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Month: April 2020

What are the effects of COVID-19 on mortality? Individual-level causes of death and population-level estimates of casual impact

Introduction How many people have died from COVID-19? What is the impact of COVID-19 on mortality in a population? Can we use excess mortality to estimate the effects of COVID-19? In this text I will explain why the answer to the first two questions need not be the same. That is, the sum of cases where COVID-19 has been determined to be the direct[1] cause of death need not be the same as the population-level estimate about the causal impact of COVID-19. When measurement of the individual-level causes of death is imperfect, using excess mortality (observed minus expected) to measure the impact of COVID-19 leads to an underestimate of the number of individual cases where COVID-19 has been the direct cause of death. Assumptions The major assumption on which the argument rests is that some of the people who have died from COVID-19 would have died from other causes, within a specified relatively short time-frame (say, within the month). It seems very reasonable to assume that at least some of the victims of COVID-19 would have succumbed to other causes of death. This is especially easy to imagine given that COVID-19 kills disproportionally the very old and that the ultimate causes of death that it provokes – respiratory problems, lungs failure, etc. – are shared with other common diseases with high mortality among the older population, such as the flu. Defining individual and population-level causal effects With this crucial assumption in mind, we can construct the following simple table. Cell…