How we die: Top causes of death in the age of coronavirus

April 20, 2020

Photo credit: MIKI Yoshihito

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On January 20, 2020, the first case of the COVID-19 coronavirus was reported in the United States. The number of diagnoses increased rapidly in the subsequent weeks: by March 11, there were over 1,000 cases reported; by March 19 there were 10,000 cases, by March 27 there were 100,000, and as of April 18, there are more than three-quarters of a million.

According to evidence from China, the time from infection to recovery, or death, is typically at least three weeks. Because of this, data on mortality lag behind those of diagnoses. In the United States, the first reported death attributable to COVID-19 was on February 29, more than a month since the first reported case. More than three months since the beginning of the COVID-19 outbreak in the United States, the number of people reportedly dead from the virus has reached 39,000.

The case fatality rate of the novel coronavirus is fiercely contested and highly reliant on the number of people who receive a diagnostic test. As the United States continues to face testing shortages, we are unlikely to fully understand the true case fatality rate in the near future.

Testing shortages impact not only the ability to understand who in a community has been infected, but also to accurately identify who has died from the virus. Like hospitals and health departments, coronors are also facing shortages in tests, limiting the ability to definitively determine if COVID-19 was the contributing cause of a person's death.

As a result, death data (like the number of diagnoses) are certainly underestimates. In Italy, for example, patients were asked to stay home until their symptoms became severe, leaving many to die at home; as a result, the official number of death were considerably lower than the true tally.

Causes of death in the United States

Even undercounted, the number of people who die from COVID-19 is an essential metric for how the virus is impacting Americans. More important is understanding how these numbers compare to how many people normally die every day.

To better understand how COVID-19 compares to other causes of death in the United States, we compared the number of reported COVID-19-related deaths with the CDC's database of the cause of death reported on all death certificates. The most recent available death certificate data are from 2018.

Deaths per day, by cause of death (U.S.A.)

In February 2018, the most common cause of death in the United States was heart attack and other cardiovascular diseases. About 2,500 people died per day of cardiovascular illness.
The second leading cause of death is cancer, which was responsible for about 1,600 deaths per day in the month of February.
Another significant group of causes of death is respiratory disease, like bronchitis, emphysema, or asthma.
Influenza and pneumonia, often compared to COVID-19, together killed about 300 people per day.
Drug overdoses were responsible for about 167 people dying per day.
On February 29, the first American COVID-19 related death was reported.
Only a few COVID-19 related deaths were recorded per day for the following three weeks. COVID-19 remained a rare cause of death.
On March 19, COVID-19 ranked among the top 20 causes of death in the United States for the first time.
By March 21, COVID-19 was killing 110 people per day, about as many people as car accidents, Parkinson's disease, or accidental falls.
On March 25, COVID-19 was responsible for more deaths than the flu or pneumonia, drug overdose, or suicide.
On March 26, COVID-19 reached the top 5 causes of death in the United States, surpassing diabetes.
On March 29th, COVID-19 surpassed Alzheimer's disease and lower respiratory diseases, becoming the third leading cause of death.
COVID-19 remained the third leading cause of daily deaths from the end of March until April 7.
On April 8, COVID-19 killed 1,906 people in one day, becoming the second leading cause of death.
For the first time, on April 15th, COVID-19 killed 2,408 Americans— more than any other cause of death in the United States.
The next day, on April 16th, that number more than doubled to 4,928 deaths.
April 17th
April 18th
April 19th
April 20th
Source: The U.S. Centers for Disease Control and Prevention's Underlying Cause of Death database (WONDER) (2018) and the European Centre for Disease Prevention and Control (current as of April 20, 2020). Daily deaths from non-COVID-19 causes are calculated averages from monthly estimates.

What can we learn from daily deaths?

The number of deaths from COVID-19 is rapidly changing, and cannot be reliably annualized yet. We also don't have 2020 data on national mortality data from other causes, so we can only compare to 2018. Nonetheless, these data provide a stark counterpoint to messaging that the virus is comparable in scale to diabetes or drug-related deaths, car crashes and pool drownings, or gun violence (or even that it is just a hoax).

How long will COVID-19 be the leading cause of death in the United States? If the social distancing measures enacted in many states are successful, and if hospitals can provide life-saving care to the people who become ill, this rate may soon begin to decline. As of April 18, the models from the University of Washington's Institute for Health Metrics and Evaluation (IHME) predicted that the peak of COVID-19 related deaths nationally was April 15. For some states, the peak is yet to come.

Want to see for yourself? All our data are on GitHub.

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