There has been much debate about the magnitude of the public health impact attributable to the SARS CoV2 epidemic in Arizona. We examine total mortality during 2020 as a measure of this impact. Our full report has the narrative along with the Figures and Tables. Below you can read the narrative of our report.
Our Question: What has been the magnitude of the increase in all-cause deaths in Arizona during the SARS CoV2 pandemic (January – July 2020)?
Our Method: We reviewed the population health and vital statistics data collected by the Arizona Department of Health Services from 2011 to 2020 and calculated total mortality rates per 100,000 populations. Because total mortality rates vary by month, with peak rates in December through March, we calculated rates per month for this 10-year period to capture all-cause mortality trends.
For our analysis, we:
Pulled death data from ADHS vital statistics by month
Pulled population estimates data 2011-2019 from ADHS population health and vital statistics, population denominators
Projected estimate for 2020 population based upon the prior 3-year average annual population growth
Calculated rates (# of deaths in a month/ estimated population in corresponding year) * 100,000 and Percent change [(new year’s rate – previous year’s rate)/ previous year’s rate] *100
Our Findings: We found a profound increase in all-cause mortality in Arizona in the first half of 2020 when compared to previous years. Table 1 displays positive percent change February through July. July had the largest percent change with a 58% increase in July 2020 when compared to 2019.
From 2011-2019, all-cause mortality death data are consistent from year to year with increased total mortality from December through March. All-cause mortality increased significantly in 2020, with an increase in deaths beginning in April 2020 and profound increases in June and July (Figure 1).
Discussion: Arizona has recorded more than 7,100 more deaths in the first 7 months of 2020 when compared to 2019. According to data from the Arizona Department of Health Services data dashboard, about 4,100 of these deaths have been as a direct result of a SARS CoV2 infection. This suggests that an additional 3,000 deaths during this period may be indirectly attributable to the pandemic.
For example, persons with chronic obstructive pulmonary disease may have developed a mild SARS CoV2 infection that worsened their underlying medical condition. Only a more detailed review of the medical record and death certificate would reveal that the coronavirus was a core cause of the death. In addition, during much of 2020, elective procedures were not available for many Arizonans unless the procedure was urgent. This causes delays in care that may be responsible for many of the additional 3,000 deaths.
There is also ample evidence that delayed care during the late spring and early summer because of fears of coronavirus infections in healthcare facilities. These decisions may have also resulted in deaths indirectly related to the novel coronavirus because of the social disruption caused by the rapid increase in cases Arizona experienced in June and July.
Some have suggested that a substantial portion of the increase in all-cause mortality in June and July is attributable to heat-related deaths, unintentional poisonings with opioids or suicides. Our review revealed no evidence that this is the case.
For example, an August 11, 2020 report from Dr. Gregory Hess, Chief Medical Examiner for Pima County concluded that: “Suicide deaths in Pima County have not increased in 2020. There was a thought that Stay at Home Orders and the social isolation caused by it could have increased the number of suicide deaths in Pima County. These deaths have not increased in 2020.” The same report could find no link to accidental poisonings and the increases in total mortality in 2020.
Our Conclusions: The COVID-19 pandemic is having a profound impact on public health in Arizona. We found clear and convincing evidence that total mortality has substantially increased during 2020, particularly in June and July. Indeed, the total mortality rate per 100,000 during July 2020 was nearly 58% higher than July 2019. These findings are consistent with the exponential growth in the number of persons infected with COVID-19 during June and July 2020 in Arizona. We find that the increase in deaths are due to the direct and indirect effects of the pandemic. We could find no evidence that suicides or accidental poisonings are responsible for this increase.
Editorial Note: Over the course of the pandemic we have seen that the SARS CoV2 virus responds to policy decisions and the administrative effectiveness of the public health response. Ill-advised decisions to emerge from the Stay at Home Order rapidly without requiring community mitigation measures resulted in an exponential spread of the virus. In addition, testing capacity was inadequate, sample turn-around times were insufficient, contact tracers were receiving tardy data, public health orders were inadequate/unenforced, and testing/infection control in care homes were insufficient. These factors also contributed to exponential community spread of the virus.
This report documents that the exponential growth in cases in June and July resulted in large increases in deaths that are directly and indirectly attributable to COVID-19 infections. Indeed, the total mortality rate per 100,000 during July 2020 was nearly 58% higher than July 2019.
We urge the governor and state health director to consider the impacts caused by the policy decisions made in May and June as they evaluate opening bars and nightclubs. In particular, we urge them to ensure that compliance and enforcement systems are in place when bars and nightclubs are allowed to reopen and when in-person school instruction begins. If community spread begins to rapidly increase (as was the case in very early June) we urge swift action to mitigate spread.
As we have learned, the public health burden of policy errors are profound.