# Excess COVID-19 Deaths

## Have 200K+ Americans really died from COVID?

TL;DR, Is the 200K+ deaths figure genuine? The answer is most likely ”YES”, but keep reading for a few interesting statistical and visualization techniques that would tell you exactly why we can confirm this.

One of the COVID-19 talking points that’s been making the rounds, ranging from baseless conspiracy accusations to genuine confusion, has been regarding the number of “true” deaths from COVID-19. Most of this is in reference to data from the CDC, which mentions 6% of the total COVID-19 deaths having no other comorbidities in the autopsy reports. What many people have been taking away from this statistic is that the true number of deaths, the people that died that wouldn’t have otherwise died, is much lower (in come cases being interpolated as less than 12,000 deaths instead of ~200,000 in the United States). It’s been such a common talking point among both social media and the news cycles that you’d have to be actively avoiding COVID-19 news to have not come across it by now. In the early days of the first wave, the differences between death rates in different age groups was a common argument for why the fear of infection (and by extension the lockdowns and social distancing rules) was overblown. Now this is coupled with this new assertion that 96% of these deaths would have happened anyways, or that they were mainly due to other causes.

“And the stimulus bill that was intended to help with the hospitals that were being overwrought with Covid patients created an incentive to record something as Covid that is difficult to say no to, especially if your hospital’s going bankrupt for lack of other patients. So, the hospitals are in a bind right now. There’s a bunch of hospitals, they’re furloughing doctors, as you were mentioning. If your hospital’s half full, it’s hard to make ends meet. So now you’ve got like, “If I just check this box, I get 8,000 dollars. Put them on a ventilator for five minutes, I get 39,000 dollars back. Or, I got to fire some doctors.” So, this is tough moral quandary. It’s like, what are you going to do? That’s the situation we have.”

Elon Musk on Episode #1470 of the Joe Rogan Podcast, May 7th, 2020

And now the recent data is seen as boosting this argument further. Health authorities have responded with various retorts to this line of reasoning, though this hasn’t really moved the needle in the sphere of national discussion as much as you’d think.

As famously productive and worthwhile as Twitter threads and YouTube comment sections are for rational and reasoned debate, there’s a simpler way of approaching this. Instead of diving into the weeds of defining “comorbidity”, there’s ultimately one question we want to answer: Are more people currently dying in the United States than would have normally died?

### How does the current all-cause death rate compare to the usual all-cause death rate for Americans?

Fortunately, the CDC’s data for the total number of deaths is readily available. This is data straight from the National Center for Health Statistics (NCHS), the organization officially in charge of aggregating data like death reports and compiling them into verified statistics. If you die in the United States, these are the people the attending physician will report the death certificate to. If there truly are an abnormal number of americans dying, we should see a spike in the counts of deaths. If not, we shouldn’t see anything too out of the ordinary compared to previous years. As a reminder, te’re not talking about the data on deaths from COVID, we’re interested in deaths across all Americans, regardless of age, sex, ethnicity, or cause of death. We’re looking for every instance of an American kicking the bucket, whether it be caused by heart disease, cancer, homocide, being crushed by a vending machine, or anything else that could make somebody join the silent majority.

Below is a code snippet any python programmer can use to get data from the data.cdc.gov API in JSON format. The data is free to the public, though you might start to run into connectivity issues if you’re making thousands of requests without an account.

!pip -qq install pandas
!pip -qq install sodapy
!pip -qq install backports-datetime-fromisoformat

from datetime import date, datetime, time
import random

from backports.datetime_fromisoformat import MonkeyPatch
import matplotlib as mpl
import matplotlib.pyplot as plt
import matplotlib.dates as mdates
import numpy as np
import pandas as pd
from sodapy import Socrata

%config InlineBackend.figure_format = 'retina'
mpl.rcParams["savefig.format"] = 'svg'

# The fromisoformat() method is not available in Python >3.7
# This 3rd-party package fixes this
MonkeyPatch.patch_fromisoformat()

# Unauthenticated client only works with public data sets. Note 'None'
client = Socrata("data.cdc.gov", None)

# First 2000 results, returned as JSON from API / converted to Python list of
# dictionaries by sodapy.
results = client.get("y5bj-9g5w", limit=175000)

# Convert to pandas DataFrame
results_df = pd.DataFrame.from_records(results)

results_df["number_of_deaths"] = pd.to_numeric(results_df["number_of_deaths"])

is_whole_us = results_df['state_abbreviation']=='US'
results_df = results_df[is_whole_us]
results_df

