Excess deaths deep dive
In this video, Roger Seheult, MD of MedCram discusses what are possible explanations for the excess deaths that are being noted as of late. He discusses why deaths from COVID-19 officially are coming down, but yet excess deaths are still going up. The question is, what is causing these excess deaths?
Dr. Seheult has taken data from the website Our World in Data for the United States. He notes that the all ages death graph is similar to the chart for ages 75-84 and ages 85+ because those are the age groups that are primarily dying. The other charts note that for ages 0-14 we are at negative excess mortality and for ages 15-64 we are at zero excess mortality, but for the older ages 65+, there does appear to be an uptick in excess deaths.
Why are people dying?
People have thrown around the idea that recently many people that were susceptible to dying have died in the past 2 years so that there should be a so-called pause on excess deaths. Dr. Seheult uses the analogy of apples falling from the apple tree as an example. If a tree is shaken and the apples that were ready to fall off fall, then later there should be less apples falling. However, if the event that caused the original apples to fall also had an impact on the remaining apples that were not ready to fall, perhaps that event did something akin to speeding up time to fall or “ripening” them to fall earlier than they would otherwise. The question is did COVID-19 not only cause people to die that were susceptible, but did it also cause those who were healthy people to become sick. If this is an explanation then there should not be an expected decline in excess deaths.
What are excess deaths?
These excess deaths only refer to people having died and not from what they died of. These are deaths that happened and we are seeing it above the level that is expected compared to prior years. It is just the fact that there is a death certificate, so these numbers are difficult to fudge as it has nothing to do with what the physician puts on the death certificate as a cause of death itself.
Looking at the data from other countries such as the Netherlands and the United Kingdom, there is an increase in all age groups for mortality. So what are 3 potential explanations? Cancer, cardiovascular and vaccines.
Deep dive into cancer
First looking at cancer deaths during the pandemic, Dr. Seheult references an article by Dr. Cary Adams that showed an estimated 46.4% decline in the average number of newly diagnosed cases of six of the most common types of cancer (breast, colorectal, esophageal, gastric, lung and pancreas). This article wasn’t referring to decreased screening, it was referring to an actual decline in the diagnosed cases of cancer. If you look as to why we were diagnosing cancer less often, during the shutdown in the US in 2020 there was a decline in cancer screening volumes; however, after the shutdowns ended, people went back in to get their screenings, but it still did not match the drop that had happened with the original shutdown. Furthermore, there was a reduction in cancer screenings thereafter.
On a personal level,Dr. Seheult notes that he sees this in his clinic with people not wanting to come in to see a physician. Whether it’s related to being afraid of COVID-19 or just a generalized distrust of the medical system is unclear. However, what statistics are showing is that there is less screening currently ongoing and with less screening there has also been a drop in new cancer diagnosis. So the question is whether this is translating into actual mortality and the answer is yes. This paper was published with ASCO the American College of Clinical Oncology and it found that compared to 2019 cancer-related mortality was lower from March to Dec 2020 in medical facilities, hospice facilities and nursing homes or long term care settings but higher in decedents homes. One thing that should be mentioned is that in Dr. Seheult’s medical setting, there was a tremendous effort made to get patients into clinics to see their physicians mostly because there was a financial incentive by the government to make sure the patient’s were getting their screening as part of their reimbursement which is based on HCC codes and diagnosis. This can lead to greater Medicare reimbursements. This is unique to the U.S. In other countries during the shutdown, the UK had an 80% decline in referral for suspected cancer and New Zealand had a 40% decline. In this article about the impact of the pandemic on cancer services in the UK, they looked at different hospitals in the U.K. and what was the 2 week wait for cancer services and on chemotherapy. In 2020, there was an unexpected drop in the two week wait time that was seen across multiple hospitals and a similar drop was also seen with less chemotherapy agents being administered either due to not getting chemotherapy or not having a diagnosis that warrants getting chemotherapy. If you are not making a diagnosis and/or those that have the diagnosis are not getting chemotherapy you will expect a disturbance in the number of deaths from cancer as one explanation.
From the Lancet review, Peru also noted there was a detrimental impact on its cancer mortality so this phenomena appears to be global and not just local including Netherlands, Belgium, and UK.
Dr. Seheult also notes that countries in the Northern Hemisphere currently are having an increase in excess deaths from all causes and it should be noted that normally towards the winter months there is typically a rise in deaths. When you look at major countries in the Southern Hemisphere which are currently experiencing its longest days there has been a decrease in excess mortality.
Deep dive into cardiovascular disease
Switching gears to cardiovascular disease, it is important to know there is a baseline of deaths which in itself is interesting. Looking at the graph in the video, it shows that at the end of every year in the Northern Hemisphere, that is when you see the highest amount of mortality. The excess deaths are on top of that but from the graphs in his video you can clearly see that the most amount of deaths that are seen are at the end of the year and beginning of the year ie the winter months, and the majority of them are due to heart disease and cancer. Going back to the apple tree analysis, the question is whether this is now not a tree-shaking phenomenon but rather a ripening acceleration so that those apples that were ready to fall fell but the other apples that were not ready to fall became more ready to fall. If this is the case then we would not expect to see a negative excess mortality.
