The coronavirus pandemic in Louisiana has marked some of the deadliest months on record for the state. From March 1 to August 1, about 24,000 people died, a 27% increase compared to the same five-month span in at least the last six years, according to a new study analyzing deaths during the pandemic.
Those cases are what scientists call excess deaths — the gap between reported deaths and expected deaths. The loss of life reflects the true toll of the virus, which impacts far greater numbers than those who die after a COVID-19 infection.
In the past seven months, Louisiana hospitals have had to meet countless challenges as the coronavirus strained their staff and hospital capacity.
Louisiana’s increase is higher than the U.S. average, which was 20%, according to the analysis, published in the peer-reviewed Journal of the American Medical Association. Of all states, Louisiana ranked fourth for its per capita rate of excess deaths, behind only New York, New Jersey and Massachusetts.
According to the study, three-fourths of Louisiana’s excess deaths are attributed to coronavirus. But about 25%, or 1,232 people, are unaccounted for by COVID-19 infection.
“For every three people known to have died of COVID-19 in Louisiana, another person died due to some aspect of the pandemic,” said Dr. Stephen Woolf, study author and epidemiologist at Virginia Commonwealth University.
Within that 25% there are two groups of people. Some of those people were infected, but their death certificate didn’t mention it — possibly because they died at home or it wasn’t confirmed in a laboratory before or after death.
The second group is made up of people who were not infected but died because of the disruption to health care the pandemic caused.
“There are people dying of heart disease, strokes, diabetes and so forth because of interruptions in their care,” said Woolf.
In Louisiana, deaths from Alzheimer’s disease and dementia doubled. There were 64 such deaths in the first week of 2020, but 127 in the week ending April 11 during the peak of the virus. Diabetes deaths also increased significantly, Woolf said.
Those interruptions are driven both by fear of seeking care during the pandemic and a strapped medical system, he said.
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“My sense is that these deaths that are caused by disruptions are occurring more during surges when the system is being overwhelmed,” said Woolf. “In calmer times, people come out for appointments and the health system has the capacity to deal with them. When hospitals are getting overrun and emergency room patients are in hallways because there’s no room for them, that’s an environment where we worry about these kinds of deaths occurring more often.”
The findings of the report match up with what the state has reported and what doctors are seeing in hospitals, said Dr. Rebekah Gee, CEO of LSU Healthcare Services Division and former Secretary of the Louisiana Department of Health.
Gee, who was not involved in the study, points out that while New Orleans was an early hotbed, the state’s cautious approach to reopening has kept it from experiencing dramatic surges like neighboring states, another data point in step with the study’s findings.
“It’s clear the Governor’s orders like masking and shutting down bars are effective,” said Gee. “We know these things work.”
A new report has found that about one in three Louisiana residents is obese, making it one of 12 states with an obesity rate over 35%.
New Orleans’ curve of deaths is “A”-shaped — meaning there was a large peak in April that largely dropped off. Louisiana’s curve is also A-shaped, with a second, smaller surge in July. That reflects Louisiana’s approach to reopening and represents a smaller period of widespread infection. The same was not true for other states, Woolf said.
“What we saw with this is a phenomenon with the states that opened early — Florida, Texas, Arizona — their curve does not look like a capital A,” said Woolf. “The duration of the epidemic was much longer. It’s a study in contrast in terms of the epidemiology of the virus but also in state policy.”
Beyond those who die, each additional death creates a ripple that affects many more. An average of nine family members are affected by each death, creating about two million additional mourners, according to an accompanying study. In Louisiana, that would total 45,468 more people grieving during March to August than in a typical year.
And the excess deaths, calculated using data from the National Center for Health Statistics, represent only the immediate deaths. Experts anticipate slower-moving causes of death — suicide, substance abuse and cancer — will also be part of the pandemic’s toll.
“We’re certainly seeing people increasing substance use as a result of anxiety and depression,” Gee said. “Cancer deaths do not occur quickly. We know routine colonoscopies and mammograms were canceled for several months. We might see worse cancer outcomes, a later stage of diagnosis.”
If the trend continues, experts expect 400,000 excess deaths in the U.S. by the end of 2020, according to an editorial by the editor in chief of JAMA. That’s approximately how many American lives were lost in World War II.
The numbers — both coronavirus deaths and the indirect deaths — depend on behavior.
“We could lower that number,” said Woolf. “Deaths from other causes makes it important for people who have warning signs like chest pain and symptoms that could be a stroke to not hesitate to call 911. We don’t want them to part of that statistic.”
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Emily Woodruff covers public health for The Times-Picayune | The New Orleans Advocate as a Report For America corps member.