2021: AMERICA’S DEADLIEST YEAR EVER

There is no denying it. Over the last two-and-a-half years, the United States has seen a sustained increase in mortality. US Centers for Disease Control and Prevention (CDC) data show that from 2019 to 2021, average life expectancy at birth in the United States declined by 2.7 years, the largest two-year decline since the early 1920s. Every state saw a decline; from New York, which saw the average lifetime shrink by three years, to Hawaii, which had a 0.2 year drop.

The CDC dubbed 2021, the second year of the COVID-19 pandemic, the nation’s “deadliest year ever.” This is determined by measuring “excess mortality,” establishing a historical baseline rate of overall deaths, or a way to compare to an average year, and measuring deviation from that level over time. Americans aged 15-64 who died in 2021 was a staggering 40% greater than what would be expected based on historical trends. While 2020 deaths were also above the historical average, it was nothing like 2021.

These staggering and sobering statistics caught the attention of life insurers in early 2022. Scott Davison, CEO of Indiana-based life insurer, OneAmerica, reported during a Chamber of Commerce virtual event that his company saw death rates increase by 40% compared to the pre-pandemic period, and that was seen across the industry. Some in the business are wondering if this is indicative of undercounted COVID-related deaths. Jonathan Porter, global chief risk officer with Reinsurance Group of America Inc. (RGA) explained their thought process on a conference call: “One of the things that makes us believe that these really are direct or indirect COVID is the causes of death tend to be comorbid with COVID. Alzheimer’s, diabetes, things like that, but in addition they tend to move with the COVID deaths.”

While some may attribute the mortality spike to the pandemic, an April 2022 paper published in the Journal of the American Medical Association (JAMA) studied 21 peer nations in addition to the US, but found that none experienced decreases in life expectancy as large as the US. These nations, which included Canada, Denmark, France, Germany, Israel, Netherlands, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, and the United Kingdom (UK), also faced significant infection rates of SARS-CoV-2, the virus which causes COVID-19. Many confounding factors make finding a direct correlation to the pandemic difficult, but the difference between American mortality to similar nations begs for an explanation.

Following the acknowledgement of the spike in death over 2021, public health experts have offered several theories as to why it might be happening. Some say that it is latent effects from the pandemic; more people caught COVID-19 than we could count, and we know that some patients have some lingering effects from the illness, so these deaths could be lagging effects of so-called “Long-COVID.”

Since COVID-19 affects younger and healthier populations less than older, less healthy individuals, some question whether the spikes in deaths of Americans under 65 are due to the somewhat-novel respiratory illness. Official statistics from the World Health Organization (WHO), UK, and US CDC show the vast majority of excess mortality occurring in 2021 and 2022 cannot be attributed to COVID-19. Instead, it is more likely these are the effects of delayed preventative medical care due to suspension of “elective” procedures during 2020, in addition to the immense social effects of lockdowns that drove sustained depression and economic malaise, which can also cut lives short.

Casey Mulligan and Robert Arnott wrote of this “historic, yet largely unacknowledged, health emergency” of dramatically increasing excess deaths among young and middle-aged American adults in a working paper published by the National Bureau of Economic Research (NBER) in June 2022:

“The age pattern of excess non-COVID deaths reveals something about the types of factors driving poor health during the pandemic. With the young experiencing so many excess deaths, even though their average personal risk from Covid is minimal, many of the pandemic’s effects on health seem to be working through market channels.”

They assert that lockdown policies, “such as closing workplaces or changing law enforcement practices, may have made it more expensive to maintain health or made unhealthy lifestyles less expensive.” Consequences of isolation fell predominantly on younger Americans, though the elderly were not spared. Lockdowns pursued in their name meant that those in long-term care homes and hospitals were not allowed visitation by family or friends, critical lifelines to the outside world. State policy emphasized isolation and disconnection among the population, young and old.

