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‘Deaths of despair’ during COVID-19 rose by up to 60% in 2020, new research says

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Deaths of despair have risen during the coronavirus pandemic, and latest research suggests the increase has been dramatic.

The pandemic and recession were associated with a 10% to 60% increase in deaths of despair above already high pre-pandemic levels, according to a working paper by Casey Mulligan, professor of economics at the University of Chicago. These non-COVID excess deaths are disproportionately experienced by men aged 15-55, including men aged 15-25, he found.

“From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID under-count and 30,000 non-COVID. Deaths of despair — drug overdose, suicide, alcohol — in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020,” Mulligan wrote in his paper, distributed Monday by the National Bureau of Economic Research.


‘Mortality in 2020 significantly exceeds what would have occurred if official COVID deaths were combined with a normal number of deaths from other causes.’


— Casey Mulligan, professor of economics at the University of Chicago

“Mortality in 2020 significantly exceeds what would have occurred if official COVID deaths were combined with a normal number of deaths from other causes. The demographic and time patterns of the non-COVID excess deaths (NCEDs) point to deaths of despair rather than an under-count of COVID deaths.” They increased steadily from March to June and then plateaued.

They were disproportionately experienced by working aged men, including men as young as aged 15 to 24. “Presumably social isolation is part of the mechanism that turns a pandemic into a wave of deaths of despair,” Mulligan said. However, he did not speculate on how much, if any, comes from government stay-at-home or business closures to encourage social distancing.

Others advise caution on such estimates. “We do not actually know that these deaths are increasing during the COVID-19 pandemic,” according to Megan Ranney, an emergency physician and associate professor of emergency medicine and public health at Brown University, and Jessica Gold, a psychiatrist and assistant professor of psychiatry at Washington University in St. Louis.

In an op-ed for the health site Stat, they said, “Police and crisis hot lines may — or may not — be receiving extra calls for domestic violence and child abuse. Firearm homicide rates are staying steady. Suicides are certainly occurring, but there is no evidence to date that their rate is on the rise (and we may not know the impact of the pandemic on suicide for years to come).”

“Despite ample evidence that anxiety is increasing during the pandemic, anxiety alone is rarely a driver for suicide. It is not even a risk factor for it,” Ranney and Gold added. “Right now it is all too easy to blame every tragedy on COVID-19. Science warns us, however, not to make this fundamental error of attribution.”

People are, of course, suffering economically. At the height of the pandemic in March, more than 30 million Americans were laid off or furloughed when the economy shut down to curb the spread of COVID-19. The unemployment rate at that point was 14.7%; it has since come down to 6.7%. The leisure and hospitality industries have been particularly hit hard by the pandemic.

In April, nearly 12 million low-wage workers were laid off, while some 6 million workers who were earning between $18 to $29 an hour were laid off. By November, all but 400,000 of those workers earning $18 to $29 an hour had returned to work, Raj Chetty, a Harvard economics professor, said. Meanwhile, some 6 million workers who earned less than $13 an hour have yet to return to work.

As of Monday, COVID-19 has infected over 85.2 million people worldwide, which mostly does not account for asymptomatic cases, and killed 1.8 million, including 351,590 in the U.S. The U.S. has the world’s highest number of COVID-19 cases (20.6 million), followed by India (10.3 million), Brazil (7.7 million) and Russia (3.2 million), according to data aggregated by Johns Hopkins University.

Mulligan measured actual deaths from a Centers for Disease Control and Prevention file for 2020 that begins on Jan. 26, and ended his calculations through week 40 — the week ending Oct. 3. COVID-19 deaths and actual total deaths are reported in this file. He defined excess deaths as the difference between actual total deaths and projected deaths, based on previous years.

“The CDC reports 12-month moving sums of deaths from drug overdose,” Mulligan wrote. During the nine months before the pandemic, each new moving figure of none-COVID excess deaths (or NCEDs) averaged 680 deaths more than the previous. In March 2020, however, they totaled 1,511 above the previous total.

“The same CDC data through May 2020 show that synthetic opioids such as fentanyl are driving the increases. Given that men have a larger share of fentanyl-overdose deaths than prescription-opioid-overdose deaths, this suggests that men would be disproportionately represented among 2020 NCEDs,” he concluded.

Some health professionals have warned of a rise in the epidemic of “deaths of despair” in the U.S. In fact, approximately 75,000 more people will likely die from drug or alcohol misuse and suicide as a result, according to predictions released last March by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.


‘A complex constellation of risk factors, only a few of which are directly tied to COVID-19, are known to drive these tragic deaths.’


— Megan Ranney, an emergency physician, and Jessica Gold, a psychiatrist, writing in Stat

Projections of additional “deaths of despair” range from 27,644, assuming a quick economic recovery and the smallest impact from unemployment, to 154,037, assuming a slow recovery and the greatest impact from unemployment. “We can prevent these deaths by taking meaningful and comprehensive action as a nation,” the researchers wrote in the report.

