Counting population-wide excess deaths offers complementary perspectives, but exhibits considerable year-to-year variation. More importantly, differentiating between COVID-19 deaths and those due to harmful response measures is challenging.
Some of the deaths due to the measures taken happen acutely (e.g. due to people with acute myocardial infarction not coming to the hospital for care), but the majority may accrue over longer periods of time (Table 1). There is strong evidence on the adverse effects of unemployment, financial crises, depression, and social isolation on long-term morbidity and mortality, but caution is needed to extrapolate this evidence to the current situation which is unprecedented in terms of the acuteness and massive impact of the measures taken.
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Some projections have been made for these excess deaths and evidence is already accumulating for some of these excess death causes. Putting projections together, the excess deaths from the measures taken is likely to be much larger than the COVID-19 deaths, e.g. disruption of tuberculosis programs alone is expected to cause 1.4 million extra deaths over the next 5 years and the death toll from famine can be even more staggering. However, the exact impact of these major problems has very large uncertainty, and some projections may be exaggerated (as was the cause also for COVID-19 projections). Their excess death toll will likely depend on our ability to address these problems
early on and to avoid recurrent lockdowns and other draconian measures.
Some/many of the first 1 million recorded deaths were potentially due to errors and mismanagement that might be avoidable moving forward. E.g., some health care systems were caught unprepared; widely-used hydroxychloroquine may have increased mortality; and suboptimal mechanical ventilation management may have worsened outcomes. Some strategic choices, e.g. sending COVID-19 infected patients to nursing homes (in anticipation of predicted acute care bed shortages) probably caused many excess deaths and nosocomial infections contributed many deaths in some hard-hit locations like Lombardy. Hopefully, many of these problems can be avoided in the future. Some are more intractable than others, e.g. some health care systems may remain
malfunctional and lack resources. Conversely, some deaths may be averted with the wider future use of dexamethasone that decreases the risk of death in severe illness.