A City, If You Can Keep It: Collateral damage – A deeper dive

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Since the week of June 27, the State of California has killed one person for every 1.67-4.7 people who died of COVID. This accounts for nearly all non-COVID deaths above the expected average nationwide. This column will be a bit drier than I would like, due to the nature of it, but I brought pictures!

Continuing where I left off with collateral damage (measuring non-COVID deaths per week in excess of the expected number), the next logical step in the discussion is to look at excess deaths in California. What I did not discuss last time is the trend of excess non-COVID deaths.

Figure 1
Courtesy image

Nationally non-COVID deaths peaked, came down below the highest expected amounts, came back up, and have gone down below the upper bound of the expected normal range (Figure 1). The graph is a bimodal distribution which at first glance appears to show two distinct waves of the pandemic in the US. But it should be considered two graphs squished together: one showing the handful of states that failed to flatten their curves, and one showing the approximately 47 states that were successful in their flattening.

In California we did not have that initial peak. We edged over the expected amount of non-COVID deaths for three weeks in April but because we were generally successful at flattening the curve (Figure 2) and protecting hospital capacity, our deaths slowly ramped up rather than spiking and crashing back down.

Figure 2
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Comparing successful versus unsuccessful flattening, we see New Jersey and New York City have sharp dramatic spikes of COVID and non-COVID deaths in April and the first week or two of May (Figure 3). In California, non-COVID excess deaths have been increasing since the week of June 27 (Figure 2).

When we exclude states and hot spots from the national case data, we can eliminate most non COVID death above the expected average in April by removing New Jersey and New York City. The same can be done for June 27 to present by removing California, Florida, and Texas (Figure 4) since they represent between 60-85 percent of the total excess deaths per week since June 27.

Figure 3
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OK, that was a lot of boring words to describe a few graphs. You’re probably thinking, “So what?” This is where we have to step back from the data, and look at what is going on in our country and state. Excess deaths in April in New Jersey and New York City are likely the result of neglect and lack of access to care. Lockdowns were harsh all over, but they had not gone on long enough to wear on the emotional wellbeing of people aside from those who were already in a fragile state. Hospitals were mostly closed to non-COVID patients, medical care was in short supply.

What about California’s current upward trend curve starting later and yet to peak? We are the only state that is

Figure 4
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still restricting indoor business operations to this extent, and most other states would be closed under our rules from what I’ve read. California has kept restrictions in place preventing businesses from opening longer than nearly all other states. Our rules have been completely changed multiples times, increasing uncertainty for all.

In the graph (Figure 2) you can see a dip in deaths at the end of August; this is likely due to a lag in reporting to the CDC since they report deaths that they have received a death certificate for. Data from the California Department of Public Health does not show a dip for that time period. We did start the Tier system around that date, so it is possible excess deaths decreased with a glimmer of hope. But based on how the CDC data has behaved so far, I suspect we will see the numbers increase in the coming weeks.

Common sense tells us at some point we will see diminishing returns with our response. I think that point was the week of June 27 for California. Collateral damage in measurable deaths began that week and has increased ever since. Last week, during the Yolo County Board of Supervisors meeting, Diane Sommers the Director of Suicide Prevention reported that 4,600 calls were made to the Suicide Prevention Hotline in the past six months. A 54 percent increase over last year. One thousand, six hundred more people contemplated suicide in Yolo County than the same time period last year.

As I write this, we have had 56 deaths and 189 hospitalizations from COVID in Yolo County, zero deaths and five Hospitalizations in Winters reported on the county dashboard. Anecdotally, I know a couple people who have had COVID. I also know more people who have killed themselves since March than I know who died of COVID. It is time to take a hard look at the question: “Is our solution causing more problems than it is solving?”

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