Don’t Forget the Uncounted Casualties of COVID-19

Many of us, myself included, have developed an obsessive concern about COVID-19 numbers. Perhaps it’s understandable, given the resurgence of the pandemic worldwide in the last couple of months and the economists’ saying: “If you don’t count it, it doesn’t count.”

But even the case and fatality numbers issued by reliable sources like Johns Hopkins University really tell only part of the story, and if we ignore the uncounted casualties of the pandemic we only ensure that the final tally will be far higher.

First of all, practically every country on Earth got off to a slow start with COVID-19. We have only a rough idea of how long it was spreading in Wuhan late in 2019 before Chinese doctors began to notice it. Its origin may have been outside China. A very recent study in a British medical journal reports a positive test for SARS-CoV-2 in a woman in Milan in November 2019. A rash on her arms had been misdiagnosed as a rare autoimmune disorder, but we now know rashes are a common COVID-19 symptom. Uncounted cases like hers must fill the databases of health-care systems around the world. Being uncounted, they don’t count.

Scientists are keenly aware of such missed cases and try to estimate them indirectly by comparing current mortality rates with those of previous years. A consortium of health departments runs the European Mortality Monitoring Project, a mortality-monitoring website. The graph in a recent bulletin shows vividly how excess mortality spiked in three waves last year.

Not all such deaths are simply due to missed cases of COVID-19. Many of the deaths and illnesses in a pandemic or serious epidemic are due to routine health problems, missed or neglected by a stressed health-care system. People tend to avoid clinics and hospitals during such outbreaks, or are turned away because no one can attend to them. In Africa’s recent Ebola outbreaks, measles may have killed more people than Ebola itself.

Those unvaccinated African children who died of measles were the victims of political decisions made long before they were born: decisions that kept their countries’ health-care systems underfunded, understaffed and under-equipped. Even after Ebola, Liberian doctors had to go on strike to get an adequate health budget. They were all too typical of health-care workers in poor countries.

Many of the excess mortalities in North America are due to similar decisions — to ignore the health problems of marginalized people, to please one political base or another, or to cut funding from public health programs.

Such decisions seemed to work until COVID-19 put our systems — and our politics — under the greatest stress they have seen in at least a century. Now we can see the disastrous consequences of our political negligence.

Unemployment has long been known to increase mortality, especially among men, whether from suicide or cardiovascular disease. A recent study by the National Bureau of Economic Research in the U.S. looks at the unemployment shock caused by the pandemic. The abstract is a shock as well.

“We estimate the size of the COVID-19-related unemployment to be between two and five times larger than the typical unemployment shock, depending on race/gender, resulting in a three-per-cent increase in mortality rate and a 0.5-per-cent drop in life expectancy over the next 15 years for the overall American population. We also predict that the shock will disproportionately affect African Americans and women, over a short horizon, while white men might suffer large consequences over longer horizons. These figures translate in a staggering 0.89 million additional deaths over the next 15 years.”

In other words, 890,000 Americans, mostly Black people and women of all races, and some white men, may die prematurely between now and 2036 because they lost their jobs in the pandemic. That is over twice the U.S. death toll of COVID-19 as of mid-January.

They will not be the only unnoticed casualties. Another National Bureau of Economic Research report looks at excess mortality during the pandemic.

The study estimated that the U.S. suffered about 250,000 excess deaths between March and October 2020. Of those, just 17,000 were likely a COVID-19 undercount. Some 30,000 deaths were “deaths of despair,” the results of drug overdoses, suicides and alcohol. Men aged 15 to 55 were the chief victims, including those between 15 and 25. “Local data on opioid overdoses,” the study concluded, “further support the hypothesis that the pandemic and recession were associated with a 10 to 60 per cent increase in deaths of despair above already high pre-pandemic levels.”

Canada has seen similar excess mortality: from May to October, StatsCan reported excess deaths of 1,385 Canadians under 45 — four out of five of them males. These were especially notable in Alberta (298 deaths) and B.C. (260).

StatsCan mentions “increased substance use” as a likely cause of such deaths and cites the BC Coroners Service as reporting such increases — with 153 suspected overdose deaths in November alone.

Dr. Theresa Tam, Canada’s chief medical health officer, has pointed to inequality as a major factor in the uneven impact of COVID-19 on Canadians of different classes and ethnicities. Her comments seem to have been ignored, and an American survey by the Rand Corp. and the Robert Wood Johnson Foundation finds a similar attitude in the U.S.:

“Between COVID-19 and calls for racial justice, 2020 appeared to be a turning point for tackling the root causes of inequities in health. Findings from the first and second waves of the survey show that many people — even those who may have been hit hardest by the pandemic and long-standing inequities — still do not see systemic racism as a barrier to good health.”

Affluent white communities have largely escaped the worst of the pandemic, and they have never much cared about deaths of despair anyway. Millions of Americans, and some Canadians, think the pandemic is overblown, or an outright hoax organized by corrupt health-care workers and politicians. Sickness and death in poor or marginalized communities don’t seem to register with these people.

Failure to recognize that unequal societies are sick societies will only ensure that the next pandemic will flourish at least as well as this one. And unequal societies will be in no position to deal with pandemics plus the climate disasters that have already descended on us. It will take very courageous leadership, in both the U.S. and in Canada, to hasten the end of COVID-19 and then prepare us for worse to come.

Otherwise, we ourselves may die uncounted.