Whose pandemic strategy really saved lives? Which states or countries lost the most people to the virus? Or to the unintended consequences of mitigation efforts? Now there’s finally some clear, objective data emerging from the fog.
The most telling statistic turns out to be the simplest: all-cause mortality. Tallies of who died, when and where can be used to calculate “excess mortality” — how many more people died in a given place and time period than would be expected.
One recently released analysis, not yet peer reviewed, concluded that in the U.S. there were 1.17 million excess deaths from March 1, 2020, to Feb. 28, 2022 — a death rate that’s about 20 percent above the normal number of deaths for that period. That’s higher than the official COVID-19 death count. Excess mortality “is the most agnostic metric because it doesn’t ask you to make decisions,” said Jeremy Faust, co-author of the analysis. “It just asks you to say, are these deaths normal?”
For example, comparisons made by Faust’s team across different counties in Massachusetts showed excess deaths clustered in areas with low vaccination rates. In their nationwide analysis, they found the South had the most excess deaths and the lowest vaccine uptake.
Faust and his team were also able to show that Native Americans, Black and Hispanic Americans died in disproportionate numbers, and that men showed more excess deaths than women. And in a surprising twist, while many more elderly people died by sheer numbers, the rate of excess death was higher among people under 50.
Comparing countries can be even more revealing. Another study, published this month in the Journal of the American Medical Association, showed much more excess mortality in the U.S. than in other wealthy countries during the delta and omicron waves.
That study tracked the period after June 2021, when vaccines were widely available in these countries. The U.S. had the most excess deaths, at 145.5 excess deaths per 100,000 people. The next-worst country was Finland with 82.2.
The U.S. fared far worse than any of the other countries studied, and New Zealand fared better. New Zealand had the lowest excess death rate before the vaccine rollout as well, and the U.S. came in second worst, next to Italy. Some of those differences may have to do with how badly hospitals were overwhelmed and whether countries were able to do anything to protect nursing home residents, as well as bad luck in getting hit early in 2020.
Of course, there are variables that are hard to control, including the timing of waves — how they coincided with seasonal patterns and waning immunity.
But the parts we can control should become clearer as more scientists study these overall death rates. Right away, it was apparent that the most vaccinated parts of the U.S. had fewer excess deaths.
It would have been impossible for any country to get through the pandemic unscathed, but excess death statistics can show how much better the situation could have been. Comparisons can also help focus on successes — whose actions weakened what would have been a Category 5 hurricane to hit as a Category 3. Those lessons could save lives in future waves of COVID-19, or the next pandemic.
Faye Flam is a Bloomberg Opinion columnist covering science.
