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  • Writer's pictureThe San Juan Daily Star

A positive COVID-19 milestone


A Brooklyn memorial commemorating Americans who died during the pandemic.


By DAVID LEONHARDT


The United States has reached a milestone in the long struggle against COVID-19: The total number of Americans dying each day — from any cause — is no longer historically abnormal.


Excess deaths, as this number is known, has been an important measure of COVID’s true toll because it does not depend on the murky attribution of deaths to a specific cause. Even if COVID is being underdiagnosed, the excess-deaths statistic can capture its effects. The statistic also captures COVID’s indirect effects, including the surge of vehicle crashes, gun deaths and deaths from missed medical treatments during the pandemic.


During COVID’s worst phases, the total number of Americans dying each day was more than 30% higher than normal, a shocking increase. For long stretches of the past three years, the excess was above 10%. But during the past few months, excess deaths have fallen almost to zero, according to three different measures.


The Human Mortality Database estimates that slightly fewer Americans than normal have died since March, while The Economist magazine and the Centers for Disease Control and Prevention both put the excess-death number below 1%.


After three horrific years, in which COVID has killed more than 1 million Americans and transformed parts of daily life, the virus has turned into an ordinary illness.


The story is similar in many other countries, if not quite so positive.


The power of immunity

The progress stems mostly from three factors:


— First, about three-quarters of U.S. adults have received at least one vaccine shot.

— Second, more than three-quarters of Americans have been infected with COVID, providing natural immunity from future symptoms. (About 97% of adults fall into at least one of those first two categories.)


— Third, post-infection treatments such as Paxlovid, which can reduce the severity of symptoms, became widely available last year.


“Nearly every death is preventable,” said Dr. Ashish Jha, who was until recently President Joe Biden’s top COVID adviser. “We are at a point where almost everybody who’s up to date on their vaccines and gets treated if they have COVID, they rarely end up in the hospital, they almost never die.”


That is also true for most high-risk people, Jha pointed out, including older adults — such as his parents, who are in their 80s — and people whose immune systems are compromised. “Even for most — not all, but most — immunocompromised people, vaccines are actually still quite effective at preventing against serious illness,” he said. “There has been a lot of bad information out there that somehow if you’re immunocompromised that vaccines don’t work.”

That excess deaths have fallen close to zero helps to make this point: If COVID were still a dire threat to large numbers of people, that would show up in the data.


One point of confusion, I think, has been the way that many Americans — including we in the media — have talked about the immunocompromised. They are a more diverse group than casual discussion often imagines.


Most immunocompromised people are at little additional risk from COVID — even people with serious conditions, such as multiple sclerosis or a history of many cancers. A much smaller group, such as people who have received kidney transplants or are undergoing active chemotherapy, face higher risks.


With vs. from

COVID’s toll, to be clear, has not fallen to zero. The CDC’s main COVID webpage estimates that about 80 people per day have been dying from the virus in recent weeks, which is equal to about 1% of overall daily deaths.


The official number is probably an exaggeration because it includes some people who had the virus when they died even though it was not the underlying cause of death. Other CDC data suggests that almost one-third of official recent COVID deaths have fallen into this category. A study published in the journal Clinical Infectious Diseases came to similar conclusions.


Even so, some Americans are still dying from COVID. “I don’t know anybody who thinks we’re going to eradicate COVID,” Jha said.


Dr. Shira Doron, chief infection control officer at Tufts Medicine in Massachusetts, said that “age is clearly the most substantial risk factor.” COVID’s victims are both older and disproportionately unvaccinated. Given the politics of vaccination, the recent victims are also disproportionately Republican and white.


Each of these deaths is a tragedy. The deaths that were preventable — because somebody had not received available vaccines and treatments — seem particularly tragic.


Yet the number of COVID deaths has now dropped low enough that they are difficult to notice in the overall death data. They can be swamped by fluctuations in other causes of death, such as the flu or vehicle crashes.


Almost a year ago, Biden angered some public health experts when he declared, “The pandemic is over.” He may have been premature to make that declaration. But the excess-deaths milestone suggests that it’s true now: The pandemic is finally over.


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