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Mortality Play: 2020 vs. 2021-22
A global survey of excess demise: Part 7
David Wallace-Wells of the New York Times has finally asked the big one.
Good question, New York Times. But it’s not just Americans.
The patterns we see in the U.S. are playing out simultaneously in high-income nations around the globe.
Sixteen months ago, in our November 2021 Covid Dynamics report, we had already noticed a jarring difference from the first pandemic year of 2020.
In the most recent three months, total U.S. excess deaths are up 69% compared to 2020. Looking at weeks 31-43 removes the effect of last winter’s Covid surge. Middle-aged Americans show the sharpest upsurge. EuroMomo data show similar patterns across 29 European nations. (Although conspicuously not in Sweden.) Excess mortality of 15-44 year olds is around double last year’s. For 45-65, excess deaths are up 40-50% from the already bad 2020. These are mostly highly vaccinated populations. Both Covid and non-Covid deaths, however, are way up.
Then last month, in January 2023, we published a survey of excess mortality in the U.S., focusing on life insurance data.
Healthy young and middle-age people, we summarized, weathered 2020 rather well but then suffered unprecedented surges of mortality in 2021 and 2022.
Now the New York Times, Justin Fox of Bloomberg, and many others are addressing the story, which had become un-unnoticeable.
The top-line mortality data may be easy enough to see, although various statistical agencies are doing their best to muck it up. The question of why is therefore a much more difficult topic.
In their articles, Fox and Wallace-Wells list and analyze several possible causes: delayed healthcare, opioids and alcohol, suicide and homicide, indirect lockdown effects, and of course ‘long Covid.’ No doubt, a few of these are important factors, though our January article showed why they can’t explain most of the 2021-22 rise.
Wallace-Wells also argues we are undercounting Covid deaths. It’s a difficult case to make given the extraordinary incentives which most people agree lead us to overcount Covid deaths.
Fox, meanwhile, suggests the youth mortality rise began before the pandemic. Which was of course true for some narrow populations – deaths of despair, fentanyl, and so forth. But it certainly was not true for many American cohorts – such as those high-income Americans with group life insurance whom we covered last time. Nor was it true for many populations around the world.
Not content with the usual explanations for a surge in sudden adult death syndrome (SADS), doctors and journalists around the globe offered a long and creative list of possible culprits – coffee, sun, loneliness, hotter nights, lack of sleep, naps, physical activity, lack of physical activity, solar storms, skipping breakfast, gardening, living in flight paths, extreme weather, video games, forgetting your statins, heat, shoveling snow, artificial sweeteners, eggs, and even excessive joy.
After combing through the more reasonable possibilities, Wallace-Wells remains perplexed and alarmed.
And though the pattern has continued for three years, there isn’t medical or scientific consensus about what is driving it. Instead, perhaps several hundred thousand “unexpected” deaths have been explained only by loose conjecture. “We’ve got to figure this out,” the University of Minnesota epidemiologist Michael Osterholm told me. “And in order to do that, you’ve got to have that discussion: Wait a minute, this is bigger than people think.”
Bigger than people think.
And yet, given the enormity of the problem, too few authorities are taking action. Economists Casey Mulligan and Rob Arnott recently looked into it. Insurance industry expert Josh Stirling analyzed the data. But most politicians, public health officials, and medical schools are aggressively ignoring it. At least those who blame eggs, naps, and global warming acknowledge the problem.
The Wallace-Wells argument – that the U.S. is undercounting Covid deaths – and the Fox argument – that astonishing U.S. mortality in 2021-22 is merely the continuation of a trend – fail to reckon with key dynamics, which can be gleaned in both life insurance data and the international experience.
Our post a month ago focused on life insurance reporting, which alone was enough to refute both the undercounting and continued-trend explanations. The demarcation between 2020 and 2021-22 and the sudden change in cohort deaths showed that neither explanation could remotely account for the unprecedented mortality surge in specific populations.
Here, we address mortality patterns around the globe, which those U.S.-centric arguments ignore. This is just a survey, so we’ve used a variety of sources and metrics, which may tend to show that no matter whose data or analysis one selects, the patterns tell a remarkably consistent story. (Thanks especially tofor his good work at Mortality.Watch, which we cite liberally.) For other analytical purposes, one would of course like to use standardized data and metrics.
