One question I have is how many of these excess deaths is due to coronavirus and how many are due to our response to coronavirus since people are not getting their regular health care. For example, my dad has congestive heart failure and sees his doctor once a month and gets an EKG every time. I've been in appointments and the majority of the discussion centers around changes in his EKGs from the previous months. Right now, he's not getting these regular checkups and appointments. He could have a change in prognosis go undetected and end up with a preventable heart attack.

Is coronavirus the black swan event or is our reaction to coronavirus the black swan event. It's hard to say.

Looking at all cause mortality excess deaths between Sweden and lockdown countries, it's hard to say:

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

One question I'm also curious about is if in the years following the coronavirus, will we see negative excess deaths relative to previous seasonal averages because of the excess deaths right now.

People are huddling inside in fear of Covid-19. How many of these excess deaths are caused by fright and the stress thereof?

"Can You Die from Fear? The Baskerville Effect"

https://www.drmirkin.com/histories-and-mysteries/the-baskerv...

And there's an opposite effect. Way fewer people are dying or being hurt by car crashes. Normally one of the leading causes of death in the "prime of life" age range. And even more weird, deaths and injuries for young people are way down as impulsive risk taking and peacocking are reigned in. So weird all the indirect effects.

> One question I have is how many of these excess deaths is due to coronavirus and how many are due to our response to coronavirus since people are not getting their regular health care.

I wouldn't personally know where to start on getting the data, but you can likely tease this out by evaluating populations with already limited access to healthcare - uninsured, low-income folks with $13k deductibles, etc.

Have you considered getting your dad an Apple Watch, so he can do his EKGs at home and send to a doc? Not as effective as a twelve-lead, but maybe it'd help at least somewhat?

I've been looking at the KardiaMobile but the reviews on Amazon look pretty bad. How well does the Apple Watch perform since it's just on a wrist?

I honestly don't have the information to answer that.

I do know the single-lead EKG has some limitations, but they may not be relevant to your dad's particular scenario. Worth a conversation with the doctor, I suspect.

Yeah the real tricky thing is how well they do. We originally thought he had bradycardia because his heart rate as measured by his heart pressure cuff showed it in the high 30s. However once he got an EKG, it became clear that his heart rate was normal but he was afib and all the irregularity wasn't being picked up properly by the BP cuff monitor. I'm guessing that something like the apple watch is accurate enough to inform someone previously healthy that something is now wrong, but wouldn't be accurate enough to tell someone who is unhealthy if their condition is worsening.

The Apple Watch's EKG is definitely good enough for diagnosing bradycardia - you can see very clear QRS complexes showing up on it.

(I would not necessarily trust the 24/7 LED-based rate monitoring.)

Yeah, but brachycardia wasn't the problem and that's easy to diagnose. What I want to know is if it is good enough to know that it wasn't actually brachycardia but was instead afibrillation with weak parts of the cardiac cycle.

Yeah, its quite amazing how poor our data is. Combine that with how politicized the issue is and I don't think we will ever have reliable numbers.

In the UK about half the excess deaths don't mention COVID at all on the death certificate.

Of those that do, a very high proportion are extremely old, i.e. they died with the disease rather than of it.

If you take that into account the lockdown kills far more healthy people than COVID.

Germany is in lockdown and seeing no excess deaths (covid or otherwise). The whole of Italy is in lockdown, but areas badly affected by covid are seeing much more more unexplained excess death than other less affected areas.

It seems to me that lock-down is very unlikely to be the thing that is killing people.

Germans haven't been told repeatedly they have a patriotic duty to avoid hospitals to save their national treasure.

The British numbers are public and speak for themselves. ER attendance halved. Cardiac patients halved. People stopped going to hospitals when they needed to - luckily Germany avoided socialised healthcare and hospitals are just seen as normal companies.

As for Italy, there have been similar problems there with elderly homes in particular and hospitals struggling with staffing sure to lockdowns and isolation.

Ultimately this is the same virus everywhere. It doesn't look like it though. So differences in national performances are telling us a lot of important things about how governments have reacted.

Where are you getting your UK stats from please?

> These numbers undermine the notion that many people who have died from the virus may soon have died anyway.

This is known as mortality displacement or the harvesting effect. We won't actually know whether this was a significant factor until we see future all-cause mortality statistics.

I think by "soon" I think he meant a few days but I don't know that anyone is making that claim.

> These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than the peak of a bad flu season. In New York City, the number has spiked to six times the normal amount.

I'm betting that in the next few years the death rate will drastically fall because the only people left will be really healthy.

Except that people who survive severe illness with Covid-19 often seem to suffer severe organ damage as a result. Mortality among Covid survivors is therefore likely to be higher than normal in the coming years, so it’s unclear how the numbers will pan out.

If it is killing people a couple of years earlier than they otherwise would have died, it is fair to consider them excess deaths.

Are you counting more than one death per person?

I will take that bet! I'd say that "drastically" means 20% or more. How much would you like to wager?

> I'm betting that in the next few years the death rate will drastically fall because the only people left will be really healthy.

If everybody died this year, then next year's death rate will be zero! That's not a good thing.

If you are old or infirm when you contract a bad case of corona, you die.

If you are relatively young and completely healthy, you spend a month in the hospital; get onto a ventilator for weeks requiring heavy sedation; lose your ability to walk, talk, feed yourself and brush your teeth; have to relearn how to swallow; maybe suffer a collapsed lung and upon release if you're lucky are confined to a wheelchair and physical therapy unable to take care of yourself, your loved ones, and return to your job.

Death is not the only negative outcome of this disease. "Recovery" from corona is sometimes the beginning of a long and slow struggle. I'm looking forward to any analysis on the economic cost of this.

The number of young people that are healthy (no pre-existing conditions like being overweight, diabetes or high blood pressure) that that experience what you describe is extremely rare.

> no pre-existing conditions like being overweight, diabetes or high blood pressure

Well over half the country ticks one of those boxes.

70% of Americans are either obese or overweight.

The coronavirus is going to with us for a long time; we're unlikely to get a miracle cure or effective vaccine anytime soon. On average American adults are about 27lbs (12kg) above their healthy weight. That means if they start losing weight now at a safe, sustainable rate then most people can be down to a healthy weight in a year or so.

Obviously there is a huge amount of individual variation but most people can take steps to improve their individual odds of survival.

If you are relatively young and completely healthy ... you overwhelmingly recover completely fine.

You've selected anecdotes from two very specific places. But that cuts both ways. There are plenty of places where so far they have been equally or less affected than a flu season.

For instance the UK is doing worse than most other countries in Europe but currently there are quite a few years within my life with similar death numbers by this point in the year: http://inproportion2.talkigy.com/

Or look at the graphs for Europe: https://www.euromomo.eu/graphs-and-maps/

There are some countries where it's higher than the flu seasons in the past 4 years. But there are other countries where it's equal or lower.

Overall weekly mortality in the EuroMOMO reporting countries peaked at approx 2x that of 2016, approx 20k deaths per week more. Given the large populations of these countries this is a tiny change. To put that in perspective 20k people is 0.03% of the British population alone, but you'd also need to include all the other countries to get the real percentage.