“More Americans could lose their lives to deaths of despair, deaths due to drug, alcohol, and suicide, if we do not do something immediately,” the report said. “Deaths of despair have been on the rise for the last decade, and in the context of COVID-19, deaths of despair should be seen as the epidemic within the pandemic.”

However, Ranney and Gold said those results should be taken with some serious caveats. “These projections are based on data from the Great Recession, meaning the models weren’t able to factor in the unique aspects of what is happening today, such as how new technologies make possible increased virtual social connection and support,” they added.

“A complex constellation of risk factors, only a few of which are directly tied to COVID-19, are known to drive these tragic deaths,” they wrote. “We have evidence-based interventions that can reduce the rates of many of the risk factors for all of these deaths whether or not the country is practicing social distancing, hand-washing, and mask wearing.”


Source: Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

President Donald Trump has repeatedly warned that efforts to stem the rapid spread of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, are spiraling the economy into another Great Recession; the impact has sent the Dow Jones Industrial Average
DJIA,
-0.35%

 ricocheting wildly in recent months.

The federal government must fully support and invest in a plan to improve mental-health care, said Benjamin Miller, chief strategy officer at the Well Being Trust. “If we work to put in place healthy community conditions, good health-care coverage, and inclusive policies, we can improve mental health and well-being,” he added.

The Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care is an independent research unit affiliated with the American Academy of Family Physicians, and works to improve individual and population health by enhancing the delivery of primary care.

Trump has vacillated between heeding the advice of public-health experts and bending to the views of his favored economists.


MarketWatch photo illustration/Getty Images

Don’t miss: New estimates on coronavirus fatalities make for chilling reading as U.S. states ease restrictions on social distancing

Anne Case and Angus Deaton, economists at Princeton University, first chronicled these “deaths of despair” among middle-aged non-Hispanic caucasians since 1999. They include deaths by suicide, alcohol poisoning, overdoses of opioids and other drugs, and cirrhosis of the liver. The CDC estimates they’ve almost doubled since 1999, reaching 150,000 in 2017.

”SARS CoV-2 is having an unprecedented impact on the world. No one alive can recall any infection or worldwide event of such magnitude and scale,” the new report added. “Along with the tens of thousands of deaths in the United States from the virus, COVID-19 overlays the growing epidemic of deaths of despair threatening to make an already significant problem even worse.”

The researchers issued a warning for the months and even years ahead, arguing for additional investment in health care and strategies to deal with the phenomenon. “A preventable surge of avoidable deaths from drugs, alcohol, and suicide is ahead of us if the country does not begin to invest in solutions that can help heal the nation’s isolation, pain, and suffering,” they wrote.

The debate over the ramifications of a months-long shutdown of the American economy has been at times both emotional and sobering. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases for more than three decades and one of the leading experts in the U.S. on infectious diseases, has pleaded with people to “socially distance.”

The debate over the economy’s survival vs. the public health emergency highlights, as well, the chasm between left and right on the American political spectrum. The left generally believes that strong social structures beget a stronger economy for all. The right traditionally follows the idea that a strong economic system begets strong social structures for all.

Ranney and Gold argue that drawing a line between deaths of despair and political policies to reduce social distancing is a crude one. “It is also wrong to imply that reopening the country will, in and of itself, stop deaths of despair. Jobs may or may not rebound when social distancing rules are relaxed. Much of the decline in travel and eating in restaurants predated formal rules about social distancing.”


Source: Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.



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No, you’re not crazy. Yes, CDC mask guidelines are confusing — should you stop wearing a mask in public or not?

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Wear a mask. Don’t wear a mask. Make one. Buy one. Wear it outdoors. Wear it indoors.

Confused? You’re not alone.

So what’s the deal with the CDC’s new guidance? “Anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing,” Dr. Rochelle Walensky, the director of the U.S. Centers for Disease Control and Prevention, said on Thursday. “If you are fully vaccinated, you can start doing the things that you had stopped doing because of the pandemic.”

Vaccines have helped to slow the spread of the coronavirus, and this appears to be a natural next step for Americans tired of masking up. “We have all longed for this moment when we can get back to some sense of normalcy,” Walensky said.

We are still far, far away from normal. You can take off your mask “except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance,” the CDC says. You still need a mask on buses and trains, in museums and most stores, possibly at your place of work, but not inside restaurants, except when you’re going to the rest room.

How do you know a maskless person is vaccinated? It’s an honors system. The CDC guidance gives less reason for people to abide by that old American Express slogan: “Don’t leave home without it.” People are leaving home without their masks, even in states that still require everyone — vaccinated or not — to wear them in outdoor public spaces, including on the streets of New York.