Let’s begin with Germany, where professors Christof Kuhbandner and Matthias Reitzner have just updated their August 2022 study with full-year 2022 data.1 As you can see, German excess mortality in 2020 was unremarkable, except for a significant decline among children and a small upward bump among 70-79 year olds. In 2021 and 2022, however, excess mortality jumped and remained substantially elevated in nearly all adult cohorts. Despite the milder Omicron variants, 2022 was around twice as bad as 2021 and roughly six times worse than 2020.
The age breakdown is crucially important. Germany suffered 33,071 Covid deaths in 2020, mostly among the elderly. Given total and cohort excess deaths did not substantially rise, however, it appears that Covid deaths mostly displaced deaths that might have occurred for other reasons.
In 2021-22, Germany suffered 128,394 Covid deaths. But non-Covid deaths also spiked, especially among younger Germans. Covid deaths were higher in 2021 than 2020 and 2022, but overall deaths were higher in 2022. Whether one attributes the excess mortality in 2021-22 to Covid or non-Covid, the bottom line is that the public health measures of 2021-22 were a major failure.
Here’s the cumulative view of age-standardized excess mortality in Germany.
United Kingdom (224.04)
Like the U.S., Israel, and Italy, the UK suffered major Covid-related losses in 2020. The persistence of both Covid and non-Covid losses over the following two years, however, may be an even bigger, and more surprising, concern.
The UK has witnessed an age shift similar to the U.S., where 2020 mortality was concentrated in older and unhealthier populations, but then younger Brits suffered disproportionately in 2021-22. As Campbell notes, the Faculty of Actuaries found 7.8% more deaths among 20-44 year olds in 2022 compared to 2019.
Italy famously suffered the earliest and most acute Covid surge among Western nations, in its Lombardi region in March 2020. Yet it too, like the UK, U.S., and Israel, has continued with elevated excess mortality over the following years.
Japan survived the initial pandemic year of 2020 without significant losses. Beginning in 2021, mortality began to rise, and then sustained much higher excess levels throughout 2022.
Joel Smalley reviewed Japanese mortality through June 2022 here.
Here’s another facet of the analysis, which deserves more exploration. Elevated deaths across nations tend to cluster in particular causes – in this example, cardiac. Japanese cardiac deaths jumped in 2021 even though Covid had only a moderate impact that year.
The island continent closed itself to the world in 2020 and did not see significant Covid losses. Yet again, however, in 2021 and 2022, Australia suffered major Covid and non-Covid mortality. As you can see in the dark blue line below, non-Covid deaths alone create excess far above the normal range (shaded light blue).
Here’s a cumulative view of Australian age-standardized excess mortality.
Canada displayed a pattern similar (though less severe) to the U.S. – a significant Covid impact in 2020, an even worse 2021, and slightly lower but doggedly persistent excess in 2022.
Continuing the unusual pattern, Israeli excess mortality in 2021 was much worse than 2020, and 2022 was also worse than 2020. You can see that in pre-Covid times, high- and low-mortality years alternate in a sort of rough mean-reversion. Bad years are often followed by good years, and vice versa. That is of course how we establish the baseline against which excess is measured. Three consecutive years of highly elevated mortality is truly extraordinary – more like unheard of.
Israel broadly deployed the Pfizer vaccine, earlier than any nation, followed soon after by the U.S. and UK. Israel also began boosting first, in the summer of 2021. In our November 2021 report, we noted that
The first results of the booster experiment will yet again come from Israel, which mass-boosted this summer and fall.
Elevated mortality in 2022 is a clear sign something went very wrong.
Singapore is a vibrant and generally healthy nation. It quickly achieved an 85% vaccination rate in 2021, and in 2022 it boosted around 79% of the population. Like Australia, Taiwan, and Japan, it did not suffer significant Covid-19 harms in 2020. In 2021, however, both Covid and non-Covid deaths jumped and then remained substantially elevated in 2022.
Here is Singapore’s own analysis, which shows a steadily falling age-standardized mortality rate, even through 2020, but then a reversal to higher ASMR in 2021 and 2022. We added the dotted red line, showing the linear trend of total deaths, which was only significantly exceeded in 2021 and 2022.
The HART Group out of the UK shows that, like Japan, cardiac deaths in Singapore jumped in 2021-22.
South Korea (250.21)
South Korea was lauded for containing Covid in 2020, but deaths steadily rose in 2021 and then exploded in 2022, a fact not fully reflected in these charts, which are limited by delayed data.
It’s a similar story in Taiwan, which pitched a near-shutout over Covid for two years, only to succumb in 2022.
