Should we still be very afraid of dying of COVID-19? Mortality during the initial unvaccinated phase of the pandemic as well as during the more dangerous Delta wave was very real and concerning, especially for those who were older or unhealthy.
The World Health Organization (WHO) dashboard as of May 24 reported 6.28 million deaths worldwide, a horrible toll. The U.S. has suffered almost one million deaths, Europe just over 2 million, Brazil 666,000 and India with the world’s second largest population, only 524,000 deaths.
Skeptics point out that if the data is believable, about 99.7 per cent of the American population survived the pandemic so why the big fuss about vaccination and mask mandates? However, while most people did indeed survive, in 2021 U.S. pandemic related deaths were the third highest cause of mortality after cancer and cardiovascular disease.
Just as we try to digest this large total mortality, on May 5, the WHO reported that previous mortality calculations were a gross underestimate and that it is more likely that 15 million pandemic related deaths worldwide occurred in the two years between January 1, 2020 and December 31, 2021.
The WHO while an important organization that promotes worldwide health has been roundly criticized for being politicized and afraid of antagonizing China. How accurate is their estimate? The new mortality calculation is based on a complex 30 page statistical analysis of potential excess mortality, comparing historic baseline levels pre pandemic to actual deaths in the past two years. This analysis adds additional excess deaths primarily to countries that don’t have good reporting systems and thus remains speculative based on complex extrapolation from countries with better reporting. India has already argued that the major increase in WHO mortality rates assigned to it is inaccurate. Is it bad data or a political cover up?
Excess mortality is real even in countries with good reporting. It may be partly due to the strain on health care resulting in missed care as well as fear of visiting hospitals, causing higher rates of untreated and fatal heart attacks and advanced cancer. Those strongly opposing vaccination also claim that much of the excess mortality is due to the harmful effects of vaccines that go unreported. While there is little evidence for this claim, it is important to not dismiss that there are some risks not yet fully discovered. For example a recent Israeli report suggested more hospital visits for coronary events in people under 40 with a temporal link to vaccination. While cause and effect are not proven it requires careful surveillance.
Regardless of past mortality, the important message now is that COVID-19 related mortality is much lower. Over 11.6 billion vaccine doses have been administered worldwide providing ongoing high levels of protection from death despite waning antibody levels that no longer confer high levels of protection from infection. The Omicron variants are also less dangerous, further reducing mortality rates. Daily U.S. mortality is now about 10 per cent of the peak rate and stable.
It is now reasonable to remove vaccination and mask mandates in most circumstances other than health-care centres and high risk congregate facilities. The pandemic has created a wave of post traumatic stress with a persisting unreasonable fear of returning to a more normal life. Just as some politicians pretended the pandemic was simply the flu, others now want to maintain a high level of anxiety for political advantage.
Age and frailty were, and still are, key predictors of a worse outcome. Healthy children have had a low rate of disability or death throughout the pandemic. Their vaccination should remain voluntary.
The most important lesson is that being unhealthy conveyed the greatest risk for hospitalization and death throughout the pandemic. Tremendous resources have been focused on managing the pandemic without adequately acknowledging that we are simply not healthy enough. Most people have sedentary lifestyles, eat too much unhealthy food, are overweight with limited muscle mass and exercise infrequently.
The pandemic’s effects are hopefully continuing to wane. Yet, in the western world we continue to ignore our ongoing, and much higher risks of death due to poor nutrition, inadequate exercise, carcinogens in our food and air and a lack of focus on disease prevention. In poorer countries we accept the ravages of poverty, lack of clean water and the harmful effects of economic and social inequalities.
Every year we face millions of preventable deaths from these challenges — far more than from this pandemic. As individuals we may not be able to save the world by ourselves, but by improving our health and resilience we can protect both our present and our future. If we are to learn anything from this pandemic, the time to do so is now.