{"id":4368,"date":"2023-01-18T15:49:43","date_gmt":"2023-01-18T14:49:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4368"},"modified":"2024-12-11T09:04:38","modified_gmt":"2024-12-11T08:04:38","slug":"dying-like-never-before","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2023\/01\/18\/dying-like-never-before\/","title":{"rendered":"Dying like (never) before"},"content":{"rendered":"<p>By Ezio Di Nucci.<\/p>\n<p>At no (other) time during the COVID-19 pandemic <a href=\"https:\/\/politiken.dk\/forbrugogliv\/sundhedogmotion\/art9164430\/Overd\u00f8deligheden-i-Danmark-har-de-seneste-uger-sat-rekord-for-hele-coronaperioden\">were excess deaths as high as they are this January 2023 in Denmark<\/a>. That\u2019s 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:<\/p>\n<ul>\n<li>that mortality is higher now than it was during any of the perceived covid-peaks; but also<\/li>\n<li>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.<\/li>\n<\/ul>\n<p>Two separate questions come to mind, one strictly epidemiological (EPI); the other broadly normative (NORM):<\/p>\n<p>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)?<\/p>\n<p>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 \u2013 don\u2019t \u2013 you\u2019ll find that, at most, folks are calling for boosters for under-50s, not exactly armed guards outside every apartment building).<\/p>\n<p>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\u2019s RS too; plus ,maybe some of those missing cancer diagnosis from two years ago;<a href=\"#_ftn1\" name=\"_ftnref1\">[1]<\/a> so let\u2019s leave EPI to the pros and move on to the softball.<\/p>\n<p>Here are some possible answers to NORM:<\/p>\n<ul>\n<li>bringing masks and lockdowns back now, proportional to current excess mortality \u2013 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 &#8211; in 2023 &#8211; tighter restrictions than we had, say, in the spring of 2020 or winter of 2021.<\/li>\n<li>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 \u201cnever\u201d before, we will not intervene restrictively.<\/li>\n<\/ul>\n<p>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.<\/p>\n<ul>\n<li>Between these two \u201cextremes\u201d, there isn\u2019t much, actually \u2013 but we could consider arguments according to which, for example, the reasons why current excess mortality doesn\u2019t 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\u2019t.<\/li>\n<\/ul>\n<p>This line of argument has the advantage of emphasizing that the current peak in Denmark (and probably the rest of Europe &#8212; I too have stopped obsessively refreshing ourworldindata pages<a href=\"#_ftn2\" name=\"_ftnref2\">[2]<\/a>) must be distinguished from what is happening in China after their own <em>liberitutti<\/em>, 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\u2019t fed by young anti-vaxxers but by the same 80-somethings that were overdying during previous peaks.<\/p>\n<ul>\n<li>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.<\/li>\n<\/ul>\n<p>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\u2019t (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 \u201cso good\u201d at lockdowns, tracking, masks, and vaccines, we should consider restrictive measures for any excess mortality, at least of the infectious kind anyway.<\/p>\n<ul>\n<li>There is one final option, and I am sorry to say, <a href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/10\/20\/have-enough-people-died\/\">but I had written about it in these very pages already back in 2020<\/a>: namely, the hypothesis that not enough people died \u201cduring the pandemic\u201d, and life is now catching up. I won\u2019t replay those arguments here, but it\u2019s just important to point out that this option #5 is counterfactually different from the previous ones and therefore deserves separate listing.<\/li>\n<\/ul>\n<p>As always, we are just philosophers, we are not here to adjudicate between those different options, it\u2019s good enough if we notice an anomaly and point out that it calls for further reflection &#8211; if not, god forbid, action.<\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8211;<\/p>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> And, obviously, inflation is literally killing people too, you don\u2019t 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.<\/p>\n<p><a href=\"#_ftnref2\" name=\"_ftn2\">[2]<\/a> If you haven\u2019t 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, <a href=\"https:\/\/uniavisen.dk\/event\/pandemic-ethics-debate-with-anders-tegnell\/\">to discuss pandemic ethics with us in Copenhagen<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Author<\/strong>: Ezio Di Nucci<\/p>\n<p><strong>Affiliation:<\/strong> University of Copenhagen<\/p>\n<p><strong>Competing interests:<\/strong> None declared<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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\u2019s 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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2023\/01\/18\/dying-like-never-before\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":354,"featured_media":4502,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8102,8070],"tags":[],"class_list":["post-4368","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid","category-pandemic"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dying like (never) before - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2023\/01\/18\/dying-like-never-before\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dying like (never) before - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"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\u2019s 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 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2023\/01\/18\/dying-like-never-before\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2023-01-18T14:49:43+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-12-11T08:04:38+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2023\/04\/Paperwork.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"300\" \/>\n\t<meta property=\"og:image:height\" content=\"217\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Hazem Zohny\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Hazem Zohny\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/\"},\"author\":{\"name\":\"Hazem Zohny\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\"},\"headline\":\"Dying like (never) before\",\"datePublished\":\"2023-01-18T14:49:43+00:00\",\"dateModified\":\"2024-12-11T08:04:38+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/\"},\"wordCount\":984,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2023\\\/04\\\/Paperwork.jpg\",\"articleSection\":[\"covid\",\"Pandemic\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2023\\\/01\\\/18\\\/dying-like-never-before\\\/\",\"name\":\"Dying like (never) before - 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At no (other) time during the COVID-19 pandemic were excess deaths as high as they are this January 2023 in Denmark. 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