The Extra Deaths

Americans have been dying in record numbers for the past three years, and though the Covid-19 pandemic’s refrigerator-truck morgues and the constant keening of ambulance sirens are gone, the surge continues to this day. An interactive map and graph of global mortality by country show the United States at 10‒25 percent excess mortality from early 2020 through to the current moment. This is so even though President Joe Biden declared an end to the pandemic in September 2022, and even though state and federal officials are preparing to lift emergency declarations beginning in May. I’m not speaking of the hundreds of daily Covid fatalities much of America has decided to accept and absorb. I’m referring to the 300,000 to 400,000 excess deaths not formally attributed to the virus.

From March 2020 to February 2022 there may have been as many as 1,134,364 excess deaths in the United States, according to Boston University demographer and sociologist Andrew Stokes and his team. Most extra deaths have been attributed to Covid-19, but in a study recently published as a preprint, Stokes notes that more than 268,000 of them were not counted as Covid fatalities. Most of them are likely due to the virus, he says.

“Outside of medical settings, our death certifiers are often coroners who lack access to a patient’s history. They are not forensic pathologists. It’s hard for them to certify that a death is due to Covid.” In fact, he found, in certain areas of the Deep South, Covid deaths were under-reported by as much as 30 percent. This, Stokes says, “can help sustain the misinformation that Covid is not a real threat, that it’s just a cold.”

Similarly, an official tally by the Centers for Disease Control and Prevention found that more than 322,000 Americans have died over the past three years over and above the tsunami attributed to Covid.

In a recent New York Times essay, writer David Wallace-Wells aptly describes these deaths as “excess excess mortality,” an extra layer of mortality that shadows American life. “The gap between Covid-19 mortality and overall excess mortality has proved remarkably, and mystifyingly, persistent,” wrote Wallace-Wells, who, like Stokes, suggests these deaths may actually be Covid deaths.

These deaths are tucked away inside our new, official narrative of back to normal. But they haunt American life all the same, deepening our rifts, driving conspiracy theories, forcing a constant undertow of cognitive dissonance, and cementing an ever-growing distrust in public health.

“You don’t manage the truth. You tell the truth,” wrote historian John Barry in the latest afterword to his influential book on the Spanish flu, The Great Influenza: The Story of the Deadliest Pandemic in History. Barry spent seven years working on that book and says this is the single most important lesson he takes from the 1918 pandemic. He contends that only by telling the truth can our public health officials keep the public’s trust so that they follow recommendations.

Telling the truth can be challenging because often it’s complex or evolves over time. Take, for instance, the view of vaccines and boosters described by hematologist‒oncologist Vinay Prasad of the University of California at San Francisco and Louisville cardiologist John Mandrola in their recent piece, The Epidemic of #DiedSuddenly, published in The Free Press.

They contend that public health officials downplayed the risk of vaccine-induced myocarditis, a rare but serious inflammation of the heart muscle that is more common in young males. “Some experts cited studies that showed that the risk was very low—in the range of 1 in 100,000 vaccinated people." Such estimates were true, the authors wrote, but they noted that the studies hid a critical nuance: “Post-vaccine myocarditis occurs at much higher frequencies …in healthy young males.”

Their own study, published in the European Journal of Clinical Investigation, says the incidence, although still very low, is 30 times higher than in unvaccinated males without Covid. Now new studies have elucidated the likely mechanism—a study from Harvard showed that individuals with what the authors call “post-mRNA vaccine myocarditis” had high levels of circulating spike protein in their plasma.

The reality here is nuanced. The total numbers of post-vaccine myocarditis are still quite low, and lower than they are in people who were infected with Covid without vaccination. But the risks are real and have generally been downplayed or ignored by public-facing organizations like the CDC, which has failed to change messaging as information has evolved.

