Why the Concern for Death Now But Not When Death Rates began to Increase?
By John W. Palmer

A month ago I expressed concern regarding the extra-ordinary treatment the nuevo corona virus, that reportedly came from Wuhan China was receiving by writing an essay tittle “Ordinary Death v. Extra Ordinary Death”. In concluding that essay I made a plea for a change in reporting death. Here are the concluding sentences from the essay:

Hopefully, a positive side effect of COVID-19 can be renewed interest in primary prevention of the leading causes of death. We can’t eliminate death but we can take actions to delay its appearance. Perhaps, if in addition to the daily posting of COVID-19 cases and death, everyone will start to post the ongoing count for the ordinary deaths.

My plea went unheeded. Now there is widespread reporting of the negative impact of the mitigations being demand by government of?cials. That negative impact came close to home late last week when I received a prayer request for a friend. Here is that request:

Dear Recites and Prayer Warriors, I am having an emergency ablation for uncontrollable a?b of my heart tomorrow morning @ 7:00 a.m. @ the VA in Minneapolis. I am praying for success because of Coronus 19. The procedure was to have been done earlier but got set back and now has gotten out of hand.

Fortunately my friend survived and is now recuperating. Unfortunately, not everyone has been so fortunate. The Daily Beast reported that “Amid social distancing, authorities nationwide are reporting a surge in fatal opioid overdoses. Addiction and recovery advocates say the U.S. is now battling two epidemics at once. In Franklin County, Ohio, for example, the coroner is warning residents of a continued spike in drug deaths, including six on April 24. One week before, the coroner announced that ?ve people died in a span of 12 hours. In February, overdoses were so prevalent the coroner said she might need a temporary morgue to handle the deluge. Montgomery County, Ohio— which is home to Dayton and was considered the country’s overdose capital in 2017 – is reporting a 50 percent jump in overdoses over last year. Indeed, authorities in counties across Florida, Texas, Pennsylvania and New York are also reporting rises in overdoses during the COVID-19 crisis.”

Then, in this recent Wall Street Journal article, this was reported:

Mental-health crisis hotlines are reporting spikes in calls. According to Express Scripts, anti-anxiety prescriptions increased by a third between mid-February and mid-March. Many in despair will probably turn to alcohol or narcotics. CVS executives warned this week that delayed care could lead to a surge of non-coronavirus related health problems.

Next is this from Fox News:

Things have gotten so bad that the American Heart Association joined seven other medical groups to remind people to call 911 and go to the hospital if they fear they’ve had a heart attack or stroke. Interruptions of medical care are taking their toll on patients. Some doctors have postponed surgeries aimed at addressing early-stage cancer. The longer these “elective” surgeries are postponed, the more people suffer. Patients in need of treatment aren’t the only ones at risk. The COVID-19 lockdown could lead to 22 million canceled or delayed tests for ?ve common cancers by June, according to a new report by the IQVIA Institute for Human Data Science. This reduction in testing could lead to 80,000 missed cancer diagnoses.

The same report found that colonoscopies dropped 90 percent between February and April; mammograms dropped 87 percent. New visits for cancer patients declined nearly 40 percent over the same period, while cancellations and no-shows nearly doubled.

In her opinion column, Liz Peek in her opinion column cited information documenting statistics on the lock down’s impact on mental health:

Deaths by suicide and because of alcoholism or drug abuse sparked by the isolation measures are no longer matters of speculation; in March and April EMT calls for drug overdoses and suicides in Milwaukee, for instance, rose 54 percent and 80 percent, respectively, compared with the year before.

Finally, Reed Abelson writing in the New York Times on May 5, 2020 in an article titled “Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’ another view on the lockdowns impact:

Some doctors estimate that the closure of hospitals to non-coronavirus cases and the reluctance of patients to burden 911 have increased mortality as much as the virus. The global depression will devastate life expectancies in the less-developed world. Overdose deaths and suicides brought on by joblessness and loss of hope will rise, as more and more businesses fold permanently.

With no change in how death is being reported, with the myopic focus on that new virus and with the emerging concerns that the treatment might be worse than the disease I decided to examine historic death rates and annual deaths in Minnesota. At this writing about 663 COVID-19 related deaths have been recorded in Minnesota. That means with a little over a month left in the reporting year COVID-19 related deaths look like they may move into the top ten causes of death in Minnesota. The 10th leading cause of death in Minnesota is suicide. In the most recent year for which data are available (2018) suicides accounted for 737 deaths.

