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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
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 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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Opinion: Few 401(k) participants changed portfolio allocation when market tanked

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The rumor has been that 401(k) participants took little action when the stock market declined by more than 30% in February and March 2020. A Morningstar study provides some numbers to back up the lore.

The data come from a major record-keeper for defined-contribution plans. The starting point was snapshots for two dates: Dec. 31, 2019 and March 31, 2020. To be included in the analysis, the participant had to show up in both samples. That is, they had to be enrolled on or before Dec. 31, 2019 and still in the plan March 31, 2020. This construct ensures that observed changes reflect active decisions by participants as opposed to the sponsor replacing one fund with another. The final sample consisted of 635,116 participants across 509 plans.

The important finding is that only 5.6% of participants enrolled as of Dec. 31, 2019 changed their portfolio allocation during the first quarter of 2020. Participants who adjusted their portfolios changed their equity allocations. Most of these changes were relatively small, with an average equity reduction of about 10 percentage points. However, older participants who changed their accounts made larger changes than younger participants, particularly if they were invested more aggressively.

Much of the report goes on to look closely at the 5.6% who did move their money. For this exercise, the report identifies four types of participants: self-directing their accounts, using a target-date fund, defaulted into a managed account, and opted into a managed account. The pattern across participants shows that those with professionally managed solutions — target-date funds or managed accounts — were much less likely to change their allocation.

On balance, this report seems like good news. Buying high and selling low doesn’t end well.



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I’m 28, have zero debt, a 401(k), Roth IRA and $45K in the bank. My parents want me to save for a home. I want a Tesla Model 3. Who’s right?

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Dear Quentin,

I’ve been flip-flopping back and forth between buying a new car or putting a down payment on my first home. With my parents being very money-minded and keeping a careful eye on my finances (still), I’m caught in a predicament.

The original plan was to save up 20% to 30% for a down payment on a condo in the suburbs of Los Angeles and buy into the market within the two years or so, and right now I’m about 40% towards that goal.

However, with the Green Act possibly on the horizon again, the Model 3 has been a temptation, especially with all the extra bonus incentives my state offers, with a net final price of around $27,000. I’m not desperately in need of a new car, but this seems like a great way to save some money on a vehicle with smart features.


With the Green Act possibly on the horizon again, the Model 3 has been a temptation, especially with all the extra bonus incentives my state offers.

I am 28 years old with zero debt as of January 2021. Retirement wise, I am well on my way to maxing out 401(k) contributions this year, and I have already maxed out my Roth IRA contributions, and if everything stays the same, I’ll have about $60,000 in retirement by the end of the year.

In terms of liquid assets and investments, I’m sitting on about $45,000 as of right now. I currently save and/or invest 50% to 60% of my take-home pay, since I moved back home with my parents after being laid off last year, and started a new job remotely.

I don’t know if I should (a) purchase the car straight up and empty out my savings as I will probably have the time to save up the money again before a potential housing crash, (b) not purchase the car and keep saving for the down payment, (c) do both or (d) invest the money elsewhere.

As financial conservatives, my parents are strongly against me buying the car because it’s a depreciating asset, and they believe entering the market should be my priority, so they think that I should have the down payment waiting, to jump into the market whenever I see a good deal.

I believe I can buy the car and strap down, and save more aggressively to replenish the funds. Any advice for me?

Pressured by the Parents

You can email The Moneyist with any financial and ethical questions related to coronavirus at qfottrell@marketwatch.com

Dear Pressured,

What the hell! Give into your impulse, splash out on the Tesla
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Model 3. You will be empowered by the knowledge that you are using your spending power to get America back on its feet, while making a cool statement that you have finally arrived. Fully embrace the American dream of being smack-bang-wallop in the middle of the eco-warrior, Tesla-driving, tech-savvy zeitgeist. All any of us have is today, after all and global warming is coming for us all in the end.

Cruise the neighborhoods where you would like to buy a home in your 30s, 40s or 50s (it will all depend on how the property market fares between now and then). Take a good look at those homes, assuming they are not obscured by manicured hedges, and enjoy the view. Drive back to your parents’ house, honk the horn so they can marvel at Elon Musk’s bold vision for themselves, and then and only then ask them nicely if they would make space in their driveway for your Model 3.