The complexity of the pandemic, as it has rolled in waves over the world, is daunting—and it’s often difficult to know which truth is correct. Here are ‘truths’ we know now, each backed by research, which seem to contradict each other or to demand a degree of precision and fine-tuning that is overwhelming:

• The pandemic is over. Infections, hospitalizations, and deaths due to Covid are decreasing, and in that sense, what was a pandemic may now be endemic. William Hanage, an epidemiologist at the Harvard T. H. Chan School of Public Health, told NPR’s Florida affiliate, WUSF: “It’s beyond question that society has moved into a stage where the pandemic is, for most of us, if not over then certainly quiet.”
• The pandemic is not over. As of January 16, 2023, 15 percent of adult Americans reported having had long Covid symptoms, and 6 percent reported current symptoms. That’s nearly 20 million Americans suffering from long Covid right now. As science writer Ryan Pryor put it in an essay for OpenMind: “We are living through a mass disabling event not unlike what occurred in the aftermath of polio or HIV.” As I write this today, I see former senator Jim Inhofe admitting he retired due to long Covid and alleging that five or six other elected representatives in Congress “have long Covid, but I’m the only one who admits it.”
• Repeat infections are often milder because of an individual’s wall of immunity.
• At the same time, repeat infections can be more severe and lead to long Covid or other complications, as well as a higher risk of dying.

The fact is, we can know the ultimate long-term consequences of Covid infection only with the passage of years. Many viruses have eventually been linked to common diseases. (One of the most common viral infections, Epstein‒Barr, for instance, has been linked to increased likelihood of mononucleosis. It has also now been linked to increased likelihood of multiple sclerosis.) SARS-Cov-2 likely will leave its fingerprints on the public’s health in unexpected ways over the coming years.

In an interview, Washington University’s Ziyad Al-Aly, director of the Clinical Epidemiology Center and chief of research and development at the Veterans Affairs St. Louis Health Care System, told me that Covid infection should be viewed as a risk factor for long-term heart disease—similar to high blood pressure and high cholesterol. “People need to start realizing this is a real connection and it can affect anyone across the life span,” he says. We’re going to have to prepare for higher rates of cardiovascular problems in the years to come across America, Al-Aly adds.

The most disturbing reports involve sudden death of the young, leading to the hashtag #DiedSuddenly in late 2022, along with the release of a documentary by that name. The film, which blamed vaccines for sudden deaths, made many wild and outrageous accusations and was mostly debunked, but the hashtag proved immensely popular on social media. Many accounts to this day link to deaths and illnesses of young people, with the assumption they are due to vaccines.

I don’t think that kind of “read the news and assume” forensics is supportable, but emerging research may ultimately shed some light. We know that even mild Covid infections can lead to strokes in young people. We now have research from the Smidt Heart Institute at Cedars‒Sinai Medical Center showing that younger adults (age 25‒44) are more likely to die of a heart attack after a Covid infection.

From March 2020 to March 2022 there were 90,160 more cardiovascular deaths than expected, in the United States; of note, two large peaks of excess cardiovascular mortality were observed during Spring 2020 and Summer and Fall 2021, coinciding with two peaks of COVID-19 deaths in the U.S. Even children have been swept up. According to the Journal of the American Medical Association, Covid ranks fifth in disease-related mortality and first among respiratory ailments in U.S. children through age 19; the virus accounts for 2% of childhood deaths, overall.

And death directly from Covid may not account for all the Covid excess. A study from researchers at Princeton, Yale, and the New York City Department of Health and Mental Hygiene, among other institutions, seeks to get to the bottom of it. While the researchers write that most excess deaths they studied were due to Covid infection itself, secondary causes were important, too: Covid appeared to increase the risk of death from Alzheimer's, diabetes, heart disease, and cerebrovascular disease, among others. An "undetected contribution of SARS-CoV-2 infection on mortality from chronic conditions ... has not fully disappeared after 2 years of ...circulation and a large vaccination program," the scientists warn, but add these statistics do not prove causation. For that, we need more research up the road.

When it comes to an increase in overall mortality, the U.S., though reporting a higher death rate than many other nations, is hardly alone. According to another article in JAMA, mortality from Covid ranged from 112 per 100,000 in the U.S. to 65 per 100,000 in Austria to as little as 3.7 per 100,000 in New Zealand. The study also reported significantly more deaths in the least vaccinated U.S. states than in the most vaccinated ones (even though highly vaccinated areas of the United States had more mortality than any companion nation the researchers described in their report).

Yet callouts against vaccines for Covid are surfacing as well. In a 2022 article in Scientific Reports, MIT professor Retsef Levi and colleagues reported that emergency calls for cardiac arrest and acute coronary syndrome were 25 percent higher than usual among Israelis aged 16‒39 from January to May 2021, during the third Covid-19 wave in Israel—and the country’s vaccine rollout. To the authors, the data “raise concerns regarding vaccine-induced undetected severe cardiovascular side-effects and underscore the already established causal relationship between vaccines and myocarditis.”