Many people are fed up, it seems. Little wonder: The CDC’s announcement took many health professionals by surprise: According to a New York Times survey, 29% of epidemiologists surveyed thought people would be wearing masks in public spaces for at least aanother year, while 26% said they believed people would do so for another year, and 26% said they thought mask wearing would continue in some form from now on.


‘You still need a mask on buses and trains, in museums and most stores, possibly at your place of work, but not inside restaurants, except when you’re going to the rest room.’

The change in CDC mask guidelines comes just over a year since the CDC said everyone should wear masks. In April 2020, the Trump administration and the CDC reversed their policies on face masks, and said all Americans should wear cloth face coverings and not — as officials previously said — just medical workers. Trump cited “recent studies,” while the CDC cited “new evidence.”

Fast-forward to Thursday. “I think it’s a great milestone, a great day. It’s been made possible by the extraordinary success we’ve had in vaccinating so many Americans so quickly,” a maskless President Joe Biden declared in the White House Rose Garden declared, citing the vaccines from Johnson & Johnson
JNJ,
+0.15%

Pfizer-BioNTech
PFE,
-0.20%

and Moderna
MRNA,
+7.68%
.

“It’s going to take a little more time for everyone who wants to get vaccinated to get their shots. So all of us, let’s be patient with one another,” the president said.

Forgive the public for having mask rules fatigue. We’ve been on quite a journey. Studies earlier in the pandemic suggested that adopting the practice of mask wearing, one that was already accepted in many Asian cultures, would have saved tens of thousands of lives. Many Americans were understandably frustrated, but also eager to do anything they could to stop the virus.

‘So what’s the deal with the CDC’s new guidance?’


MarketWatch illustration

Flashback: Dr. Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases, said in a briefing on Jan. 30 last year, “The virus is not spreading in the general community. We don’t routinely recommend the use of face masks by the public to prevent respiratory illness. And we certainly are not recommending that at this time for this new virus.”

Three months later, New York Gov. Andrew Cuomo, a Democrat, ordered all New Yorkers to cover their faces in public when they can’t maintain a proper social distance. “You’re walking down the street alone? Great! You’re now at an intersection and there are people at the intersection, and you’re going to be in proximity to other people? Put the mask on.”


‘These are just guidelines from the CDC. It’s up to the states to decide what to do next. New Jersey and New York still maintain their mask guidelines in public spaces.’

The CDC’s latest mask announcement are just guidelines. It’s up to the states to decide what to do next. And that’s a whole other story. New Jersey and New York still maintain their mask guidelines when in public spaces. Gov. Phil Murphy, a Democrat, is examining the guidelines, a spokeswoman for his office said in a statement. Murphy, like many governors, wears a mask in his Twitter profile. Perhaps that tells us all we need to know.

Roughly half of U.S. states have some mask mandate. Alabama, Louisiana, South Carolina, Florida, Mississippi, Nebraska, and Texas, among others, had already removed their statewide mask mandates in public spaces and/or had not instituted one. Florida Gov. Ron DeSantis, a Republican, said Thursday he would grant clemency to gym owners who broke the mask mandate.

Texas Gov. Greg Abbott, a Republican, officially ended his state’s face-mask mandate in March, and allowed businesses to reopen, despite opposition from rival lawmakers and health professionals at the time. Gilberto Hinojosa, chairman of the Texas Democratic Party, described the move as “extraordinarily dangerous” and said it “will kill Texans.”

Cuomo, meanwhile, perhaps still reeling from this time last year when New York was the epicenter of the pandemic in the U.S., was definitive in maintaining current policy. Keep your masks on. “In New York, we have always relied on the facts and the science to guide us throughout the worst of this pandemic and in our successful reopening,” he said in a statement.


‘People take off their masks to make phone calls on the street in states where there is a mandate to wear them in public places, and they take them off while they are sitting outdoors eating.’

Vermont Gov. Phil Scott, a Republican, said his state will follow the CDC guidelines. “Later today, we’ll be updating Vermont’s mask mandate following the CDC’s updated guidance, announced yesterday,” he tweeted Friday. “This will mean those who are fully vaccinated no longer need to wear masks — indoors or outdoors — nor do they need to be concerned with physical distancing.”

In Nevada, Gov. Steve Sisolak, a Democrat, said the state updated its own policies on mask wearing to follow the CDC’s guidelines with immediate effect. Nevada Health Response added: “COVID-19 is still very much a threat in our State and many Nevadans may choose to continue using masks based on their and their families’ personal health concerns. Others should respect this choice.”

That statement, perhaps more than any other, illustrates the tension, fear and frustration not only with state laws and changing guidance, but with each other. People take off their masks to make phone calls on the street in states where there is a mandate to wear them in public places, and they take them off while they are sitting outdoors eating. Most people are doing the best they can.