In this article by Nature, it shows that over the next 12 months after even a mild infection with COVID-19, there was an increased risk in all cardiovascular diseases such as stroke, TIA, atrial fibrillation, sinus tachycardia, pericarditis, myocardial infarction, cardiac arrests, acute coronary disease, ischemic cardiomyopathy, heart failure, deep vein thrombosis. pulmonary embolism. This study involved 11.6 million subjects that involved controls and those that had a COVID-19 infection. Cardiovascular deaths are the most common cause of death in the U.S. An easy way to pick up some of these diseases is via an EKG. MedCram does have an EKG course. But why would the countries in the northern hemisphere be having an increase in deaths as COVID-19 deaths are declining? Is it possible that COVID-19 caused a number of people that would normally have not had cardiovascular disease to now have cardiovascular disease and now be more susceptible to dying especially in the winter months. There was a study done on association of outdoor temperature, sunlight and cardiometabolic traits in two European cohorts. They found that when they drew blood tests on patients they found that the more sunlight available in the days prior to the blood draw the better their measures of glucose and lipid metabolism were. Is it possible that the proportion of individuals that have cardiovascular disease has now increased? Per Dr. Seheult, this may indeed be a possibility especially in light of what we know about COVID-19 and its effects on the human body.
Deep dive into vaccines
A third possibility for excess deaths to consider is vaccines. If we look at the U.S. what has happened, we can see in the graph that is shown in the video that during the first wave of COVID-19 infections we were having 200-300000 cases a day. If you view the graphs as a dose-response curve, you can see there is a response part of the curve with an excess mortality curve which is delayed by about 2 weeks. You can see a bump correlating with each of the bumps in the first wave. In the Delta wave, there is also a bump again a few weeks later.
The Omicron wave was much larger than the Delta wave, but for both waves they had about the same amount of excess mortality during that time frame which may have been related to the reduced mortality associated with Omicron infections. When looking at the daily vaccine doses, the date where the most people were vaccinated in a day was approximately 3.5 million. Looking at the excess mortality graph following these vaccinations, we would expect a rise in excess deaths if the vaccine were contributing to excess deaths acutely; however, we are not seeing this in the excess mortality graphs at least for acute deaths from the vaccine. It could be that vaccines are causing a slow increase in mortality over time and that has yet to manifest itself. At least for now, excess deaths in the U.S. are coming down so this has yet to manifest itself.
Looking at a graph from the SOA Research Institute, it showed that after Omicron the advantage people who were vaccinated had compared to unvaccinated individuals went away because most likely Omicron was extremely infectious and as it not have as high of a mortality, it caused those unvaccinated individuals to develop immunity. If the vaccines were now causing deaths, we would expect that individuals who were vaccinated would now be having increased deaths compared to those who were not and the graph is not showing this at this time.
To round out the discussion, it should be noted that that external causes of deaths in ages 15 to 34, excess deaths were starting to go up before the pandemic even occurred. This was attributed to accidents, suicides, homicides even prior to the pandemic.
So what does this mean?
These are the best theories we have based on the current data, and it must be noted that if the data changes then the theories would likewise need to be adjusted.
LINKS / REFERENCES:
Search Open Payments (Open Payments) | https://openpaymentsdata.cms.gov
Why are we not Talking About Cancer Deaths due to COVID-19? (Onco’Zine) | https://www.oncozine.com/why-are-we-n…
Missed cancer screenings from COVID flash a warning to US life expectancy (Munich RE) | https://www.munichre.com/us-life/en/p…
Changes in cancer-related mortality during the COVID-19 pandemic in the United States (ASCO) | https://meetings.asco.org/abstracts-p…
Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study (BMJ) | https://bmjopen.bmj.com/content/10/11…
Excess mortality in patients with cancer during the COVID-19 pandemic in Peru: an analysis of death registry data (Lancet) | https://www.thelancet.com/journals/la…
The Netherlands has one of the highest cancer rates in Europe (Expat) | https://www.iamexpat.nl/expat-info/du…
Debunking the False Claim That COVID Death Counts Are Inflated (Scientific American) | https://www.scientificamerican.com/ar…
Long-term cardiovascular outcomes of COVID-19 (Nature) | https://www.nature.com/articles/s4159…
Associations of Outdoor Temperature, Bright Sunlight, and Cardiometabolic Traits in Two European Population-Based Cohorts (JCEM) | https://academic.oup.com/jcem/article…
A geographical approach to the development of hypotheses relating to Covid-19 death rates (Melatonin Research) | https://www.melatonin-research.net/in…
Group Life COVID-19 Mortality Survey Report (SOA) | https://www.soa.org/4a368a/globalasse…
More Young Americans Are Dying, But Not From Vaccines (Bloomberg) | https://www.bloomberg.com/opinion/art…
All coronavirus updates are at MedCram.com (including more discussion on delta variant covid, COVID Delta, COVID children, natural immunity COVID 19, and more).
MedCram Update 46: https://youtu.be/EFRwnhfWXxo
MedCram Update 47: https://youtu.be/H1LHgyfPPQ8
MedCram Update 132: https://youtu.be/9OZZ6_M4OB0