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279,700 extra deaths in the US so far in this pandemic year

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Professor of Statistics and Associate Dean for Faculty Affairs and Administration, Virginia Tech
Ronald D. Fricker Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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The number of deaths in the United States through September 2020 is at least 10% and likely 13% higher than it would have been if the coronavirus pandemic had never happened, according to Centers for Disease Control and Prevention data. Conservatively, that’s at least 224,173 deaths and probably as many as 279,700 deaths above what was expected, just for the first nine months of the year. That’s 24,000 to 79,000 extra fatalities above the number of deaths attributed to COVID-19.
When someone dies, the death certificate records an immediate cause of death, along with up to three underlying conditions that “initiated the events resulting in death.” The certificate is filed with the local health department, and the details are reported to the National Center for Health Statistics.
As part of the National Vital Statistics System, the National Center for Health Statistics then uses this information in various ways, such as tabulating the leading causes of death in the United States. Currently, heart disease is the leading cause of death, followed by cancer. COVID-19 is now the third-largest cause of death for 2020.
To calculate excess deaths requires a comparison to what would have occurred if COVID-19 had not existed. Obviously, it’s not possible to observe what didn’t happen, but it is possible to estimate it using historical data. The CDC does this using a statistical model based on the previous three years of mortality data, incorporating seasonal trends as well as adjustments for data-reporting delays.
So, looking at what happened over the past three years, the CDC projects what might have been. By using a statistical model, they are also able to calculate the uncertainty in their estimates. That allows statisticians like me to assess whether the observed number of deaths looks unusual compared to what we expect to see.

The number of excess deaths is the difference between the model’s projections and the actual observations. Through September, that gives 279,700 deaths above what was expected. The CDC also calculates an upper threshold for the estimated number of deaths to help determine when the observed number of deaths is unquestionably high compared to historical trends. Even using that threshold as a very conservative standard means there were at least 224,173 excess deaths.
Clearly visible in a graph of this data is the spike in deaths beginning in mid-March 2020 and continuing to the present. You can also see another period of excess deaths from December 2017 to January 2018, attributable to an unusually virulent flu strain that season.
The magnitude of the excess deaths in 2020 makes clear that COVID-19 is much worse than influenza, even when compared to a bad flu year like 2017-18, when an estimated 61,000 people in the U.S. died of the illness.

The large spike in deaths in April 2020 corresponds to the coronavirus outbreak in the Northeast, after which the number of excess deaths decreased regularly and substantially until July, when it started to increase again. That uptick in excess deaths is attributable to the outbreaks in the South and West that occurred over the summer.
It doesn’t take a sophisticated statistical model to see that the coronavirus pandemic is causing substantially more deaths than would have otherwise occurred. Mortality in 2020 is clearly different from the previous years’ regular patterns, with substantial increases and unusual trends.
The number of deaths the CDC officially attributed to COVID-19 in the United States was 200,499 through Oct. 3.
Some people who are skeptical about the impact of the coronavirus suggest these deaths would have occurred anyway, perhaps because COVID-19 is particularly deadly for the elderly. Others believe that, because the pandemic has changed life so drastically, the increase in COVID-19-related deaths is probably offset by decreases from other causes. But neither of these theories is true.
In fact, the number of excess deaths in the U.S. currently exceeds the number attributable to COVID-19 by at least 23,674 and likely up to 79,201. What’s behind those additional deaths is not yet clear. It could be that COVID-19 deaths are being undercounted, or the pandemic could also be causing an increasing number of deaths due to other causes. What we are starting to learn is that it is probably some of both.
A recent study in the Journal of the American Medical Association found that COVID-19 was documented as a cause of death in 67% of excess deaths between March and July in the U.S. But the researchers also identified increased mortality rates due to heart disease, as well as two spikes for deaths related to Alzheimer’s disease/dementia. Some people are delaying medical treatments for fear of getting infected with the coronavirus.
Another JAMA study found that the 2020 excess death rate is higher in the U.S. than in other countries hard-hit by COVID-19. That difference is likely the result of multiple factors, including inconsistent public health guidance, a decentralized and sometimes conflicting governmental response, and disruptions triggered by the pandemic.
Regardless of the reasons, this pandemic has resulted in substantially more deaths than would have otherwise occurred – and it is not over yet.
This is an updated version of an article originally published on Aug. 13, 2020.
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Your corner pharmacy – joining the front lines of the COVID-19 fight