Chile has one of the highest excess mortality totals even though it is one of the most highly vaccinated nations.
South Africa (63.53)
By comparison, look at a country like South Africa, which does not enjoy the state capacity of the other nations surveyed here. It suffered several Covid waves in 2020 and 2021 but then returned to near-normal mortality rates.
We can’t end without discussing Sweden, a nation that’s special for many reasons.
Sweden stands out compared to most high-income nations because of its non-alarming mortality rates in 2021-22. (In fact, for the entire pandemic period, Sweden’s excess mortality is among the very lowest in Europe.) We can probably blame a portion of the 2021-22 effect on its higher mortality rate in 2020 (which itself was probably in part due to much lower mortality in 2019). More vulnerable people were around in 2020, while fewer vulnerable people were left in 2021 and 2022.
Unlike its Nordic neighbors, and even Germany, Sweden suffered a spike in mortality in 2020 but then apparently avoided the common fate of its peers in 2021-22.explored the mid-2021 flip in which mortality suddenly surged in Norway and Finland but not Sweden. Now, cumulative excess mortality is higher in Sweden’s neighbors.
You can see below that mortality rose most steeply in 2020. And yet – excess mortality did not then fall. It kept rising in 2021 and 2022, just not as steeply as it did in some of Sweden’s peer nations.
Another factor we won’t address in detail today but is nevertheless an important commonality to explore: birth rates in most of these nations, including Sweden, are way down and perinatal deaths are up.
So, while Sweden’s favorable 2021-22 mortality experience is a happy outlier, bolstering the wisdom of its stay-open strategy, it did not mean-revert as one might expect after a high-mortality year. Mortality rates were still higher compared to the long-run trend.
Uniting the Nations
The international data demonstrate that in high- and upper-middle income nations several things tend to be true. In places hit hard by Covid in 2020, excess mortality persisted (and sometimes grew worse) in 2021 and 2022. In nations which mostly avoided Covid in 2020, excess mortality rose sharply in 2021 and 2022.
Whatever the mix of Covid and non-Covid causes, the public health strategies of 2020-22 were mostly unsuccessful. Given that a respiratory pandemic like Covid should have receded in relative terms in 2021-22, one could argue that policy in 2021-22 was worse than the draconian lockdown responses of 2020. Even with the obvious acknowledgement that the effects of 2020 policies spilled over into morbidity and mortality in following years.
Hold on, one reasonably retorts: weren’t nations that avoided the first major Covid waves of 2020 bound to ‘catch up’ in 2021 and 2022 when Covid inevitably arrived? Yes, in part, especially for highly vulnerable populations. But remember three things:
In 2021-22, these nations had widespread vaccine coverage. One justification for extended lockdowns was to avoid the virus until vaccines arrived. Total mortality over three years does not show this strategy worked.
The milder Omicron variants dominated all of 2022. Vaccines combined with milder variants should have, according to public health officials, substantially blunted any catch-up effect, but they did not.
Younger, healthier people who were not vulnerable to any Covid variants in any year suddenly succumbed to something in 2021-22. Both old and young, vulnerable and healthy suffered in 2021-22, even if they were spared in 2020.
The consistent mortality experience across high-income nations dramatically downgrades any explanatory power the Wallace-Wells and Fox arguments might have contained. Not every nation counts Covid the same way, but if anything they probably overcount, so the “America undercounts” thesis doesn’t look plausible. Most of these nations, meanwhile, were not suffering the same pre-pandemic deaths-of-despair problem as the U.S., so they had no trends to continue. The Mexican drug cartels did not suddenly find a way into Japan and Singapore.
Other common factors among high-income nations are thus implicated.
The Actuarial Elephant
Which leads us to inevitable discussion of the biggest single factor of 2021-22 – the delivery of billions of doses of novel genetic transfection agents, which we call the Covid-19 mRNA and DNA vaccines.
Citizens of the 12 high- and upper-middle income nations listed above have taken around 1.35 billion doses. The number in parentheses next to each country’s subhead is the doses taken per 100 people, from the lowest Israel (197.29) to the highest Chile (319.78). By comparison, South Africa (63.53) and the United States (202.28).
Wallace-Wells dedicates all of one parenthetical sentence to brushing aside the billions of gene therapy doses as a possible factor in a global health calamity.
(If vaccination risk was playing a role, it might create the same pattern, but that’s not what the curves show.)
