ARIZONA DEATHS ROSE 25% IN 2020
Surging fatalities likely due to COVID-19’s grip on the state
Overall deaths in Arizona increased by 25% in 2020, underscoring the toll of the COVID-19 pandemic, preliminary new state data shows.
Arizona recorded 60,161 deaths in 2019 and 75,133 deaths in 2020, according to the preliminary data from the Arizona Department of Health Services. That’s a difference of nearly 15,000 deaths, a year-over-year increase of about 25%, but the uptick cannot yet entirely be attributed to SARS-CoV-2, or the new coronavirus, which causes COVID-19 disease.
Year-over-year increases in total deaths in Arizona have typically ranged between 1% and 4% in recent years, and population growth in recent years has ranged between 1.6% and 2%. Death totals for 2020 are still preliminary, state officials said.
“There’s no obvious end in sight. As we collect thousands of new cases a day, some fraction, roughly 2% if you take all comers, will end up dying.”
Joshua LaBaer Director of ASU’s Biodesign Institute and leader of the university’s COVID-19 research efforts
The final numbers typically come out in May or June.
Known deaths from the virus in Arizona last year surpassed 10,200, although that number is expected to change as more COVID-19 deaths are identified.
That leaves more than 4,700 additional deaths over the 2019 count. Some may be COVID-19 deaths not yet identified; others may be pandemicrelated deaths due to delayed care or avoiding emergency rooms.
Other possibilities include deaths related to increased substance abuse and mental health issues that have been reported during the pandemic. State officials are already reporting that opioid overdose fatalities in Arizona appear to have increased significantly in 2020. Though final numbers aren’t yet available, suicides in Arizona do not appear to have spiked during the pandemic, state officials said.
“There are always multiple factors that contribute to a death and we utilize our medical examiners and the practitioners that knew that patient to identify and make the call for cause of death,” Dr. Cara Christ, the Arizona Department of Health Services director, said Friday.
“Deaths can be pretty predictable and fall within a certain percentage, but this year there were multiple things that impacted the community. If you’ve got unemployment or loss of health insurance because you weren’t working or you lost your job, homelessness can cause issues that could result in death. The other thing we saw was a significant increase in opioid-related deaths.”
COVID-19 likely is the leading cause of death in Arizona over a 12-month window, Joshua LaBaer, director of Arizona State University’s Biodesign Institute and leader of the university’s COVID-19 research efforts, predicted at a Wednesday news briefing.
In recent typical years, roughly 12,000 Arizonans died each from heart diseases and cancers, according to state mortality data. The two have been the leading causes of death in the state for more than a decade.
But COVID-19 is surpassing them as Arizona’s number one cause of death in a 12-month period. The state had identified just over 12,000 known COVID-19 deaths as of Friday, and with the state’s first virus death recorded on March 17, it has still been short of 12 months.
Recent data: 1,000 deaths per week
There’s no indication the death count will slow, as Arizona continues to add high numbers of cases, a fraction of which end up hospitalized and dead.
In January, the state has been adding about 1,000 COVID-19 deaths per week, although many occurred days or weeks prior because of reporting delays. The state surpassed 9,000 deaths on Jan. 1, 10,000 deaths on Jan. 9, and by Friday the tally of known deaths had reached 12,001, according to the state health department.
Arizona as of Friday was leading the U.S. for its rate of COVID-19 deaths over the past seven days, according to the CDC’s COVID Data Tracker.
“There’s no obvious end in sight,” LaBaer said. “As we collect thousands of new cases a day, some fraction, roughly 2% if you take all comers, will end up dying.”
That percentage varies along the lines of age and comorbidities. In Arizona, 75% of all COVID-19 deaths have been in the 65-and-older age group.
In terms of raw numbers, July and December had the largest percent changes from 2019 to 2020, aligning with the state’s two major surges of the virus.
Total deaths in July 2020 were up by 67% with 8,242 deaths, compared with 4,923 in July of the prior year. Total deaths in December 2020 increased by 64%. A total of 8,554 deaths were recorded in Arizona in December, compared with 5,212 in December 2019, the data shows.
The Arizona Public Health Association, which analyzed the data in a report released this week, noted that the numbers indicate significant increases in allcause mortality in June and August, with “profound” increases in July and December.
When COVID-19 is reported as a cause of death on the death certificate, it is coded and counted as a death due to COVID-19, federal officials say.
The CDC says COVID-19 should not be reported on the death certificate “if it did not cause or contribute to the death.”
The state and Arizona counties follow the CDC’s guidelines and definition of a COVID-19 death, which since March has had its own ICD (International Classification of Diseases) medical code.
“COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death,” the definition says.
The guidelines say anyone writing the death certificate should include as much detail as possible based on their knowledge of the case, including medical records, laboratory testing, and chronic conditions such as COPD or asthma that may have also contributed to the death.
State health officials expect to look more closely at the COVID-19 deaths, including primary and secondary causes of death, once they have the final data, Christ said.
“One of the things we’ll tease out as we get more information is how many of the deaths had COVID-19 as the primary cause versus being an underlying cause that wasn’t the ultimate cause of death,” Christ said.
