Excess Mortality From COVID-19: Are We Out of the Woods?

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In this video, Jeremy Faust, MD, editor-in-chief of MedPage Today, discusses his group’s recent manuscript analyzing excess mortality rates in Massachusetts during the spring of 2022.

The following is a transcript of his remarks:

Hello, it’s Jeremy Faust, editor-in-chief of MedPage Today. Thanks for joining us.

Today, I’d like to talk to you about a manuscript that my colleagues and I published recently. It’s about excess mortality, that is, not worrying about why anybody has died, but just counting the number of people who died in any given period of time and comparing that to the historical numbers of what should happen during that time period, because that really gives us a sense of where we are in the pandemic overall.

Early in the pandemic, we had these massive, massive spikes in excess mortality that, of course, paralleled completely COVID outbreaks. As time has gone on, we’ve seen that same story unfold over and over again.

But this spring in Massachusetts, where I work, we actually saw something different, and I wanted to share it. The name of this manuscript is: Uncoupling of all-cause excess mortality from COVID-19 cases in a highly vaccinated state.

Here’s what happened: we had Delta and we had not a lot of excess mortality early on, and then later in Massachusetts we did have excess mortality; then Omicron hit and we actually had tons. This idea that it was mild was really not correct because it was severe enough that it was tipping people over the edge, and we had genuine, huge all-cause mortality in the state up until the end of February. Then what happened in the spring, in March, April, May, and June, is we actually had another rise in cases. Despite that, despite over 225,000 cases and maybe more, we did not see an increase in mortality over what we would expect to see in a typical timeframe and in the exact same timeframe in prior years.

That is totally different from what we’ve seen in prior waves. Again, March, April, and May of 2020 was just terrible, the winter of 2021 was another terrible experience with excess mortality and the Delta and Omicron waves, all of these waves eventually led to excess mortality and we can really track that, but not this spring.

We think we understand a little bit as to why this is, and we also think we have an idea of the implications of this. I think one thing that matters greatly is that we failed in a sense — Omicron infected so many people. In another way, we succeeded. We actually boosted a lot of people and we had four doses in some higher-risk people in the spring.

So what you had in the spring of 2022 here in Massachusetts was a pretty immune cohort, a pretty protected cohort of people, so that they had a recent immune-generating experience either through Omicron or through a booster. So when they did get another infection, because we know that that protection against infection does wear off, when that did happen in the spring and people got infected, the outcomes weren’t as severe. They didn’t have to go to the hospital as often and there was not any excess mortality statistically. There might have been a little trend towards it, but even if that was statistically true, it’s just a fraction of what we saw in the previous waves. So there’s really that uncoupling between COVID cases and all-cause excess mortality.

Now, does that sound to you like, “Oh, great. The pandemic’s over”? It could, but here’s the problem: we think it’s very temporary, because we think basically this kind of immunity is not necessarily the immunity against COVID pneumonia and it’s not necessarily immunity against all severe outcomes. It’s basically how well does your body do once infected. So I think we have to watch this carefully.

What’s fascinating is that we did see an increase in hospitalizations this spring. So with those 225,000 cases, we did see hospitalizations, but we did not see excess mortality. What this implies to us is that the population was immune enough to not have excess mortality, but not so immune that they couldn’t have some untoward effect.

All to say, good news, but not, “Okay, we’re done. See you later.” I think what’s really interesting as well is that this happened in Massachusetts, a place where we had a lot of Omicron and a place where we had a lot of boosting going on both before and after the initial Omicron wave, especially in high-risk people.

So the question is, was there excess mortality in other states this spring? The problem is that we know some but not enough. Massachusetts is great. We have very, very fast reporting, so we know almost immediately what’s going on. In other states, it can lag weeks and weeks and even months. Sometimes you’re looking at data — even now in September, you’re looking at data from May and it’s not complete yet. We don’t know whether the fact that some states appeared not to have had excess mortality in May really didn’t have it, or they’re just lagging.

We don’t know that, but what we can say is there were a great number of states that had excess mortality this spring just as we did not in Massachusetts. In other words, they had cases, but they did have excess mortality. That tells me that those states had a less protected cohort in terms of the most severe outcome, which of course would be excess mortality.

I think that argues quite nicely for the idea that an immune cohort is protected against excess mortality, but at the same token, it’s probably temporary and it’s not the only thing that counts. I think this is a piece of good news in the context of “we’re not done yet.” And I think it’s a good example of policy on one hand succeeding, on one hand failing. Succeeding because this happened in a highly vaccinated state; failing because, even here, what probably got us to that sort of safer spring in terms of excess mortality was the fact that Omicron just swept through the state like it swept through everywhere else, leaving behind a little bit more of a protected cohort.

You can check out this article that we published. It’s in The Lancet Infectious Diseases. I also summarized this in my newsletter, Inside Medicine. As always, thank you for joining us here on MedPage Today.

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

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