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Director of Skills Education and Clinical Assistant Professor of Pharmacy Practice, Binghamton University, State University of New York
Assistant Professor, Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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The new year has brought the deadliest weeks of the U.S. COVID-19 epidemic thus far, with thousands of deaths every day. It’s been several weeks since the U.S. Food and Drug Administration issued the first of two emergency use authorizations for COVID-19 vaccines, but getting one isn’t easy.
There are no available appointments to get a vaccine in many communities. Wait times at California’s Dodger Stadium, the nation’s largest distribution site, reached five hours earlier this month. At the current rate, it could take until 2022 for all adult Americans to be vaccinated, according to some estimates.
The Biden administration is trying to change that. The national strategy President Biden rolled out in his first week in office includes a target of injecting 100 million vaccines during his first 100 days as president and strengthening distribution to high-risk communities.
A key component of the president’s five-step vaccine plan, he said, is to “fully activate the pharmacies across the country.” This will greatly expand the number of providers to administer vaccines – and expand the role of pharmacists in the pandemic in the weeks and months ahead.
As pharmacists who work in both rural and urban settings, we are among those who are preparing to meet this challenge.
With the slow rollout, community pharmacies are being brought on board much sooner than anticipated. They’ve been an underutilized resource: U.S. pharmacies have experience storing and administering many types of vaccines. In 2018, they gave about one-third of all flu shots, up from 18% in 2012. They are now preparing to handle the new Pfizer-BioNTech and Moderna COVID-19 vaccines.
These messenger RNA (mRNA) vaccines have a new, but not unknown, mechanism. The Moderna vaccine can be kept in a traditional freezer, but the Pfizer vaccine requires ultra-cold storage at -112 to -76 F before being thawed and administered. Health systems and federal partner pharmacies equipped with these specialized freezers are key hubs for distribution.
It’s not just the vaccine that needs to be protected. Pharmacies are stockpiling personal protective equipment to keep staff safe. They have also established safety protocols for patients – social distancing, disinfection and observation for 15 to 30 minutes after vaccination.
There are also administrative requirements, issuing immunization cards to those who have been immunized and reporting the number of administered doses to state and federal officials.
Pharmacies are registering with the searchable Vaccine Finder website – where people will be able to search for participating pharmacies. The vaccine is free: Insurance companies will be billed an administration fee, though a national relief fund covers that cost for the uninsured.
Under a U.S. Department of Health and Human Services mandate, pharmacists and pharmacist interns who have completed a minimum of 20 hours of accredited training are authorized to administer COVID-19 vaccines.
While health departments and local officials are working to share information, many people are calling their local pharmacies with questions. Because the vaccine was produced, tested and approved in record time, some are questioning its safety. It was produced quickly because government funding fast-tracked various phases of development, allowing them to be conducted simultaneously rather than sequentially. Thousands of volunteers signed up for clinical trials, speeding the process, and emergency FDA approval allowed for rollout while some phase 3 studies are completed.
People are also concerned about contracting coronavirus from the vaccine, which is impossible. Neither mRNA vaccine contains live virus; they simply teach the body to recognize the unique spike protein on the outside of the COVID-19 virus to create a faster immune response to the invader if exposed. Two doses must be spaced 21 to 28 days apart, and it takes another few weeks after the second dose to reach full immunity.
Some who have called us are worried about possible side effects. The most commonly reported aftereffect is pain and swelling at the injection site; some individuals have also reported chills, fever, headache or fatigue. While this may be uncomfortable, it’s not alarming: These are all signs that the immune system is doing its job.
We have also helped explain to people why all are monitored after their shot. A few people have had serious allergic reactions – anaphylactic shock, which is why there is an established observation period after the vaccine that is longer for anyone with a history of allergies. Pharmacists are trained to respond to these rare reactions should they occur.
There have also been reports of individuals who have died within days or weeks of receiving the vaccine. Researchers are investigating these rare events, but so far, there is no evidence that the vaccine is responsible. Unrelated or “incidental” illness seems to be the culprit, which is unsurprising given the demographics – many of those vaccinated in the early rollout are elderly people who are in frail health.
Vaccines have the power to bring this pandemic under control. They could possibly even end it, but only after some 70% of humanity is inoculated. Almost 90% of Americans live within five miles of a local pharmacy where, starting in February, many will be able to get vaccinated against this virus.
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How to stay safe with a fast-spreading new coronavirus variant on the loose

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Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
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A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 20 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.

The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
This story was updated Jan. 18 with latest CDC count and map showing B.1.1.7 cases now found in 20 states.
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Copyright © 2010–2021, The Conversation US, Inc.

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Coronavirus

How to stay safe with a new fast-spreading coronavirus variant on the loose

Avatar

Published

on

Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
View all partners
A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 10 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.
The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
Write an article and join a growing community of more than 119,500 academics and researchers from 3,844 institutions.
Register now
Copyright © 2010–2021, The Conversation US, Inc.

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