Lockdowns, tried in spring 2020 for the first time in history, continued far beyond that initial panic of an unknown coronavirus emerging from the central Chinese city of Wuhan. These prohibitions and restrictions receded, then swelled again and again over the course of the last two-and-a-half years, continuing to cast a shadow over Americans’ daily lives.

How many lives did we actually save in the pursuit of suppressing the coronavirus? Studying changes in all-cause mortality, or the overall death rate among the population, compared to the pre-pandemic period, will allow for a more unobstructed view of the effects of these novel policies. It will highlight which age groups and causes of death warrant further examination. Comparing those with historical cause of death data will help parse out a truer picture of the impact on life over the last two years. 

This analysis necessitates the use of federal CDC data because Maine CDC has not been fully transparent with data related to COVID-19, as well as other issues. Limited data offered by health care systems and by state officials like Dr. Nirav Shah, director of Maine CDC and Governor Janet Mills made determining which fatalities and hospitalizations were caused by COVID-19 difficult. 

While some hospital systems report how many patients were admitted “for COVID” versus “with COVID,” they don’t all count it the same way. That question had not even been addressed in the public sphere until late 2021, so for the first 18 months of the pandemic, the public heard “COVID-19 deaths” reported not realizing that those could have been anyone who passed away after having received a relatively recent positive PCR test result. Because of this policy, deaths attributed to COVID likely overcount the number of true deaths “from COVID,” rather than undercount.

Hospitals in Maine rarely distinguished between incidental and primary admissions for COVID hospitalization or deaths (“with COVID” vs “from COVID,” respectively) in its public data reports.  Some estimates, offered by representatives of large hospital systems like MaineHealth, ranged from 20% to 30% of patients being admitted for something other than COVID-19, but testing positive during their stay. Every patient admitted to Maine hospitals were being tested for the virus, sometimes daily, but certainly upon admission. Maine CDC estimates on incidental hospitalizations were only released upon specific request from legislators. Those data show the percentage of “fully vaccinated” hospital inpatients exceeded 40% at multiple points during the fall of 2021 into the winter of early 2022, while the state experienced a significant surge in hospitalizations. Thus, figures of “COVID-related” deaths are likely inflated from continuing this practice for more than two years.

Additional mischaracterization was more likely to occur during the prevalence of the Omicron subvariants of SARS-CoV-2. For instance, by June 2022, the weekly UK-based news and culture magazine, The Spectator, noted that 65% of COVID-positive National Health Service (NHS) patients were not primarily being treated for the virus. A preprint paper first appearing in early June 2022 supported by the Keck School of Medicine of the University of Southern California found that “67.5% of SARS-CoV-2 PCR positive hospital admissions were not for COVID-19 but with COVID-19.”

In a paper recently published in Lancet, a prestigious UK medical journal, researchers attempted to measure excess mortality “due to the pandemic” and found that their estimate is more than triple the number of reported COVID-19 deaths worldwide:

“In addition to deaths from SARS-CoV-2 infection, social distancing mandates and other pandemic restrictions might have decreased deaths from some diseases and injuries, such as road accidents, and increased others, such as deaths from chronic and acute conditions affected by deferred care-seeking in overstretched health-care systems, relative to expected or baseline conditions…The magnitude of disease burden might have changed for many causes of death during the pandemic period due to both direct effects of lockdowns and the resulting economic turmoil. To correctly divide excess deaths into those directly due to SARS-CoV-2 infection and those associated with changes in other diseases and injuries, multiple drivers of change in mortality since the onset of the pandemic need to be considered.”

As shown later in this report, counterintuitively, traffic deaths in Maine rose over the pandemic. These Lancet researchers concede that within their definition of deaths “due to the pandemic,” they include the effects of lockdown policies which caused the loss of millions of livelihoods and separated people from their communities. The paper regards the “effects of the pandemic” to be much greater than what has been attributed to the virus itself, even with the liberal application COVID as cause of death. As they mentioned, multiple potential drivers for mortality must be discussed.