COVID-19: The forgotten victims

I’ve written previously about the massive public health impact of government responses to the pandemic:

Researchers are beginning to grapple with these consequences. A study just published in the BMJ systematically details the many public health effects of social distancing and lockdowns. The situation is illustrated by the infographic below.

A brief, thoughtful piece by John Mandrola, MD, reflects this reality as evidence mounts of the profound, lasting consequences of the lockdowns:

We Can’t Ignore the Harms of Social Distancing

“While uncertainty prevails, I worry that hard questions are being avoided. I will strive not to be tone-deaf, but in the same way we discuss prognosis with patients with cancer or heart failure, we must also address difficult questions concerning the COVID-19 crisis.

The social distancing policies are harming people—not potential harms, but real harms.

… A recent paper, in preprint form, suggests a substantial proportion of excess deaths observed in Scotland, the Netherlands, and New York during the current pandemic are not attributed to COVID-19 and may represent an excess of deaths due to other causes.

While the virus has been shown to harm minorities and the disadvantaged, it is also true that these same groups could be disproportionately harmed by our interventions. Shutting our clinics and reducing non-COVID care in hospitals threaten the poor more than the wealthy. Basic warfarin management in disadvantaged patients has been a huge challenge.

I don’t have an easy answer for societal inequities, but it does public intellectuals no favors to ignore the fact that decision-makers have the luxury of a job and the ability to work from home. Our public interventions have made the poor even poorer. Raj Chetty and coworkers have shown that lower wealth strongly associates with a shorter lifespan.”

The paper Mandrola mentions is available here. The researchers found that, contrary to media reporting, in places where excess deaths are observed, less than half are attributable to COVID-19.

“Of these deaths, only 43% in Scotland and England and Wales, 49% in the Netherlands and 30% in New York state were attributed to Covid-19 leaving a number of excess deaths not attributed to Covid-19. Conclusions: A substantial proportion of excess deaths observed during the current COVID-19 pandemic are not attributed to COVID-19 and may represent an excess of deaths due to other causes.”

In another piece on his blog, Mandrola discusses the shifting meaning of “flatten the curve,” and makes a point that seems little appreciated in public commentary during the pandemic: “Why can one safely critique a drug for COVID19 but not massive public health interventions?”