I am kidding, of course. You have done everything right so far. Buy the house first and the $27,000 electric car later. You already have a destination in mind. Don’t allow an automobile, regardless of how cool you think it would be to drive, to deter you from that destination. Listen to your parents. They have seen more than you have. They are trying to set you on the road to financial freedom. And as nice as they are to drive and to be seen driving, you don’t need a Tesla to achieve that.

The Moneyist:‘Warren Buffett and Harry Potter couldn’t get those two retired early’: Our spendthrift neighbors said our adviser was ‘lousy.’ So how come WE retired early?

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 group where we look for answers to life’s thorniest money issues. Readers write in to me with all sorts of dilemmas. Post your questions, tell me what you want to know more about, or weigh in on the latest Moneyist columns.



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My wife and I are in our 60s. Should we skip our undeserving children and leave everything to our grandkids instead?

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Dear Quentin,

My wife and I are in our mid-60s and we are both retired. My parents have passed on. I have no living siblings or children. My wife has three adult children in their 40s. None of them are mature, responsible adults (alcohol, drugs, can’t hold a decent full-time job, etc.). They have four children.

We have to make some tough decisions regarding estate planning. Is it a viable option to skip the “middle generation” and bequeath all to the four grandkids? They are aged between 10 and 18.

We don’t want the middle generation to gain from our estate while cheating our grandkids out of their rightful inheritance, and we don’t want our life savings burned up by three undeserving kids while the grandchildren suffer. Can a trust or will assure us that our desired plan will actually happen?

Concerned Grandparents

You can email The Moneyist with any financial and ethical questions related to coronavirus at qfottrell@marketwatch.com

Dear Grandparents,

Can you skip the middle generation? You can. May you skip the middle generation? You may. I don’t want to sound like an elementary-school teacher, so let me reassure you that my opinion is not a judgment call on whether you should or shouldn’t, it is merely a vote of confidence for you to trust your gut and always remember that past behavior is the best predictor of future behavior.

A trust is a more private option than a will, and you can obviously set out terms of that trust and give the beneficiaries an income instead of a lump sum, if you don’t feel comfortable that your grandchildren would give the money to their parents to support bad habits. You could also provide money from the trust for, say, a down payment for a home in the beneficiaries’ name.


‘Alternatively, you could add terms to the trust to encourage good behavior in your wife’s children.’

Alternatively, you could add terms to the trust to encourage good behavior in your wife’s three children. “Incentive distribution schemes are common ways clients encourage productivity. If a beneficiary is in school, cash distributions from the trust can be made only if the beneficiary maintains a certain grade point average,” according to the Sketchley Law Firm.

Similarly, any distribution to your kids or grandkids could require proof that they have been alcohol- or drug-free for X number of years. ”Distributions may be conditioned on continued participation in drug and alcohol counseling, completion of in-patient rehabilitation programs, or remaining free of any further criminal or traffic violations related to drugs or alcohol,” the Sketchley Law Firm adds.

Your letter comes at an opportune time. I moderated a “MarketWatch: Mastering Your Money” online town hall, and I hosted a session on setting up wills and trusts with Elizabeth Forspan, an estate-planning attorney and partner at Forspan Klear, and Amy Zehnder, managing director and leadership and legacy consultant at Ascent Private Capital Management of U.S. Bank.

Zehnder summed up the difference between a will and a trust this way: “You don’t want all of your stuff to be visible to everyone, dumped in the front yard. And that’s probate! Trusts help to maintain privacy.” Should you decide to have a conversation with your kids about a trust — and you are under no obligation to do so — Zehnder suggests using words like “hopes,” “dreams,” “achieve” and “preserve.”

Forspan recommends that wills and trusts be revisited and, if need be, updated every four to five years. “Any time there is any major change in the tax law, or if there is any change in your family situation, or you get divorced, married or, God forbid, if someone in your family dies, you should always have a plan,” she said. “And appoint a power of attorney should you become incapacitated.”

There is much you can do to help your children and your grandchildren, whether they see it that way or not.

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