The cure is worse than disease may be literally true for much of the country, including Colorado. While it is clear the worldwide response to coronavirus has created unprecedented economic devastation, there is also reason to believe many of the excess deaths that have occurred over the last couple of months were not caused by coronavirus, but by our response to coronavirus.
The reaction that has potentially done the most damage is the delaying or altogether skipping of emergency room (ER) visits. In New York City, between March 22 and May 16 of this year, ER visits were about half of what they were in 2019. In Colorado, ER visits dropped by about 45% starting in late March. There have been reports from around the country of reduced traffic in emergency rooms. Moreover, ER visits are also down outside of the U.S.: in England, ER visits are down 57% and in southern Sweden, ER visits are down 63%.
In this landscape, though data is scant, it is reasonable to estimate ER visits in the U.S. have been cut in half. In the United States in 2017, according to the CDC, there were 99 million non-injury related ER visits. Accordingly, between March 22 and May 16 of this year, based on the 2017 numbers, we would expect about 15 million non-injury ER visits. Cut that in half and it indicates possibly more than 7.5 million people who would have sought non-injury emergency treatment at an ER have decided not to go.
The reductions in ER visits are driven by two major factors: fear and advice. The fear comes from believing that ERs and hospitals are potential sources of coronavirus infections. This fear is amplified by a media eager to find hospitals in distress and report on healthcare workers with coronavirus. Regarding advice, early in the panic authorities were actually telling people to stay away, even those who suspected a coronavirus infection. Though it is very difficult to quantify the effects, common sense tells us with ER visits down 50%, most people who do end up at an ER, probably hesitated before going.
These delays cost lives. A 2011 study looked at the practice of boarding ER patients. Boarding is the process of holding a patient in an ER while waiting for hospital admission. The study found that patients who were boarded for more than 12 hours had a 2% greater chance of mortality during their hospital stay. A 2007 study indicated delaying admission to an ICU resulted in 2.3% greater mortality. A 2019 study by England’s National Health Service (NHS) found a patient waiting 11 hours in an ER waiting for hospital admission had a 3.3% chance of dying as a direct result of the delay.
Determining the number of deaths resulting from people postponing or forgoing ER visits may not be fully understood for years, if ever. Because deciding when to go to an ER is a personal decision made before any medical care is sought, it will be very difficult to directly measure people shifting their personal ER visit threshold. However, we can look at aggregate numbers to develop a range of possible effects.
For example, typically around 10% of ER visits result in hospital admissions, but the 10% is of visitors during normal times. Under normal circumstances, the period between March 22 and May 16 would have resulted in about 1.5 million non-injury ER-to-hospital admissions (10% of 15 million visits). If all of those visits were significantly delayed due to fear or “expert” advice, and the delays caused 2.5% fatalities (averaging the studies), we could possibly have suffered 37,500 delay-related deaths. I do not present this value as a standalone indicator; I present it to demonstrate the potential scale of the problem and as an alternative to the every-excess-death-must-be-coronavirus narrative. Of course, not everyone who visited an ER delayed, but of those who delayed, many likely delayed for far more than 12 hours. One could envision people waiting for days and the 2.5% mortality rate climbing along with lengthening delays.
Clearly, delaying treatment in emergency situations may have had dire consequences. To develop a better picture of the possible scope of the effect we can look at anecdotes, front-line doctor testimony, related studies, and high level data trends.
Of course anecdotal evidence can’t reasonably be used to estimate broad trends, but it can be used as proof of the existence of potential scenarios. For example, a neurosurgeon in Bellevue, Washington saw a patient who had had an aneurysm and delayed going to the hospital for a week out of fear of coronavirus. The patient ended up dying from, in the words of the doctor, “something that most of the time we’re able to prevent.” In another example, a heart attack victim delayed seeking attention for 14 hours “out of fear of COVID-19” and passed within minutes of being placed in an ambulance. On a larger scale, in the same southern Sweden region where ER visits have plummeted, they are seeing acute heart attacks drop by two thirds. Are we to believe that in a country that never went into lockdown, coronavirus has somehow cured heart disease?
Doctors throughout the world are reporting that they are seeing fewer ER patients, and the ones they are seeing are much sicker than normal. In Los Angeles, an ER saw eight non-coronavirus deaths in a five day stretch when they would usually see two deaths in a week. The director of the ER lamented, “They are delaying care for heart attacks, strokes, appendicitis, problems that can be easily treated.” Similarly, doctors in Delaware, Chicago, and Texas all report the few patients they are seeing are much sicker. In one Utah medical center, stroke patients went from 14 a week in early March to one in a week in early April accompanied by “a threefold increase in patients who present too late to intervene .” In the words of one Oregonian doctor, “Waiting is the worst thing you can do.”
