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A data analysis conducted by the Centers for Disease Control and Prevention found the Covid-19 pandemic is linked to a rise in deaths from all causes.
About 360 “excess deaths” reported in Vermont during the last five months of 2021 reflect the added burden of the pandemic on the health care system as well as the rise in mental health conditions, substance misuse and deaths from delayed care, according to researchers.
The state reported 220 deaths from Covid-19 during that time period, meaning some 140 were likely from other causes.
“The combination of … shipping resources to Covid, which means shifting resources away from preventive care services, and the combination of mental health and lack of mental health resources, really creates a really dire state for Vermont,” said Jennifer Laurent, a researcher from the University of Vermont.
Laurent’s recent research shows that in summer 2021, many Vermonters reported higher rates of mental health issues, substance use, food insecurity, weight gain and chronic health issues.
“Many of those are comorbidities that are associated with worse outcomes with Covid,” she said.
The mental health crisis coincided with a surge in hospital demand, putting pressure on the health care system that may have led to even worse outcomes for patients.
How to find the death toll of a pandemic
The CDC reported that from August to December 2021, the number of fatalities was often far higher than expected based on data from previous years — totaling 363 excess deaths above the expected tally of about 2,600.
In total, Vermont reported 6,500 non-Covid deaths in 2021, the highest since at least 2017, according to the CDC analysis.
These findings are in line with the kind of impact a natural disaster or widespread pandemic can cause. Public health officials usually tabulate an initial death toll from death certificates that are available at the time. Then, months down the line, epidemiologists review the records to evaluate and compare death rates to the baseline of previous years.
CDC data showed that Covid-19 deaths cannot entirely explain the rise in deaths. Covid-19 deaths more than doubled at the same time, up to more than 40 a month by fall 2021. Even without these extra Covid-19 deaths, most of the weeks during the Delta surge still would have excess deaths over the threshold.
Some of the largest causes of death — heart disease, cancer and Alzheimer’s disease — were linked to more fatalities than average during the pandemic. The CDC does not release data on other categories such as accidental death.
Mark Hayward, a University of Texas-Austin professor who researches mortality data, cautioned that the precise number of deaths in a region can be uncertain, particularly for the most recent death data.
Could the deaths actually be Covid-19 deaths that were not recorded? Hayward said it’s a possibility, particularly for people who died outside of hospitals and were never tested for Covid-19.
But Elizabeth Burdock, Vermont’s chief medical examiner, said her office takes several measures to ensure they catch every Covid-19 death in the state, including flagging Covid-like illnesses on death certificates and performing post-mortem Covid-19 tests if there are any reasons to believe the decedent was infected.
“I wouldn't say we're testing them all. It's likely that some are missed,” she said. “But the vigilance is quite high, and the processes we have in place are pretty extensive.”
How are people dying?
Hayward said the data indicated that other causes of death were on the rise.
Some of the other deaths may be the result of delayed care from doctors’ offices and hospitals postponing nonessential procedures. For example, Propublica reported in 2021 that the nation was facing a crisis of undiagnosed cancers because of canceled or postponed cancer screenings.
At the same time, Laurent noted an increased demand for mental health services — “the waitlists are tremendous” — and an increased number of people who struggling to afford health care.
“What we see is that (emergency departments) and urgent care are really strongly affected by individuals who need care now, and then people put off care because they didn't want to go anywhere,” she said.
State officials said people seeking care for non-Covid-related conditions — such as mental health issues and delayed health issues — were responsible for crowded hospital rooms and intensive care units in late 2021.
That crisis continues. Earlier this week, the University of Vermont Medical Center’s emergency department had more than 20 adults and children waiting for inpatient beds at psychiatric facilities. That’s roughly half of the slots in the emergency department at the hospital, spokesperson Annie Mackin said.
That crowding, itself, may also have contributed to a rise in deaths.
“As hospitals fill, the quality of care patients get usually declines,” said Carri Chan, who studies hospital operations at Columbia University in New York City.
“People who need intensive care may be at a lower acuity bed, which could cause complications,” she said. “Intensive care units that fill up also mean that nurses and doctors have more of a chance of missing things.”
The medical examiner’s office is already seeing the effects of the change: Burdock said that the number of investigations her office performed increased 20% from 2019 to 2020, then even further in 2021, driven by a rise in unexpected deaths such as overdoses.
Laurent said the impact of delayed care now could resound for years.
“The chronic physiological reaction to all this stress and depression and anxiety really facilitates the onset of our chronic health conditions which we may not actually see for the next three, five, maybe even 10 years,” she said.
“Hindsight is going to really tell us how we've done in terms of our management of (pandemic) related health conditions,” she said. “Vermonters are a wonderful group of people, and they're supportive of each other, and we have great community resources, but I think we're just going to need a little bit more, especially for those that are underserved.”
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