An indirect death toll because of delayed health care
The indirect death toll of COVID-19 will likely still be felt even as deaths directly from the virus itself do eventually start to wane.
LaBaer said those may come in the form of people who delayed care because of concerns about visiting hospitals during the pandemic or those who weren’t able to have timely surgeries as hospitals canceled or postponed elective procedures to handle the onslaught of virus patients.
“What we don’t know about and won’t know about for some time to come is how many excess deaths we’re having due to other causes because care was delayed,” LaBaer said, mentioning people who had chest pains but waited to go to a hospital, people who discovered lumps but wanted to avoid the ER or people with tumors who couldn’t get them removed on time.
“There’s a lot of medical care — preventative care that usually gets done that preserves lives and is not getting done right now,” he said. “Months from now we’re going to look back at those folks and they’re going to have increased stages of cancer when they’re diagnosed and other problems because care was delayed due to COVID-19.”
In one example, people with chronic obstructive pulmonary disease may have developed a mild SARS-CoV-2 infection that worsened their underlying medical condition, the Arizona Public Health Association’s analysis says.
“Only a more detailed review of the medical record and death certificate would reveal that the coronavirus was a core cause of the death,” the report said. “Perhaps of most importance, non-emergency procedures were not available for many Arizonans unless the procedure was urgent.”
Delays in care may be responsible for many of the additional unexplained deaths, the report said.
Will Humble, executive director of the Arizona Public Health Association, said while drug overdoses may have spiked and accounted for some of the excess deaths, he suspects most of the added deaths are from delayed care, though he does not have evidence to support that theory.
“My hypothesis, which I can’t prove, is that it’s the delayed care — increases from deaths from stroke, increases from deaths from heart attacks, increases from kidney failure, all of the constellation of other delayed care causes,” Humble said. “What’s happening is this huge displacement of patients.”
As of Thursday, 52% of inpatient beds in Arizona were filled with suspected or confirmed COVID-19 patients and that percentage was at 59% on Jan. 11. For most of the first three weeks of January, COVID-19 patients occupied 60% or more of the state’s ICU beds.
“There’s a lot of people that aren’t there because of procedures, or people with chest pain that would have been admitted for observation that are just sent home and then have a bad outcome with a heart attack or something like that,” he said. “... There are hundreds of different diagnoses that would need to be looked at and all collectively.”
Researchers at DanaFarber/Brigham and Women’s Cancer Center in Boston this month documented a substantial decline in cancer and precancer diagnoses at the Northeast’s largest health care system during the first peak of the pandemic because of a drop in the number of cancer screening tests performed.
The study, published online by JAMA Oncology, provides added impetus for people who missed or postponed a cancer screening test early in the pandemic, the study authors said.
“It’s widely thought that fewer people were screened for cancer and precancerous lesions during the first surge of the pandemic, because of limitations on non-urgent medical procedures, restrictions on patient volume, and patients’ concerns about the spread of the virus and the need for social distancing,” study co-author Dr. Ziad Bakouny said in a news release. “For this study, we wanted to document the extent of this decline, and its impact on cancer diagnoses, at a major U.S. health care system.”
Bakouny and other researchers found that a decrease in screening tests was accompanied by decreases in diagnoses of the cancers detected by those tests. The falloff in diagnoses, though temporary, is a source of concern because cancers detected at an early stage are often easier to treat than those that have had time to grow and spread, the authors said.
Fatal drug overdoses spiked during pandemic
In 2018, two people per day died of an opioid-related overdose in Arizona, state numbers show. In 2019, that number increased to nearly four people per day, or a total of 1,358 deaths.
Preliminary 2020 numbers from the state health department presented at The Arizona Drug Summit on Sept. 14 showed that opioid overdose deaths through the end of April 2020 were up by 38% when compared with the number of fatal opioid overdoses during the same time period in 2019.
Christ estimates the total end-of-year tally for fatal opioid overdoses in Arizona will be about 2,300, which would be a 69% increase over 2019 deaths.
There’s a strong correlation between unemployment rates and substance use disorders, and isolation is another risk factor for substance abuse.
Provisional data from the CDC shows a spike in overdose deaths nationwide in a 12-month period ending in May 2020. During that time, more than 81,000 drug overdose deaths occurred in the U.S., the highest number of overdose deaths ever recorded in a 12-month period, according to provisional data released last month.
The federal agency issued a health advisory to public health departments, first responders and others on Dec. 17, alerting them to a “substantial increase in drug overdoses” across the U.S. involving opioids, “likely illicitly manufactured fentanyl,” with the largest percentage increases occurring in the western U.S.
Christ said that while state health officials had thought suicides were increasing, that doesn’t appear to be the case. Now, the projections are that the state’s suicide tally will either be stable or lower than it was in 2019, she said, though the numbers could still change as causes of death are investigated.
The state publishes a book each summer that includes trends, analysis and findings from death certificates.
“I think our findings are going to be very interesting. We’ll have a decrease in traffic deaths. We know we’ll have an increase in opioid deaths,” she said. “We won’t have a complete, accurate picture until we do that analysis.
“COVID-19 had a huge impact on the health and wellbeing of Arizonans and it is going to have a huge impact on the deaths.”