EVALUATING ALL OF IT
Last week, the Centers for Disease Control and Prevention released its provisional death statistics for 2020, and it gave us a shocking figure: While a reported 345,323 people died of COVID-19 last year, total deaths jumped by much more than that. In 2020, the United States lost about 3.4 million people, compared with about 2.9 million in 2019, an increase of roughly half a million. Those extra deaths represent about 1 in every 650 Americans, or, alternatively, the entire population of Atlanta.
It’s hard to grasp what numbers like that mean; the imagination trails off into strings of zeroes. But even if you dig beneath the headline data and try to focus on the smaller numbers, you’ll find them equally elusive. What they keep driving home is how little we still know about this virus, and what it’s done to us — indeed, how much we may never know.
Consider the 158,000 extra deaths that weren’t directly attributed to COVID-19. It’s safe enough to link most of them to the pandemic, but if you want to know more than that, you quickly run into trouble.
Some of them, of course, are probably just COVID-19 deaths that didn’t get recorded that way. It seems significant that deaths from strokes and heart disease rose during the pandemic, while cancer deaths held steady. Strokes and heart attacks are known complications of COVID-19; cancer is not.
We can probably also blame the virus for 13,000 extra deaths from diabetes, a known COVID-19 risk factor. But what about the reported rise in traffic fatalities, most of which probably weren’t feverish patients crashing their cars on the way to the emergency room? A more likely culprit is the faster speeds and reckless driving enabled by suddenly open roads.
In some cases, we may never know whether to blame the virus, or our reaction to it. Notably, Alzheimer’s deaths increased 10 percent from 2019. Dementia patients are, of course, especially likely to live in nursing homes, among the places hardest hit by COVID-19. But when those nursing homes isolated patients in their rooms to keep the virus from spreading, it was particularly catastrophic for those suffering with dementia. For frail individuals who can’t pass their days Facetiming friends or browsing the Internet, isolation was a profound torture that might have sent them into decline even if they never got COVID-19.
Moving beyond the medical, we will have to reckon with the sharp spike in homicide across dozens of American cities. How much should we attribute to COVID-19, how much to prior trends, how much to the deterioration of policecommunity relations or some other factor?
Finally, we come to the most surprising category of all: things that actually got better. Deaths from chronic lower respiratory disease actually fell about 3 percent in 2020, presumably because people with serious respiratory disease were serious about staying home, wearing masks and washing their hands. And despite the harrowing predictions I kept hearing about how lockdowns would trigger a wave of suicides, suicide actually fell by about 6 percent.
This was so counter to expectations that I reached out to Mark Olfson, a professor of psychiatry and epidemiology at Columbia University. He indicated that many experts also found the numbers surprising. Suicides often follow the kinds of traumatic events that happened a lot during the pandemic: losing a job, a business, a loved one. There also had been a rise in unintentional overdoses and emergency
The trauma of this year might have lingering consequences.
room visits for psychological distress.
But we could name some countervailing factors. Extra-generous extended unemployment benefits, for example, meant that many people who lost jobs were actually better off financially in 2020. In fact, with fewer leisure activities to spend money on, a lot of household balance sheets look very healthy right now, though, of course, some individuals have suffered intensely, especially small business owners.
Meanwhile, some people who ended up living with their families might have had more psychological support than they normally would, and the sense of collective misery might, Olfson said, “buffer it for some people.” If you’re at home by yourself while everyone is out socializing, you feel like a failure; if everyone is at home bingewatching Netf lix, you’re one of a crowd.
But Olfson also pointed out that even if the numbers went down in aggregate, there quite possibly were individuals who were driven to suicide by the pressures of the pandemic. The people who looked at struggling friends and family and concluded that we were facing an unprecedented psychological tsunami weren’t wrong, exactly; it’s just that their experiences weren’t representative of the whole country.
For that matter, it’s possible that the trauma of this year might have lingering consequences that will show up in mortality reports five or 20 years from now — the psychological wreckage continuing to wash up well after the storm. We will probably never know quite how bad the hurricane got, only that a terrible thing swept over us, and that much of what it destroyed can never be recovered.