There has been pushback against the publication, with critics questioning its methodologies and noting that Levi is a mathematician, not an epidemiologist. And a small German study looked at autopsies performed on 25 individuals who died unexpectedly at home within 20 days of vaccination. Five may have had lethal, vaccination-associated myocarditis, according to the authors. They note that their data is descriptive, not definitive, and limited by the relatively small cohort size. This study has been questioned as well, especially since new data find that vaccination reduces risk of major cardiovascular events after a bout of Covid-19.

A new study in Nature Communications finds an increase in cardiac death in women in the U.K., after a first dose of non mRNA vaccines. The New York Times, reporting on the study, notes that the vaccine in question, made by AstraZeneca, had already been withdrawn for use for young people under 30 in April 2021, citing the risk back then of rare but dangerous blood clots.

In the end we are left with contradictions and turmoil regarding the cause of the current surge of deaths. With so many points and counterpoints, all the studies and critiques, we are left to weigh the risks ourselves. That task is almost impossible to do well. And without honest acknowledgment and guidance from stewards of public health, without an admission that data are still evolving, everybody will have their own purchase on the truth.

We do know this: Life is much better than it was in 2020. Vaccines and natural immunity have slashed hospitalizations and deaths. But reports of vaccine injuries still go largely unacknowledged. It is only recently that natural immunity has been openly embraced. In the wake of Covid, the increase in all-cause mortality, like Edgar Allen Poe’s purloined letter, is still hidden in plain sight. Not surprisingly, society seems to be separating, like the wake of water behind a ship, into those who have entirely moved on from Covid and those who are still cautious.

A recent article in Time magazine, penned by epidemiologist Steven Phillips, was headlined “The Covid-19 Pandemic Will Be Over When Americans Think It Is.” The article urged public policy that would help the one-third of Americans who are still being cautious to join the herd and get exposed, perhaps multiple times. “A recent national poll demonstrates a strikingly divided public, not ready to make peace with the virus,” the author wrote. “While nearly half say that they have returned to their pre-Covid life, one-third still believe this is more than a year away or never.”

The Time author concluded that “new courageous ‘accept exposure’ policies, public education and behavior change strategies are needed to capture the benefits of the new paradigm.” Not surprisingly, some individuals were appalled. “They can absolutely go fuck themselves until the end of time,” tweeted one long Covid sufferer.

The desire to move on isn’t new, says John Barry. Take Spanish flu. There were four waves. And the fourth wave, he says, “was actually deadlier in some cities than even the second wave. But nobody did anything about it. They were just tired.” People are so tired of Covid right now that many resist even completely logical, obvious health fixes like better indoor filtration and ventilation.

Part of the problem may be a crisis in public health policy and thinking itself. “Our existing public health leaders are primarily clinical thinkers, lab scientists, medical doctors,” points out Eric Reinhart, an anthropologist of law and public health and a physician at Northwestern University. “They don’t look at society as a whole or tend to examine the structurally determined factors—that is, the policy choices—that render us vulnerable to disease.” That may be why CDC Director Rochelle Walensky guided America to the “you do you” phase of the pandemic, in which those at higher risk were advised to have a private conversation with their doctor on how to manage their lives.

Reinhart says thinking like a clinician inevitably undermines a collective response that should be focused on policy shifts to facilitate behavioral changes rather than individual behavior and choices made in isolation. In fact, we have been in a public health crisis for decades, he says. “Tens of thousands die every year because they can’t afford access to health care. Is that a crisis? We have a massive population that’s unhoused. Is that a crisis? We have a fatal overdose epidemic that is 20 times the global average. Isn’t that an emergency and a crisis?”

The mismanagement of public health messaging around the Covid-19 crisis has left us with lasting damage and a profound loss of trust in those whom we normally trust to guide us. Many now associate the pandemic with blunt-tool mandates that seemed to align public health with loss of freedom. There is a new wave of anti-vaccine sentiment. Those who are trying to look at our “excess excess” mortality straight on are at odds with those who want the entire nation to “make peace” with the virus right now. Individuals suffering from long Covid and ruined lives feel left behind, or ashamed, as do those who are immune-compromised. Masks—even when necessary for those at high risk—have been compared to diapers, and Walensky herself has called them a “scarlet letter.”

No wonder #DiedSuddenly is a popular hashtag. Something deeper is dying, and we know it.