Dying like (never) before

By Ezio Di Nucci.

At no (other) time during the COVID-19 pandemic were excess deaths as high as they are this January 2023 in Denmark. That’s right, more people are dying now than at any other time since the beginning of the pandemic (the last time excess death numbers were comparable was, in fact, the winter 2017/2018). There are actually two different headlines here:

  • that mortality is higher now than it was during any of the perceived covid-peaks; but also
  • that never during those perceived covid-peaks was mortality as high as it was in the influenza winter 17-18, before anybody had heard of lockdowns and (in the west) masks.

Two separate questions come to mind, one strictly epidemiological (EPI); the other broadly normative (NORM):

EPI: why are more people dying now than at any other time during the pandemic, especially in a rich welfare state with one of the highest vaccine uptakes worldwide (as in, not China)?

NORM: why, if more people are dying now than ever before (during COVID-19), is nobody calling for lockdowns or even masks (if you do a deep-dive in covid-twitter – don’t – you’ll find that, at most, folks are calling for boosters for under-50s, not exactly armed guards outside every apartment building).

The EPI question is boring and predictable: influenza is back with a vengeance because it missed last season, while at the same time COVID-19 is still around. And there’s RS too; plus ,maybe some of those missing cancer diagnosis from two years ago;[1] so let’s leave EPI to the pros and move on to the softball.

Here are some possible answers to NORM:

  • bringing masks and lockdowns back now, proportional to current excess mortality – after all, excess mortality, rather than COVID-19 CFR (case fatality rate) was always the better measure, which would have the apparently counterintuitive effect of having now – in 2023 – tighter restrictions than we had, say, in the spring of 2020 or winter of 2021.
  • Admitting that lockdowns and all the rest of it were never reasonable and proportional priority setting; we just panicked because that sh*t was new and unknown; we got, basically, carried away, but now we have regained a certain perspective and distance, so that even though people are dying as “never” before, we will not intervene restrictively.

This second option is also in line with the latter headline, namely the fact that we had similar excess mortality in the winter of 2017/18, but nobody suggested lockdowns back then.

  • Between these two “extremes”, there isn’t much, actually – but we could consider arguments according to which, for example, the reasons why current excess mortality doesn’t warrant restrictions (but previous lesser excess mortality did), have to do with, say, the wide availability of vaccines and boosters, so that now there are alternatives while during previous peaks there weren’t.

This line of argument has the advantage of emphasizing that the current peak in Denmark (and probably the rest of Europe — I too have stopped obsessively refreshing ourworldindata pages[2]) must be distinguished from what is happening in China after their own liberitutti, because of the lack of availability of effective vaccines in the latter case. Against option #3, on the other hand, speaks the fact that current excess deaths aren’t fed by young anti-vaxxers but by the same 80-somethings that were overdying during previous peaks.

  • Can you think of any other possible differences between current excess deaths and previous peaks? Here we should at least mention that NORM is not independent from EPI, so that there are possible epidemiological explanations that might make a difference to answers to NORM, at least in principle.

Imagine, for example, that the true answer to EPI had nothing to do with the pandemic: as in, not just that current excess deaths weren’t (only) COVID-19 deaths, but that current excess deaths were wholly unrelated to the pandemic and our reaction to it altogether. Even then, though, there would still be the question of why, assuming that somehow COVID-19 makes justifying restrictions easier than some other cause of excess mortality. At least in principle, then, now that we have become “so good” at lockdowns, tracking, masks, and vaccines, we should consider restrictive measures for any excess mortality, at least of the infectious kind anyway.

  • There is one final option, and I am sorry to say, but I had written about it in these very pages already back in 2020: namely, the hypothesis that not enough people died “during the pandemic”, and life is now catching up. I won’t replay those arguments here, but it’s just important to point out that this option #5 is counterfactually different from the previous ones and therefore deserves separate listing.

As always, we are just philosophers, we are not here to adjudicate between those different options, it’s good enough if we notice an anomaly and point out that it calls for further reflection – if not, god forbid, action.

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[1] And, obviously, inflation is literally killing people too, you don’t have to be a Marxist to see that. The more complex economics question is how much current high inflation levels are causally related to covid (rather than, say, Putin). I use the following rule of thumb: take your inflation number, split it in two equal halves, one is Putin, the other the ECB (or FED etc); and the ECB is (also) covid, but not just that (remember Draghi). Also, Putin might be mad but he aint stupid, he waited for the ECB to bring about unsustainable levels of inflation, then double-downed.

[2] If you haven’t moved on yet yourself, you might be interested in hearing that, on 8 February, we have invited Anders Tegnell, who ran the unique Swedish response to COVID-19, to discuss pandemic ethics with us in Copenhagen.

 

Author: Ezio Di Nucci

Affiliation: University of Copenhagen

Competing interests: None declared

 

 

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