This will return is a dataframe that shows the number of deaths per week for each age group, which we’ve gone ahead and filtered for the entire United states (we’re not interested in state-by-state breakdowns for now). We’ll do one last check of the unique column values just to be sure.

print(results_df['state_abbreviation'].unique())
print(results_df['year'].unique())
print(results_df['age_group'].unique())
print(results_df['time_period'].unique())
print(results_df['type'].unique())
print(results_df['week'].unique())
week_ending_dates = results_df['week_ending_date'].unique()
print(results_df['note'].unique())
['US']
['2015' '2016' '2017' '2018' '2019' '2020']
['25-44 years' '45-64 years' '65-74 years' '75-84 years'
'85 years and older' 'Under 25 years']
['2015-2019' '2020']
['Predicted (weighted)' 'Unweighted']
['1' '2' '3' '4' '5' '6' '7' '8' '9' '10' '11' '12' '13' '14' '15' '16'
'17' '18' '19' '20' '21' '22' '23' '24' '25' '26' '27' '28' '29' '30'
'31' '32' '33' '34' '35' '36' '37' '38' '39' '40' '41' '42' '43' '44'
'45' '46' '47' '48' '49' '50' '51' '52']
[nan
'Data in recent weeks are incomplete. Only 60% of death records are submitted to NCHS within 10 days of the date of death, and completeness varies by jurisdiction.']

We’ve correctly settled on data for the full US (not just individual states), for data across 5 years, along with a handy identifier of data from before and during the pandemic. It’s not all rosy, though. As you can see by the notes, there’s about a 10-day delay in the submission of death records to the NCHS. This means that the most recent two weeks of data will be unreliable (thus we will drop these before the visualization step).

For now, our data is still split among age groups and we want to aggregate across all ages. We want to know the total number of deaths across all Americans for any given week.

for week in week_ending_dates:
week_cohort = results_df.query('week_ending_date=="{}" & type=="Unweighted" '.format(week))
total_weekly_deaths = week_cohort.sum(axis=0)['number_of_deaths']
year = week_cohort.mode(axis=0)['year'][0]
week_number = week_cohort.mode(axis=0)['week'][0]
time_period = week_cohort.mode(axis=0)['time_period'][0]
new_row = {'jurisdiction': 'United States',
'week_ending_date': week,
'state_abbreviation': 'US',
'year': year,
'week': week_number,
'age_group': 'All',
'number_of_deaths': total_weekly_deaths,
'time_period': time_period,
'type':'Unweighted',
}

#append row to the dataframe
results_df = results_df.append(new_row, ignore_index=True)

# If you want to look for the deaths for specific age groups, just
# change the "All" to one of the age group categories in the list of
# unique values in the printout above
results_df = results_df.query('age_group=="All" ')
results_df = results_df.reset_index()
results_df = results_df.drop(['index'], axis=1)

Now that we have our data, it’s just a simple matter of plotting. Fortnately for us, the design team at FiveThirtyEight already did more of the heavy lifting on the style guide.

week_endings = [datetime.fromisoformat(x) for x in results_df['week_ending_date'].to_list()]

plt.style.use('fivethirtyeight')

fig, ax = plt.subplots(figsize=(30, 10))

x = week_endings[:-2]
y = results_df['number_of_deaths'].to_numpy()[:-2]

ax.bar(x, y, width=7)
ax.set_title('Number of Deaths per week in the United States (all causes, all ages)')
ax.set_ylabel('Number of deaths (all causes)')
ax.set_xlabel('date (week)')
ax.xaxis_date()

plt.savefig('total_deaths.svg')
plt.show()

We can see that looking for spikes in the data isn’t going to be so simple, as there’s immediately obvious seasonal spikes in the numbers of deaths. We want to know which of these spikes or valleys shouldn’t be there. We already have a cumulative number of deaths per week across all ages, but we also want the typical number of deaths per given week of the year (not just the deviation from the all-time average) to compare against. For example, if we have the number of deaths for week 17 out of 52 for 2020, we’d like to know how this compares to the average number of deaths for week 17 out of 52 for 2015-2019. This should allow us to distinguish unusually high/low numbers of deaths from the seasonal variability.

