Study finds 35 percent deaths tied to causes other than COVID-19

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Since the novel coronavirus (COVID-19) spread to the United States earlier this year, death rates in the U.S. have risen significantly. However, deaths attributed to COVID-19 only account for about two-thirds of the increase in March and April, according to a new study published in the Journal of the American Medical Association.

Researchers at Virginia Commonwealth University (VCU) 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 showed that only 65 percent 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, according to lead author Steven Woolf, MD, 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.

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, and Pennsylvania. At COVID-19's peak for March and April, diabetes deaths in those five states rose 96 percent above the expected number of deaths when compared to the weekly averages in January and February of 2020. Deaths from heart disease (89 percent), Alzheimer's disease (64 percent), and stroke (35 percent) in those states also spiked.

New York City's death rates alone rose a staggering 398 percent from heart disease and 356 percent from diabetes, the study said.

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. Still others may have struggled to deal with the consequences of job loss or social isolation.

Woolf said the 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. He 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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