long comment, but it's a combination of half-started replies to your earlier pieces - apologize for being a "time burglar", but time permitting give the second half some consideration.
If you, Ben, or some of other data minded colleagues get a chance, the mortality worldwide is fascinating and offers lots of challenges to consider. What happened in South Korea this past spring as I noted earlier, with average deaths jumping from 5,800/week to 10,500/week is one of the many unexplained datapoints that doesn't seem to fit within the current hypothesis.
Dumped the data from mortality.org to a google spreadsheet if interested. (Imported from excel so the pivot tables don't work, but you can create own using "Raw Data" tab. Just filter for Sex = "B" for both so don't double dip, and use "D_Total" for total deaths)
https://docs.google.com/spreadsheets/d/1p-1YPkkBF9u7IjrUJ-XsbMlUer_OUtnfJpUQv4JB27M/edit?usp=sharing
Contd-
7) Suppose we traveled back to 2018 or so, and we hypothetically sketch out some models for what happens with changes to behavior and inputs. Imagine that in 2009, instead of halting testing for H1N1 flu and not asking the public to make any changes in behaviors, we instead employed the approach used for Covid 19. Would more or less people have died if we just did 2 of the changes:
- Prevented the roughly 2 million people in nursing homes from having visitors for several months
- Indirectly caused obesity to significantly increase [6]
Now I might be quite wrong, but I suspect you would have modeled higher excess deaths as an outcome as we add these sorts of changes in behavior. No?
Public Health, specifically when issued from government authorities, is notoriously slow to respond to new data or consider that they have made mistakes. This is the nature of politics. How long did politicians who promoted the War on Vietnam, The War on Drugs, or The War on Terror cling to their failed hypothesis? How many came out and admitted when the evidence was in that their policies lead to worser outcomes?
I'm pragmatic. I don't expect very many of the public health scientists who backed policies which may have made outcomes worse to admit error, if there was one. I don't expect them to channel their inner William Farr and concede that the evidence doesn't completely match their hypothesis - even as evidence comes in. (Complete side note, I wonder if William Farr had been promoting Miasma and the impact on altitude for Cholera on Twitter and CNN, instead of just to his buddies at the London Statistical Society, would that have made him less likely to realize and admit his error?)
At the very least, as a starting point, there were 40,000 more than expected accidental deaths in 2020. That rose to 55,000 in 2021. Early to tell but 2022, but projections are for 60,000. That's 155,000 excess deaths in 3 years, and while only 10% of the excess mortality issue, I suspect the age adjusted "Years of Life Lost" exceed "Years of Life Lost" from Covid underlying cause of death.
We should acknowledge that our approach and policies to fighting covid may be responsible for that increase.
_____________________________________
TL;DR: The inclusion of accidental deaths in Covid figures doesn't negate the death toll of covid, but it does expose that our counting methods are unique to Covid and have not been employed in measuring mortaliaty from other ILI until 2020.
This leads to the question of why excess deaths remain elevated across the world, despite measures to contain, mitigate, and vaccinate.
An agnostic look at the data reveals some conflicts to the current hypothesis and warrants a disinterested consideration of whether our approach can be linked to some of the harm.
While this may seem heretical, we have to remember that the history of medicine is punctuated by instances where scrutiny lead to worse health outcomes, especially early in our understanding.
____________________________________________
* You or Ben could check my findings at mortality.org. Go to "Data > STMF > then click the links in "STMF output file (xlsx or pooled csv): weekly death counts.". Clean, easy to use data which I have cross referenced to the US CDC, Korean CDC, and Swedish CDC (equivalents). The team there is also fairly good at responding to questions.
[1] https://www.nbcbayarea.com/news/coronavirus/daughter-of-patricia-dowd-the-first-u-s-covid-victim-breaks-her-silence/2466324/
[2] https://www.wsj.com/articles/how-the-coronavirus-killed-its-first-female-victim-in-the-u-s-11586961428
[3] "Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition" Carl Sagan, The Demon-Haunted World
[4] https://www.npr.org/sections/coronavirus-live-updates/2020/12/01/940395651/coronavirus-was-in-u-s-weeks-earlier-than-previously-known-study-says
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938741/
[6] https://www.npr.org/sections/health-shots/2021/09/29/1041515129/obesity-rates-rise-during-pandemic-fueled-by-stress-job-loss-sedentary-lifestyle
This doesn't address the main critique of those who don't believe covid killed as many as reported - that doctors check off Covid as a cause when it is not. Excess mortality numbers are the only case against as far as i know. And i'd still like to know when we get into the negative on excess mortality since so many very old people died a year or two early due to Covid.
Yeah it's an ancillary point. And to you other question, yes, in the 85+ category, we've seen that at times (pull forward). But never in a sustained way in most places. I keep meaning to get those data out.