United States: Covid-19 and 4,000+ Extra "Influenza/Pneumonia" Deaths

September 19, 2020

I've been doing some excess and by-cause deaths analysis that's been especially fruitful regarding 2020's weekly fatalities in the United States. So far this suggests - as many others have noted - many thousands of deaths probably caused by unconfirmed and unknown infections by Covid19/SARS 2. I did some tracking of mysteriously surging deaths from heart disease, Alzheimer's, diabetes, and more, using a CDC data table, updated weekly to show weekly totals for many natural causes, by state and national, for both  2019 and 2020 for comparison. That is available here:

https://data.cdc.gov/NCHS/Weekly-Counts-of-Deaths-by-State-and-Select-Causes/muzy-jte6/data

The latest weeks are always incomplete, and weekly data continues to be revised to varying degrees for many weeks afterwards. So this is provisional data, but so far it seems fairly complete and settled over most of the long span examined.

Those other categories might seem unclear in their relation, but the SARS2 coronavirus causes circulatory and other damage in many of those it infects. That will include ones we didn't know were infected, who for example had heart disease to start with, then die soon after an unknown illness maybe even they didn't feel (more likely they just didn't say anything). Case-by-case there might seem no reason to guess covid involvement, but when you see the scale and timing of the rises, it's hard not to see. (a rough sketch of several of these is included at the bottom of this article).

The category I'm looking at now is a little more direct in its relation: "influenza/pneumonia (J09-J18)" - for short I/P. I may be hazy what's included. The related codes are broken down elsewhere as:

J09  Influenza due to certain identified influenza viruses

J10  Influenza due to other identified influenza virus

J11  Influenza due to unidentified influenza virus

J12  Viral pneumonia, not elsewhere classified

J13  Pneumonia due to Streptococcus pneumoniae

J14  Pneumonia due to Hemophilus influenzae

J15  Bacterial pneumonia, not elsewhere classified

J16  Pneumonia due to other infectious organisms, not elsewhere classified

J17  Pneumonia in diseases classified elsewhere

J18  Pneumonia, unspecified organism

https://www.icd10data.com/ICD10CM/Codes/J00-J99/J09-J18

Then I'm hazy on the exact definition of influenza vs. pneumonia. But anyway ... I think it includes the two main classes of influenza (A+B) and a larger number of deaths caused by pneumonia, which I gather has many causes (not a specific virus or bacteria but many of both)but - as I gather - not the fullest list of pneumonia deaths (some may be in other categories here). I suspect Covid19 or "Kung Flu" as a select few have called it, would fit here, as a pneumonia or maybe a flu of unknown cause, until it was given its own category on account of being this deadly super-bug. 

And when people don't know it's covid19 they're seeing, it may keep getting listed here.

I had seen some evidence cold and flu transmission dropped sharply under lockdown conditions, in the U.K. anyway. That makes sense, and I expected lower cases and thus deaths in most or all places that used lockdown and advised social distancing, etc. That includes the U.S. of course, even though mitigation efforts were not universally employed and complied with. In contrast, 2020's I/P death toll is high and erratic, in some states I've looked at (but not others), and on a national level; U.S. totals include quite a few hundred more than expected. 

On analysis, these deaths seems to be below average for a baseline (or below 2019 levels anyway), and by when the extra deaths come in, it's almost certain they were caused by unknown Covid19 infections. Perhaps the most interesting detail is how the biggest spike of these comes right at the year's start, immediately after Christmas and New Year's, suggesting the virus was already circulating widely by then, about a month earlier than known.

Here is the graphic, with some discussion following. It's too small to read in this preview, except that:

* the tall red curve is Covid deaths (mostly far off this scale to 2,000), 

* the darker orange line is 2020 I/P deaths, 

* the lighter orange line running normally beneath it is the same thing in 2019, and 

* the steep green slopes show the seasonal declines in flu cases for for each year, with 2020 being the darker, steeper, and earlier of the two (explained below).

To get a clear picture, I had to trace the data back to late 2019 to be fairly sure I was seeing a pre-covid baseline. For comparison purposes, I tried a bit to find the equivalent I/P tallies from late 2018. One list broke down flu (tiny numbers like 30) and pneumonia, with bigger numbers in the 3,000 per week range - far bigger than the kind of combined totals I've been plotting. The same number included covid-19 deaths in the pneumonia category when they came in, but it started out higher even before those. It must include other illnesses lumped differently than on the table I'm using, which may have their own patterns, but ... for now I'll stick with the 2019-2020 table and the one column, and offer a guess for the late-2018 lead-up, traced back from the visible trend, with a reasonable seasonal increase. (this lack of comparable historical data is also why I didn't even try for a multi-year average - I just use 2019's weekly levels, using a relatively normal year as a stand-in for an average.)

2019 ends with around 8-900 I/P deaths per week, well under what late 2018 probably should be, climbing past 1,000 in a rise that might be all seasonal, or include a few early covid deaths. Then 2020 starts with a jump to 1,555 deaths in week 1, ending Jan. 4. That's 283 more I/P deaths than in the same week of 2019, when it had been about 100-200 per week below that level.  

This is unusual, and it comes just as the first few confirmed Covid19 deaths were coming in. As listed on the CDC table, three deaths occurred prior to the first confirmed infection we heard about at the time, on the 21st. The first listed covid death is on January 4, at the end of that deadliest I/P week. (2 more came the following week, then alternating 1 and 0 for a few weeks before a quick takeoff in weeks 10-13.) 

