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The uncounted

January 3, 2022

While the tally of US Covid-19 deaths is near 825,000, there is good reason to suspect that the actual toll is significantly higher. Many deaths go poorly attributed:

The nation’s struggle with recording COVID-19 fatalities underscores a truism about death in the United States: Where people live and die has a lot to do with the accuracy of their death certificate. Some deaths are investigated with state-of-the-art technology and expertise. Others don’t go beyond a phone call from the family.

I suspect that happens some even in rich urban areas with relatively good processes for accounting the dead. When all three people in a household are found dead, that raises enough notice that the local coroner does autopsies and micrology tests. But when a lone and homeless alcoholic, with cirrhosis and few social ties, is found dead one morning on a sidewalk, how much effort is spent to determine whether they were suffering Covid-19 pneumonia? Or might some overworked examiner just attribute it to cardiac arrest, subsequent to exposure and long-term alcoholism?

Jean-Henri-Marlet-Morgue_de_ParisWe want our government institutions to accord people the same respect in death. We want good data. Like many things we want, there is only so much we’re willing to pay for it.

Well, we’ve made good progress since the Paris morgue in the 19th c. put unclaimed corpses on public display, so that those missing friends or family might walk by and find them. The morgue then became a popular tourist destination. See the contemporary engraving, right.

Those who are vaccinated seem to have lower all cause mortality excluding Covid-19 than those who are unvaccinated. (Cite.) That is not surprising. There are several plausible explanations.

  1. The Covid-19 deaths that are not identified: Those will show up more among the unvaccinated. The first article linke provides some explanation for the reduced other cause mortality. Some of that “other cause” is the same cause, misidentified.
  2. Unaccounted harm from the disease: Many diseases leave those who survive more likely to suffer other diseases following. A recent study finds some evidence of this for Covid-19. (Cite.) Similar research years past found that those who had the flu vaccine were less likely  to suffer cardiovascular events. There is a sense in which a vaccine for a disease provides a lens for measuring the long-term harm a disease does.
  3. Unaccounted benefit from the vaccine: There have been vaccines past that had health benefits other than prevention of the disease targeted. I don’t know any evidence that is the case for these vaccines.
  4. Demographic and behavioral differences between the vaccinated and unvaccinated: There are all sorts of ways these groups might differ, that would lead to different health outcomes independent of Covid-19 infection. Those kind of confounders are a reason clinical trials need to be randomized.

Of course, there is no way to determine which of these or other explanations are the case, except by doing studies designed to surface such effects. That reflects a common pattern in statistics. And more generally. Experiment or data that shows a result thereby excludes some alternatives, and favors others. At the same time, it reveals a new layer of uncertainty. Smaller in some sense than the previous. Still large enough to matter.

Update: Judy Melinek, a pathologist, argues that there could be quite a bit of unaccounted mortality from the disease, due to long-term harm.

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