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5,000 'excess' deaths in Massachusetts since the start of the pandemic, but not all are from coronavirus, expert says

The Harvard Gazette interviews Dr. Druv Kazi, director of Beth Israel Deaconess Medical Center’s Cardiac Critical Care Unit and associate director of the hospital’s Smith Center for Outcomes Research in Cardiology about a new study that suggests a number of the 5,000 extra deaths Massachusetts has seen over the past two months were not caused directly by Covid-19 but by other conditions people put off going to the hospital for because of Covid-19 concerns.

In March and April, Kazi, reports, the hospital saw a 33% decrease in heart attack patients and 58% drop in stroke patients.

Based on the heart attack and stroke data that we just discussed, it’s very clear that there are patients who are having heart attacks and strokes and deciding to sit it out. They are either presenting to the hospital late - and not eligible for some of the very effective therapies for cardiovascular conditions that must be administered early on - or they may have died at home. We know from data from the Centers for Disease Control and Prevention that Massachusetts has had approximately 5,000 excess deaths since the pandemic started. Many of these are due to the pandemic itself, and some may be undiagnosed COVID-19 cases, but my hunch is that many of those deaths are from undiagnosed cardiovascular conditions, like heart attacks and strokes, where people decided to sit out the symptoms and it didn’t work out well.

Kazi acknowledged many people were afraid to come to Boston hospitals for fear of contracting Covid-19 and said hospitals need to do a better job communicating that they remained safe even at the height of the surge, because they took immediate steps to segregate potential Covid-19 patients from other patients.

Let’s be clear about this - staying at home and “flattening the curve” in Boston saved lives. We have the luxury in Boston of having numerous world-class hospitals, and each of the big hospitals more than doubled their critical care capacity. In hindsight, the early outbreak in the beginning of March may have pushed us all to prepare well in advance, yet, even with the flattened curve, most hospitals got pretty close to being full during the peak of the pandemic. So, I don’t interpret our findings to mean that we shouldn’t have locked down or shouldn’t have sheltered in place. Far from it. Even our hospitals with all of their spare capacity would have been completely overwhelmed if we had had the same numbers as New York. But I think we could have done a better job communicating about emergencies. And that’s a job that’s not finished.

Gov. Baker began urging residents with non-Covid conditions to get to an ER in mid-April.

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Comments

I looked on the CDC website to get more information:

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

If you look at the weekly graph for Massachusetts, you see data similar to the data cited in this article, but displayed as weekly data. The total deaths are above the typical seasonal level of typical deaths plus COVID-19 deaths.

Why look so closely at these numbers? These help to give perspective, and help with good decision making (individually and collectively) about what to do and what to expect this summer & fall.

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Voting closed 23

MA had 58,000+ deaths in 2017 the last year that the detailed data is available

Amongst that total nearly 1/3 of the deaths were not attributed to any specific cause [of the top 10]

That comes to about 2,000 deaths per month which have no specific attribution -- or about 5,000 deaths since the Pandemic first showed up here in numbers [10 weeks ago]

In addition this had been a fairly significant Flu Season -- one of the largest Flu outbreaks in past 10 years

So -- could some of the COVID-19 attributed deaths be due to mostly the underlying factors such as cardiovascular disease with the COVID-19 infection just pushing the already sick person over the edge?

No way to tell since very few of the deaths outside of hospitals ever were autopsied as per the current protocols for such things

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Because I'm wondering how to weigh your comments with those of a cardiologist with a background in statistics at a teaching hospital.

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Your analysis is not quite the gotcha you think it is. The report acknowledges that some of those deaths might be related directly to Covid-19: the point is that with people scared off from hospitals, people may have died who could have been saved.

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as every other blowhard who wants to reopen everything. He and FISH and a couple of other Dunning-Kruger all-stars have an answer for everything, and just like everything else coming out of their mouths, it's simple, self-assured, and completely wrong. A doctor with a background in statistics? Who is he to compare with the intellectual firepower of a couple of guys who took Intro to Statistics 30 years ago and watched a few Youtube videos?

Engineer's disease is a helluva drug. This one can't even clear the hurdle of registering for an account. Maybe we could try to catch the ear of the guy who runs this place, and have a chat about the value-add of unregistered commenters?

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I'm glad he's a good if not great cardiologist and may have some experience with statistics

That still doesn't make his analysis complete

as someone has pointed-out hereabouts -- Since it takes several years for the complete reports to be in -- it was only this September that the Commonwealth published the report on 2017 deaths

So how can someone seriously come up with a definitive study on the "excess deaths" over the past dozen or so weeks -- apparently working mostly with data from one hospital

Sounds more like a marketing pitch than it does science as a serious scientist would spend most of the time analyzing the sources of error in the assessment

I pointed out a few loose ends -- there are plenty more

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Nice try. Just because you have some background in science doesn't mean that you are "good at all sciency things".

Case in point: nearly every blowhard comment you make here.

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This one analyzes the death rate in 366 counties across the US, and suggests that COVID deaths are grossly underreported.

We expect to see this: it’s not surprising that much of the excess death rate in 2020 is attributed to COVID-19. But COVID-related deaths don’t account for all the excess mortality. On average, excess death rates are 30% higher than reported COVID-19 death rates.
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Once again the question comes, how many people died in MA from January 1, 2019 through May 23, 2019 compared to January 1, 2020 through May 23, 2020? Does anybody have an answer? Of course any numbers from Covid should be viewed with skepticism, especially since a lawsuit from factfinders caused the Colorado Covid death rate to drop 25%.

It is really lazy and inept of Baker's Department of Health and Human Services, in the midst of a reported pandemic, to fail to update their own website, continuing to post 2017 death statistics as "the latest" numbers on their website. They only got around to publishing the 2017 numbers last fall.

At a time when the media seems heavily invested in prolonging the scare and frightening people away from important hospital visits, it would be nice to have updated, true numbers from the Commonwealth. With a $46 billion budget, the state can do better. At least Dr. Kazi seems to be admitting that the medical community and media partners did a poor job informing people with stroke and cardiac symptoms that it was safe to come to the hospital. Some people were led to believe the hospitals were filled to overflowing, which even the Doctor admits was untrue.

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Annual reports usually lag by over a calendar year as the stat people want to make sure the data is accurate.

Keying in on the current topic, I would imagine that where possible, there will be the desire for some post mortem examinations to get to causes. Conversely, I see things that seem to indicate that people might be getting buried too quick for a true cause of death to be established. It depends on how thorough the rules are for completing death certificates.

Deaths above expected is a good metric in the short term, but it will take time to establish what was the exact cause of death for people.

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Annual reports usually lag by over a calendar year as the stat people want to make sure the data is accurate.

Agreed, that's why in mid-2020 it's lazy and inept to have 2017 statistics as "the latest." I thought "excess deaths" was the current topic, I must have misread the headline. How can anything be determined to be in excess when there is no benchmark? In excess of what, the 2017 official stats?

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Which is the heart of the difference between what we can see and what the people at the Registry of Vital Records and Statistics have. The simplest thing is to do a total of people who died for a time period. The hard part is synthesizing the data. For instance, I am sure that you have seen that the CDC published influenza numbers for the past season. Those “numbers” are a broad estimate. Meanwhile, those charged with getting the numbers together need time- yes, several years- to produce an accurate report. Hence, the most recent reports available are for calendar year 2017. In a few months, calendar year 2018 figures will be published, and the cycle will continue.

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