As of mid-December we were just hearing about a deadly flu in China, but it seemed like a Chinese issue we had some distance on, and it was somehow not certain if it was even contagious. Later we learn it was contagious and was a Chinese problem from October or earlier, and could have spread anywhere since then. And seemingly out of nowhere, some extra-deadly infections occur somewhere in the United States roughly at the Christmas and New Year's holiday. That's a time known for visits to older family members, a few spare days for incubation, and people packed on airplanes flying to airports across the nation and overseas. Note that very frail people can die from the virus and the damage it causes within just a few days rather than the common struggle of 2-3 weeks. It can be incubation then almost instant death. Infected with SARS at Christmas and died New Years to be classed as an I/P death ... may have happened about in about 280 cases nationwide last year. That would be almost a one-in-a-million occurrence, when it had seemed like something that couldn't happen at all.

The elevated I/P death toll stabilizes after the January jolt, but remains well above 2019 levels to week 7, and roughly matches 2019 in week 8 (ending Feb.22). Then deaths rise steadily, just as weekly Covid deaths shoot straight from 9 to 35, 53, 571, and 3,155 over weeks 9-13. I/P deaths peak just before Covid ones, with 1,870 logged in week 14 - 646 more deaths than in week 14, 2019 - in fact an increase of over 50%. 

An interesting detail is how test-confirmed infections of influenza fall off here, a month earlier and more sharply than in 2019. See below bar graphs of weekly test results for the last 4 seasons, broken down by influenza types. The latest is from the weekly CDC update - but that changes, and where it'll be then, not sure. The others from prior years are from quick Bing image searches. 

For my graphic, I took the two relevant graphs (2018/19 and 2019/20) into my graphic, roughly scaled them vertically to my scale, drew a shape (in MS Paint) including the green line between bar tops, then set and stretched it between the right weeks on my timeline (and erased the rest of the shape - I like the tedium up to a point).

So 2020 has a rather sharp decline in flu cases just as Covid19 was taking off. However, by these graphs, infections always fall pretty sharply at around weeks 10-20, and in 2020 testing/confirmation may be low due to "lockdown" and such, which is when the numbers drop so sharply. But also transmissions should be down as people kept a distance from each other. It might be the vast number of actual flu infections dropped just as sharply as these few that ever get confirmed. 

The same should probably apply to all kinds of pneumonia - if it's contagious, it should suddenly spread more slowly under lockdown and social distancing, with the use of masks, etc. Yet something classed as "influenza/pneumonia" - that might be especially deadly and/or extra-contagious - infects enough people to push the death toll far higher than usual. When it strikes just as Covid19 was taking off, there's only one overwhelmingly logical culprit.

Back to my graphic and its narrative: supposed influenza/pneumonia deaths peak in week 14 (ending April 4), then decline sharply by the following week. The infections leading to those deaths must have fallen off several days to a week or more before this. This would be roughly in late-March to early April, which is when most states imposed strong control measures, and president Trump did, to his credit, send out that postcard to everyone, including his hardcore fans who had been doubting the danger, based on some of the conflicting things Trump had said. From here the weekly deaths decline steadily to roughly 2019 levels (around 800/week declining to around 650) by week 19. This still probably includes some Covid deaths and thus less of all the other kinds than in 2019. 

A week after the 4th of July, the flu and pneumonia get a bit deadlier again, just as Covid does the same, but much milder than after the surprise attack of January. The level only rises to slightly above average, and holds about there for 3 weeks before falling again to seasonal levels and even below 2019 at several points. But it should be a bit higher at the end than shown here; final data points tend to be incomplete (the last two so incomplete I didn't even include them). 

And again, this is after after I/P deaths started - and likely stayed - below 2019 levels, aside from the stray coronavirus deaths that probably explain all this erratic overage. Just through week 18, there were 3,988 deaths above 2019 levels. From there to week 34, the ups and downs combine to just 51 deaths above. 4,039 total. But it seems 2020 was a low year, with a baseline of something like 100-200 I/P deaths per week below 2019 levels. That would add about 1-200 extra, likely-covid, deaths per week to explain the levels we see. As the increase only starts clearly in week 1, that math is easy - it would be between 3,400 and 6,800 extra deaths added to all the differences from 2019 levels. including any baseline adjustment for now. I'm pretty sure there is one, but the late-2018 level being unclear keeps me from  being able to say the scale of it, except that I can safely say it will add at least another 1,000 deaths. Conservative total: More than 5,000. 

This adds to the notable but yet-to-be-calculated overages in deaths from (at least) heart disease, Alzheimer's, diabetes, and unclassified causes (R00-R99), which also can relate to unknown covid19 infections, and swell just before, after, and during spikes of covid deaths. Just heart disease is over by more than 2,000 deaths in the worst point, weeks 15, just before covid deaths also peaked at 16/17,000. Alzheimer's and diabetes were both up about 600 deaths the same week. To be revised, but here's my prior US total analysis, with numbers that have been changed since, and including a rough version of this I/P pattern, from week 4 on (where they differ, the new one is both updated and more carefully done). Some of these other death causes had showed high early levels I mostly ignored, but after re-examining the New Year's I/P deaths, I should extend this back further when I revise (after the next weekly updates, if they come).