Fox spends far more time on them, but cites a couple delusional studies claiming cardiac and clotting events fall after vaccination. The FDA and CDC aren’t so bold.
In fact, we know from dozens of studies and autopsies that the mRNA vaccines cause myocarditis at alarming rates and that this form of heart inflammation is not uncommonly fatal. In fact, many myocarditis events are never registered as such because sudden death occurs before any cardiac symptoms are detected.
Too little attention is paid to the specific biology. Journalists and even most doctors assume the label ‘vaccine’ is dispositive. Yet our scientific authorities failed to understand, or to explain, just how novel the LNP-mRNA technology is, and how bio-active the SARS-CoV-2 Spike protein is. A mere label cannot predetermine complex biology.
We’ve documented the specific mechanisms of action whereby lipid nanoparticle (LNP) vessels deliver synthetic modRNA to many organs and cell types; modRNA then generates large amounts of Spike protein not for hours or days but, potentially, for weeks or months; and toxic Spike often devastates the vascular endothelia (inner lining of blood vessels and capillaries) and other tissues, including the kidneys, adrenals, heart, and brain.
The autopsies prove it.
Synthetic modRNA and Spike can also disrupt the extraordinarily intricate immune system and other bio signaling mechanisms – the body’s information networks.
We’ve got more than 3,000 peer-reviewed case reports of specific vaccine-induced injuries and deaths, including pulmonary embolisms, diverse vascular and coagulatory pathologies, Bell’s palsy and Guillain Barré, viral reactivation (shingles, Epstein-Barr, etc.), numerous autoimmune troubles (such as lupus, arthritis, thyroiditis, IgG4 disease), Covid-like lung disease, endless neuropathies, turbo cancers, aortic dissections, acute kidney failure, and reproductive problems in both men and women. For each one of these published case reports, many thousands of similar events likely go unreported.
In their December 2022 review, math professorsand found a positive correlation between excess mortality and the portion of national populations fully vaccinated.
Spiro Pantazatos, a Columbia University neuroscientist, and Herve Seligmann, an Israeli data analyst, had previously shown a tight temporal correlation between vaccination and death in Israel, Europe, and the U.S. Dutch immunologist Theo Schetters showed the same thing in the Netherlands.
Lockdowns, opioids, economic dislocation, and of course Covid itself all have rolls in this mortality play. And yet across many varied cultures, cohorts, time periods, and pandemic policies, there was one common actor.
Whither State Capacity
We also return to the essay, the manifesto of State Capacity Covidology, which prompted us to begin this series. The U.S. failed to sufficiently militarize its response, it argued. If we’d just gotten serious, earlier, like Germany, Japan, Taiwan, Australia, or even China, we would have performed better. More early testing, more masking, more locking down could have stamped out the virus. The singular success, it raved, was the vaccines, which supposedly saved three million American lives, and more than 20 million around the world.
Can we agree that extraordinary excess mortality among these ‘serious countries’ in 2021-22 sinks the State Capacity narrative? Or will they continue claiming 20 million lives saved when the nations who most aggressively deployed a novel technology are suffering the worst death rates in memory, even among young and healthy populations, who were barely vulnerable to the virus, but low-income nations who did not consume the technology are doing just fine?
Brief U.S. Update
Total excess mortality in the U.S. exploded in 2020, was slightly worse in 2021, and then remained historically elevated, though not as extremely terrible, in 2022. In the last six weeks, total mortality mercifully fell into the top end of the ‘normal range’ for the first time in nearly three years. As you can see below, we had not broken out of the normal range at any time in the previous five years (2015-19).
We notice that in week 6 of 2023, excess mortality, at 15.4%, once again not only broke out of the normal range but also exceeded the ‘substantial increase’ range.
This could be a blip of preliminary data that will vanish with next week’s CDC print. At this point, however, significant and extended mortality deficits should be making up for the past three years of devastating surpluses.
Even normal or slightly lower-than-normal mortality going forward would be a sign of prolonged pathology. Continued excess signals calamity.
Comments on State Capacity Covidology
Update on May 27, 2023. The pre-print we cited showing German mortality 2020-22 has now been published in Cureus. Kuhbandner C, Reitzner M (May 23, 2023) Estimation of Excess Mortality in Germany During 2020-2022. Cureus 15(5): e39371. doi:10.7759/cureus.39371. Here’s the link: https://www.cureus.com/articles/149410-estimation-of-excess-mortality-in-germany-during-2020-2022#!/.