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Beyond coronavirus, what’s causing nearly 10% spike in deaths in LA County?

Deaths from all causes have spiked nearly 10 percent this year over what would normally be expected, according to a detailed analysis of provisional mortality data through mid-May by the Los Angeles County Department of Public Health.

That equates to 2,528 more lives lost than in years past — but just two-thirds of that spike can be officially attributed to COVID-19. Confirmed coronavirus deaths in the county were about 1,800 as of mid-May.

So what accounts for those hundreds of extra deaths?

“One possibility is that we missed some COVID deaths, particularly early on, where there was very limited testing. Pneumonia or acute respiratory distress may have been listed as the cause of death,” said Paul Simon, chief science officer with the Los Angeles County Department of Public Health.

“Another possibility is that persons with serious medical conditions such as heart disease and diabetes may have avoided medical care because of fear about COVID.”

A discarded surgical mask in the parking lot at Beverly Hospital during the Coronavirus Pandemic in Montebello on Friday, April 10, 2020. (Photo by Keith Birmingham, Pasadena Star-News/ SCNG)

L.A.’s sophisticated analysis — which has yet to be emulated by Orange, Riverside or San Bernardino counties — accounts for population changes over the years and is an ongoing attempt to answer these questions, even as the pandemic continues to unfold.

A similar analysis in New York City found much greater carnage — 24,172 more deaths than would have been expected. Fewer than 19,000 of those were directly attributed to COVID-19, leaving the Big Apple with more than 5,000 phantom deaths.

The Southern California News Group is working on its own excess mortality analysis for Orange, Riverside and San Bernardino counties.

Phantom deaths

In Los Angeles County, officials averaged the number of deaths per week for the previous three years — 2017, 2018 and 2019 — and then plotted that average against deaths per week in 2020.

They also broke out six major causes of death — pneumonia and influenza-like illnesses, circulatory, respiratory, COVID-19, homicide and suicide — to see how they stacked up to past years.

Examining provisional data from January through mid-May, they found:

  • 50 more deaths attributed to pneumonia and flu-like illnesses than would otherwise be expected.
  • 14 more deaths from circulatory issues.
  • 17 more deaths from respiratory issues.

COVID-19 officially killed 1,793 people as of May 16 in L.A. County, a great deal more than died of pneumonia and the flu. But it doesn’t account for the rise in total mortality.

A small number of deaths may have been labeled as pneumonia or flu when they were actually COVID-19, “but we may never know,” Simon said. “That could have contributed some to the excess mortality, but not all of it.”

In a perhaps surprising twist, there were 77 fewer suicides this year — a 23 percent drop over the previous years; and homicides ticked down by seven. But by mid-May, California was less than two months into its stay-at-home orders.

“The mental health effects may become more marked the longer we’re in this,” Simon said. “In a crisis, people have a fight-or-flight response — they’re engaged. Later comes despair and depression. As time goes on, more people may be seeking services.”

L.A. County is regularly updating its analysis. It takes time, though, for deaths to be recorded, so the analysis lags a bit to avoid using incomplete data.

The figures used in the county’s analysis are drawn from the California Electronic Death Registration System, which differ slightly from the totals reported daily by the L.A. County Department of Public Health.

Reason to worry

While Los Angeles is California’s hotbed of coronavirus infection, it hasn’t suffered the ravages of New York City. While total deaths in L.A. climbed 9.8 percent, they quadrupled in New York.

Public health officials there said thousands of excess deaths might be attributed not directly to the virus, but to its impact on the health-care system and city services. Hospitals in New York were flooded with more patients than they could handle — something that hasn’t been a major issue in California so far.

“Our system was not overwhelmed as theirs was, so hopefully there were not as many preventable deaths,” Simon said. “California had a relatively early stay-at-home order, too, which was probably very important. And we’re just not as densely populated as the big cities on the East Coast. Being spread out is not good for public health in many ways, but for preventing communicable diseases, it is.”

But as public life resumes, Simon worries.

“Less than 10 percent of the population has antibodies to the virus, which means that 90 percent or more remain susceptible,” he said. “If we open up too quickly and see lots of spread, these death numbers could go up very quickly. It’s important to move in a very deliberate way.”

Source: Orange County Register

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