The following script gets those weekly averages and plots the differences between those averages and the total number of deaths.

weekly_averages = {}
for week in week_ending_dates:
week_cohort = results_df.query('week_ending_date=="{}" '.format(week))
week_number = week_cohort.mode(axis=0)['week'][0]
typical_week_cohort = results_df.query('week=="{}" & time_period=="2015-2019" '.format(week_number))
typical_week_deaths = typical_week_cohort.mean(axis=0)['number_of_deaths']
weekly_averages.update({int(week_number): typical_week_deaths})

typical_deaths = results_df['week'].apply(lambda x: weekly_averages[int(x)]).to_numpy()

plt.style.use('fivethirtyeight')

# plot it
fig, ax = plt.subplots(figsize=(30, 10))

x = week_endings[:-2]
y = results_df['number_of_deaths'].to_numpy()[:-2] - typical_deaths[:-2]

ax.bar(x, y, width=7)
ax.set_title('Deviation from 2015-2019 Week-average Number of Deaths in the United States (all causes, all ages)')
ax.set_ylabel('Deviation from mean number of deaths for week $N$ (for 2015-2019)')
ax.set_xlabel('date (week)')
ax.xaxis_date()

plt.savefig('death_deviation.svg')
plt.show()

There’s definitely spikes in earlier years resulting from nasty flu seasons, but 2020 is clearly experiencing something much worse than a typical bad flu. We could go further by doing additional statistical tests on the data, but this seems like the kind of graph where a career $p$-value-hacker would say, “Nah, that’s not necessary for this one.”

Some of us might be living in sparesly populated areas that might not have been seeing much of the effects of the pandemic beyond all the businesses in town suddenly requiring masks.

My experience? I was in Brooklyn earlier this year when the hospital 3 blocks down the street from my apartment started having a lot more refrigerated trucks in front of it (being used as mobile morgues after the hospital’s own started to overflow). While it’s true that many of the “mass grave” pictures on social media have been coming from places like Hart Island (already a place for burial of those with no next of kin, and not the only destination for those that have died of COVID), there’s definitely been a dramatic uptick in the number of burials.

#### How can we be sure these numbers are trustworthy?

Unclear autopsy results are one thing, but excess deaths on this scale are another. One can make a case for incentives by hospitals to put down a specific cause of death. It’s a lot harder to believe in the falsification of tens of thousands of death certificates for people that have not actually died (like some inexplicably scaled-up reverse-Weekend-at-Bernie’s plot). Don’t get me started on what could possibly motivate a conspiracy like that, or how such a plan would even be coordinated for months across hundreds of thousands of hospital staff without anybody else catching on).

But criticisms aside, how would we even test whether official figures are accurate (or whether they’re being pulled out of thin air)? As it turns out, there are a lot of statistical techniques for identifying real data from fudged data. Many of the techniques in this space draw upon the fact that humans are pretty bad at generating numbers from a probability distribution. Humans will often favor numbers ending in 5 or 0, or add in digits with abnormal frequency because they might seem “more random” than others.

COVID death data from US, Canada, China, and France doesn’t stray too far from the expected distribution of trailing digits. For a negative example, Boris Ovchinnikov used this kind of digit analysis to great effect to spot such unusual patterns in Russia’s official COVID-19 statistics. For example, he found that the reported numbers of new cases officially ended in the digits 99 four times in a timespan of 25 days. He calculated that the likelihood of this happening on it’s own randomly is about 1.1%. This was made even more dubious by the fact that the trend in the number of cases followed a linear pattern rather than an exponential pattern.

What does it look like if we apply techniques like those used by Boris Ovchinnikov to the US death counts? Are there any discrepancies between the digit preference patterns before and during the pandemic?

import pandas
from collections import Counter

client = Socrata("data.cdc.gov", None)
results = client.get("y5bj-9g5w", limit=175000)
results_df = pd.DataFrame.from_records(results)
results_pre_df = results_df.query('time_period=="2015-2019" & type=="Unweighted" ')
results_post_df = results_df.query('time_period=="2020" & type=="Unweighted" ')

death_pre_list = results_pre_df['number_of_deaths'].tolist()
death_post_list = results_post_df['number_of_deaths'].tolist()
leading_pre_digits = [str(x)[-2:] for x in death_pre_list]
leading_post_digits = [str(x)[-2:] for x in death_post_list]

x = [] # Last leading digit (index -1)
y = [] # 2nd to last digit (index -2)

# The list of digit frequencies before and during the pandemic
pre = []
post = []

for i in range(0, 10):
for j in range(0, 10):
x.append(j)
y.append(i)
pre.append(digit_pre_counts[str(i) + str(j)])
post.append(digit_post_counts[str(i) + str(j)])