In order to examine COVID-19 related death in the big picture of death in Minnesota the following data from the Minnesota Department of Health’s “Summary of Death 2018”. Table 1 reports the total number of deaths and the death rate per 1000 persons by year from 2005-2018 and for 1950-2004 deaths and death rate per 1000 are reported every ?ve years. No death rate per 1000 was reported for 1985.

The total number of deaths per year have increased from 1950 to 2018. The rate of increase in the total number of deaths has been accelerating since 2006 reaching the highest recorded number on record (44,730) in 2018. From 1950-2018, the lowest number of deaths in a year occurred in 1950 (27,897)( see Table 1 and the graph titled Deaths by Year).

From 1950 to 2018, the total number of deaths in Minnesota increased by 60%. However, using simple counts for examining changes in an event over time can be very deceiving. It is clear that the number of deaths in a year is related to the population at risk to die in that year needs to be accounted for. To control for variation in the population at risk, a comparison of death rate per 1000 persons is preferred over simple counts since rates can be compared in an apples to apples approach.

The scatterplot titled Death Rate by Year illustrates the trend in death rate in Minnesota from 1950 to 2018. The highest (9.4) death rate per 1000 Minnesotans occurred in 1950. Death rates declined consistently from 1950 to 2007 when the lowest (7.1 per 1000) death rate was recorded. The 57 year decline is a 24% reduction in the death rate. That meant the chance of dying in a given year was 24% lower in 2007 than in 1950.

The downward trend ended in 2008 when the death rate per 1000 went from 7.1 to 7.4. Annual death rates have consistently increased from the low of 7.1 recorded in 2007 to the contemporary high of 8.0. This was a 12.6% in eleven years. If that rate of increase continues the death rate per 1000 Minnesota’s could reach 8.2 per 1000 this year. Independent of the Covid-19 outbreak the rate of death has been increasing.

With all the interest in preventing death the COVID-19 outbreak is generating why has the accelerating and troubling trend toward higher and higher death rates been ignored? Clearly the trend has nothing to do with the COVID virus since the rate increase predates COVID-19 by over a decade. Perhaps it’s a case of ordinary events not being news?

With it becoming increasingly obvious that death related to the virus is not going to signi?cantly increase death in Minnesota and probably the death rate this year in Minnesota and the state and nation opening for business one good outcome from the outbreak might be a new found concern for increasing death rates in Minnesota and the USA.

For the good outcome to be realized people are going to need to be presented with the facts concerning why deaths and the death rate are increasing. Then they need to be given direction on speci?c behaviors with high potential to prevent deaths. If attention shifts away from death and reporting on death returns to relying on obituaries not linked to the cause of death nothing will change and the death rate will continue to climb higher and more and more deaths will occur each year in Minnesota.

You have heard it said: Don’t let a crisis be wasted. No matter the cause or true magnitude of the most recent viral outbreak let’s hope we all wake up to the need to manage risks and engage in behaviors that reduce the probability of death. Ignoring the upward trend in both the number of deaths and the death rate until the next epidemic caused by some novel disease wastes an opportunity to enhance life for many Minnesotans. It is past time to include consideration of ordinary death whenever the new cause of death is discussed. Improving people’s behavior with regard to the leading causes of death in Minnesota probably has a greater chance of reducing both the number and rate of death in Minnesota.

With over 18,000 deaths per year caused by cancer and heart disease a 5% reduction in these two causes of death will save more lives than all of the cover death this year. With the ten leading causes of death in Minnesota accounting for over 30,000 deaths per year it would only take a 3% reduction in these causes to save as many lives as lost to COVID this year.

Finally, if behavior changes cut the number of COVID-related deaths along with a new focus on the other contributors to death in Minnesota many more people’s lives will be save than continuing a myopic view of death in Minnesota. I hope Minnesotans will make the behavior changes needed to reduce death from all causes and stop focusing almost exclusively on the new kid on the block.

Author’s note: As this essay was nearly complete this important commentary was published by the Wall Street Journal: Medical Lockdown Will Cause a Disease Surge Patients who are sick with conditions other than Covid-19 aren’t seeking screening and treatment. By Jeff LeBenger and Mike Meyer May 11, 2020 6:12 pm ET.

John W. Palmer, Ph.D. is a retired professor of health and safety. He can be reached via email at palmertss@cloudnet.com

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