It is also quite likely even the number of coronavirus deaths may be exacerbated due to delays in seeking medical treatment. A study conducted in China found earlier screening and intervention in Jiangsu province was a key in achieving a 23% lower mortality than in Hubei province. This makes perfect sense, if one is on the downslope from coronavirus and waits too long, chances of survival are decreased – if it were otherwise there would be no need for hospitals to treat coronavirus.
Against this backdrop, the CDC estimates 107,000 excess deaths between March 22 and May 16. This represents a 23% increase over the 443,000 deaths that would normally occur this time of year. During this period, the CDC also estimates the U.S. suffered 90,000 deaths from coronavirus. That leaves 17,000 excess deaths unaccounted for. Most reports seem to present this gap between the 107,000 excess deaths and the 90,000 identified coronavirus deaths as evidence of undercounting of coronavirus fatalities. Those who report in such a manner seem to be operating under the assumption that 100% of the excess deaths must be from coronavirus. This assumption is rooted in ignorance, not wanting to see possible side effects of the reaction to the virus, or simple deception for political reasons.
An example of ignorance is this Wall Street Journal article discussing the gap between excess deaths and coronavirus deaths that states, “If the gap widens … it means unexplained deaths, which these days are likely Covid-19 deaths.”
An amazing example of not wanting to see that the cure may be as bad as the disease is a New York Times piece showing that there is one non-coronavirus excess death for every two coronavirus deaths. The article displays a graph of New York and New Jersey deaths, that if extrapolated across the nation would mean that over 34,000 of the 107,000 deaths between March 22 and May 16 would have been not from coronavirus, but from the reaction to coronavirus. Yet, the article simply declares without evidence that the many of the excess deaths “may be undercounts or misdiagnoses of Covid-19, or indirectly linked to the pandemic otherwise.” The article had followed an April 28 piece in the Times suggesting all excess deaths are likely coronavirus related and only paid lip service to other possibilities.
As to politically motivated counting, New York City typically sees about 20 to 25 at-home deaths per day, but as coronavirus was raging in the city in early April, that number jumped to around 200 per day. This article highlights multiple city officials declaring the rise in at-home deaths is due to undercounting coronavirus deaths, with one councilman going so far as to declare that even if they don’t have coronavirus, they should count as coronavirus deaths. After all, preventable deaths of people too frightened to seek help would not look good come reelection time.
As if all of the above isn’t enough, there is another potentially huge factor indicating the reaction is the disease. It is the idea that for every person who dies with coronavirus who would have died anyway, there is another excess non-coronavirus death. For example, if 15,000 of the 90,000 U.S. deaths from coronavirus were among people who would have died independent of having coronavirus, those 15,000 deaths should be in the expected death category which would mean an additional 15,000 of the excess deaths would not be coronavirus and thus attributable to the reaction to the virus.
Why estimate 15,000? In Colorado, the health department is reporting the CDC-required death count as “deaths among cases” along with another number of deaths “due to COVID-19.” They are finding that 17% of deaths where coronavirus is present are not “due to COVID-19.” Applying the 17% to 90,000 results in 15,000 U.S. deaths “with” coronavirus but not “from” coronavirus. Interestingly, if the 15,000 is added to the CDC’s 17,000 non-coronavirus excess deaths, the total ends up being about a third of the total deaths, a finding similar to the New York Times study that indicated for every two coronavirus deaths, there is one death from the reaction to coronavirus.
In the end, it is probable that the response to the coronavirus is responsible for at least a third of the excess deaths the U.S. has experienced over the past few months. A large portion of these non-coronavirus deaths are likely due to people delaying or altogether avoiding visits to emergency rooms and doctors.
Our response to coronavirus has been a disaster. It has cost 40 million jobs, greatly contributed to social unrest, destroyed countless businesses both large and small, likely caused thousands of deaths of despair due to suicide and substance abuse, likely enabled significant increases in domestic abuse and child abuse, delayed the education of millions of children, added over 2.4 trillion dollars to the national debt, increased murder rates, diminished the quality of life of the vast majority of Americans, and may have literally killed 30,000 or more people who were not under threat from coronavirus.
The response to coronavirus will go down as the largest communal blunder in world history. We have transformed what would have likely been the worst flu season in a generation into unimaginable worldwide devastation.
The point isn’t that coronavirus is a hoax or doesn’t kill. Clearly given the right environment, such as in New York City, coronavirus is a major concern. The point is overall and especially outside such areas, the response isn’t just worse than the disease, the response is the disease.
Karl Dierenbach is an engineer, attorney and writer living in Centennial.