# We will normalize the digit counts as fractions of the total
# (we multiply by 10,000 because otherwise our scatterplot dots will be too
# small to see).
pre_sum, post_sum = sum(pre), sum(post)
pre = [(x / pre_sum)*10000 for x in pre]
post = [(x / post_sum)*10000 for x in post]

fig, (ax1, ax2) = plt.subplots(ncols=2, figsize=(30, 10))

ax1.scatter(x,y,s=pre)
ax1.set_title("Relative Digit Preference in Weekly Death Totals; 2015-2019\n(pixel-widths of dots correspond to normalized frequency)")
ax1.xaxis.set_ticks(np.arange(0, 10, 1))
ax1.yaxis.set_ticks(np.arange(0, 10, 1))
ax1.set_xlabel('ones-place digit (xxxX)')
ax1.set_ylabel('tens-place digit (xxXx)')

ax2.scatter(x,y,s=post)
ax2.set_title("Relative Digit Preference in Weekly Death Totals; 2020\n(pixel-widths of dots correspond to normalized frequency)")
ax2.xaxis.set_ticks(np.arange(0, 10, 1))
ax2.yaxis.set_ticks(np.arange(0, 10, 1))
ax2.set_xlabel('ones-place digit (xxxX)')
ax2.set_ylabel('tens-place digit (xxXx)')

plt.savefig('digit_preference.svg')
plt.show()

…nope. Nothing really out of the ordinary here. In fact, if you were to transpose the tick for the tens-place 0s to the top of the grid, it looks like an almost ideal 2-dimensional Newcomb-Benford distribution (i.e., the distribution of digits we would expect if these numbers were occuring naturally).

### But what’s going on with the autopsies?

Given that my pre-software career was focused on biological aging (you can read more of my posts on that subject here), I can talk pretty confidently at length about aging, morbidity, death, and decay. Early in college, when I was touring medical schools and witnessing medical cadavers, I got to witness firsthand how much better you could understand what’s going on in somebody’s body when you don’t care about how invasive you’re being. Cutting someone open leaves a lot less room for ambiguity than any non-invasive medical imageing. It’s pretty common for the autopsy technician to find comorbidities that the person on the table didn’t know about in life. I’ve heard examples from medical examiners ranging from previously undiagnosed genetic diseases, to hidden cases of liver disease, to surprise MRSA infection, to non-smokers whose lungs were unexpectedly grey, to sepsis coming from getting pricked with a paperclip, to lethal blood clots that upon closer inspection would have been long time coming in hindsight. The list goes on and on.

When I hear that the percentage of autopsy reports with one or more “comorbidities” is 94%, that fits pretty neatly with my worldview that the majority of us are probably not as healthy as we think we are. When we picture the body’s innards, many of us will probably picture something that’s pristine like a textbook. Even those of us in the biological sciences might have a mental model where all the tissues and organs are neat, organized, labelled, and don’t look like the diseased tissues you see in the pictures in later chapters of your anatomy textbook. Living human bodies (except for maybe infants) are not like this, and this is especially true for corpses. True, when you look inside a body for the first time there might be more truth to the color-coding in your textbook than you expected, but beyond that things are a lot more messy and varied. If you want a better sense for this and aren’t good friends with a mortician or medical examiner, I’d recommend checking out Body Worlds (WARNING: This Link is the webpage for an exhibit containing skinless cadavers preserved in plastic. NSFW, obviously).

For a less gruesome comparison, it’s like we’re all players in a game of Dungeons and Dragons (played by a truly sadistic GM). Many of these comorbidities (from high blood pressure to being diabetic or pre-diabetic) act as constitution penalties. Even if you’re pretty confident that you don’t have any of these, any D&D player can tell you can still fail your saving throw, and 0.2% is not as low as you think when talking about chances of dying.

TL;DR Is the 200K+ deaths figure genuine? The answer is most likely yes.

Cited as:

@article{mcateer2020autopsies,
title   = "Excess COVID-19 Deaths",
author  = "McAteer, Matthew",
journal = "matthewmcateer.me",
year    = "2020",
url     = "https://matthewmcateer.me/blog/excess-covid-deaths/"
}

If you notice mistakes and errors in this post, don’t hesitate to contact me at [contact at matthewmcateer dot me] and I will be very happy to correct them right away! Alternatily, you can follow me on Twitter and reach out to me there.

See you in the next post 😄

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