In California, Gov. Gavin Newsom, a Democrat, said people should still wear masks in public spaces for now, but likely not after June 15 when the state fully reopens. “Only in those massively large settings where people around the world, not just around the country, are convening and where people are mixing in real dense spaces,” Newsom told KTTV.

“Otherwise we’ll make guidance, recommendations, but no mandates and no restrictions in businesses large and small.” Is that all crystal clear? I’ll leave that for you to decide.





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My friends raised $15,000 on GoFundMe while I was comatose after an accident. But I inherited $1 million, and my insurance covered the costs

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Dear Quentin,

Last month, I was in a terrible accident. Most of the expenses are covered by insurance and a couple months before that, I received almost $1 million from a relative. I had not told anyone about my good fortune nor made any purchases (yet!) that would indicate a change of status. While I was in the ICU and comatose, a friend started a GoFundMe for me.

By the time I found out about it, it was up to $15,000 and over 300 friends, even strangers, had contributed. Several friends gave hundreds of dollars. I asked several more knowledgeable friends about somehow canceling it, and they discouraged that action. Too late! Now not only am I racked with guilt, but I am afraid to make improvements on my house.

I make donations to every GoFundMe that I come across, and I made donations to my favorite causes, but meanwhile there is THAT money. I did one “status update” on Facebook, thanking everyone and mentioning my ego “accepting” help. I am afraid to even look at the total, and have not gone to the site. To make it worse, before this, I was lower-middle-class, and so are many of the friends who gave money.

I am sick at the thought of their sacrifice. I will buy them lunch and drinks when I am on my feet, but what else can I do? I can’t even enjoy the money I received before the accident for fear of upsetting someone.

Ask Before Funding Me

You can email The Moneyist with any financial and ethical questions related to coronavirus at qfottrell@marketwatch.com, and follow Quentin Fottrell on Twitter.

Dear Funding,

You are still recovering from your accident, and no doubt traumatized by that ordeal. The last thing you need is this hanging over your head. It may have become a proxy for all of the emotional turmoil you endured during and after your accident.

That said, I suggest you rip off the Band-Aid and take action. Tell your friends that you appreciate what they did for you, but your insurance covered most of the costs, and you have an inheritance and more money than you need to get through this.

GoFundMe can also return the money to your friends. You can post another status update to say the gesture meant more than any monetary value, but the insurance has come through, and you have been very fortunate. GoFundMe makes it easy to refund donors.

And, yes, I take your point. Setting up a GoFundMe without the knowledge or permission of a friend or neighbor or coworker is a risky prospect, and should be avoided in most, if not all, instances. In this case, you were in the ICU and sedated, so they can be forgiven for that.

Godspeed with the rest of your recovery.

The Moneyist: My friend set up a GoFundMe to pay for her sick pet, instead of getting a refund on our vacation. I canceled the trip. Who’s right?

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My friend of 30 years owes me $20,000 after living in my apartment rent-free. She texted on my birthday to say she misses our friendship

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Dear Quentin,

One of my oldest friends of 30 years rented an apartment from me for 8 years. She stopped paying rent during the last year when she started her own business. She kept saying she would pay me back, but by the time she moved out 3 years ago, she owed me more $20,000 in back rent and stopped taking my calls when I tried to collect it.

Out of the blue she texted me on my birthday last week, and said she missed me, and would like to be friends again. However, her texts mentioned nothing about paying me back. I have already made peace with the lost money, and lost friendship, but I’ll bring up the back rent if we do speak again, which will probably be the end of that.

So what should I do? What should I say?

Bad Blood

You can email The Moneyist with any financial and ethical questions related to coronavirus at qfottrell@marketwatch.com, and follow Quentin Fottrell on Twitter.

Dear Bad Blood,

“…and I miss my $20,000.”

If your friendship is that important to your friend, she should have led with her amends. The price of that is $20,000. The most interesting, if not surprising, thing about her text message is that it focused on how she feels, and her needs. It does not address the harm she has done to your friendship — possibly irrevocably.

U.S. states have a dollar limit on small-claims court cases. Unless you live in Delaware, Texas or Tennessee, it seems that your dispute with this friend exceeds that amount in other states. But that also speaks to the amount of money she pocketed. It’s a lot of money, and it should not be brushed off so lightly. Think again about taking legal action.

Enough texting. Meet her face to face. Tell her that you had to pay the mortgage while she lived there rent-free, and remind her that she is not the only person with financial responsibilities, and that she abdicated her duty to you as a tenant and as a friend to pursue her needs. She used your friendship as leverage to scam free rent.

She cannot repair the friendship until she has repaid the debt.

The Moneyist: My boyfriend talked me into depositing my paychecks into his bank account, and paying for a car in his name. What can I do?

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