As if the 300,000 dead in the U.S. from COVID-19 weren’t horrific enough, consider how many more have died from the pandemic’s indirect effects. Evidence from the Centers for Disease Control suggests mortality is higher in 2020 than expected for reasons beyond coronavirus infections. Most of the excess deaths are health-related, but they extend as far as motor vehicle crashes.
A recent analysis based on the CDC data shows that 40,000 more Americans than expected died this year from diabetes, Alzheimer’s, high blood pressure and pneumonia. Some of these deaths may have been caused by the virus and just recorded improperly. But a large share may reflect the effect of people getting less health care. Non- COVID care has dropped as government mandates have prevented discretionary procedures and as patients have grown fearful of being infected at hospitals.
If the forgone care is having adverse health consequences, then it would be fair to consider them indirect costs of the pandemic. Evidence has long suggested that the U.S. health system suffers from substantial inefficiencies, so that the amount of care potentially could be reduced without worsening health outcomes. But the type of care that people are skipping during the pandemic may well not be the things that can be cut back without doing harm. The excess mortality unfortunately suggests there has been too little non- COVID care this year. More careful analysis is needed to sort out how much of the mortality is due to COVID itself as opposed to a reduction in other health care, but either way the pandemic is the culprit.
Perhaps most surprising are the motor vehicle death data. For decades, fatalities from accidents relative to distance driven have been falling sharply. Fifty years ago, the U.S. recorded 5.3 deaths per 100 million miles traveled. By 2019, that rate had fallen to less than 1.1. Multiple factors contributed to the decline — including a reduction in drunk driving, fewer teenage drivers, safer cars and increased seat belt use.(1)
In the second quarter of 2020, however, the motor vehicle fatality rate suddenly jumped to 1.4 per 100 million miles traveled.(2) The National Highway Traffic Safety Administration concluded that the increase from March to June 2020 has been due primarily to the effects of pandemic-related stay-at-home measures.
I have no idea how the NHTSA can already conclude that stay-at-home measures explain the mortality increase. Some background data would be helpful here, including whether the mix of miles driven shifted between cars and motorcycles. The motorcycle death rate is more than 20 times that for cars, so even modest changes in the share of vehicle miles attributed to each could cause noticeable movement in the overall numbers. But assuming the NHTSA had good reason for reaching its conclusion, it’s another illustration of the deadly indirect impact of the pandemic.
Taking all of this together, it seems quite likely that 2020 will be another year in which average U.S. life expectancy declines — perhaps by a significant amount. One estimate suggests COVID could lower life expectancy at birth by a full year, a huge effect. With additional deaths possible from forgone health care and perhaps from road accidents, the indirect costs of the pandemic become enormous. And the additional mortality is likely to fall mostly on African-Americans and Latino Americans, further exacerbating concerns about racial and socioeconomic gradients in life expectancy.
Over the next several years, President-elect Joe Biden’s administration will need to make a wide variety of investments in U.S. public health infrastructure. Once the pandemic is over, it will be possible to conduct a better accounting of its devastating direct and indirect mortality effects. But what we already know makes it abundantly clear that substantial investments to improve public health will be money well spent.
(1) Seat belt use exceeded 90% in 2019. Sam Peltzman of the University of Chicago suggested in the 1970s that increased seat belt usage did not reduce deaths, even though it made car occupants more likely to survive an accident, because drivers compensated by driving more dangerously, thereby having more accidents and also increasing pedestrian deaths. More recent research debunks this theory, however, showing that seat belt mandates have substantially reduced death rates.
(2) The absolute number of deaths in the second quarter of 2020 is estimated to be lower than in the same period of 2019, because miles driven fell by more than the increase in the death rate.
Peter R. Orszag is a Bloomberg Opinion columnist. He is the chief executive officer of financial advisory at Lazard. He was director of the Office of Management and Budget from 2009 to 2010, and director of the Congressional Budget Office from 2007 to 2008.
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