Are Pandemic-Related Excess Deaths Due to COVID or Vaccines? Depends on Who’s Counting (Part 2)

In Part 1 of this report, we reviewed a recent preprint linking excess deaths in Australia to the mRNA vaccine campaign. In Part 2, we consider the challenge of identifying the root cause of excess deaths, whether from COVID-19 or non-COVID-19 causes, such as vaccine adverse events or public health restrictions.

Summary of Key Facts

• COVID-19 deaths may have varying definitions set by hospitals and states.
• Vaccine-attributable deaths require more study to understand the mechanism of injury.
• Estimates of excess mortality vary worldwide, causing them to be challenged as unreliable. 
• Excess deaths among young people may have more to do with public health mitigations than the virus itself.
• Australian officials have formally linked a young woman’s death due to cardiac arrest with the mRNA-1273 booster.

Are Excess Deaths Due to COVID or Vaccines? Hard to Decide

Cleaning Up the Death Data Could Start With Admissions to the Hospital

Reviewing reasons for excess loss of life during the pandemic depends on accurately ascribing causes for deaths.

To begin this work, states and countries should agree upon a standard case definition of a “COVID death.”

Consensus around the “case definition” is a core element of any public health investigation, whether the situation is food poisoning at a baseball picnic or a global pandemic. It would also settle an important distinction: hospitalization “with” versus “from” COVID-19.

Throughout the pandemic, a fraction of patients have tested positive for SARS-CoV-2 upon admission to the hospital, but they were not admitted for COVID-19, the disease caused by SARS-CoV-2. These patients may have been admitted for appendicitis, a broken leg, a psychiatric condition, an overdose, or an obstetric condition.

Estimates of these “incidental” admissions have ranged from 42 percent in New York in January 2022 to 90 percent in Los Angeles in July 2022. The fraction of incidental admissions was lower earlier in the pandemic prior to widespread vaccine-induced and natural immunity-reduced severity of illness. For instance, a Los Angeles study conducted between August and October 2020 found 12 percent of admissions were not related to COVID-19. Nevertheless, it is very difficult to ascribe COVID-19 as the underlying cause of death without a chart review. For instance, an audit of deaths by Irish researchers concluded: “The COVID-19 death definition in Ireland may require revision so it can distinguish between deaths caused by COVID-19 and those in which COVID-19 played a less direct role.”

Leana Wen, MD, writing in The Washington Post a month ago, also called for better differentiation between hospitalization “with” and “for” COVID-19 among patients being admitted. One state has begun this work. Shira Doron, MD of Tufts Medical Center in Boston collaborated with Veterans Health Administration researchers on a study that showed that the administration of dexamethasone (a steroid used to help patients with low oxygen levels) was a good proxy for determining cases of severe COVID-19 in hospitalized patients. Based on those results, Massachusetts began requiring daily reporting of this metric by hospitals in January 2022. At that time, nearly 50 percent of patients hospitalized in the state with a positive COVID test had received dexamethasone. Since April 2022, that number has consistently been around 30 percent.

In other words, on most days, the proportion of patients being admitted “for” COVID-19 is 30 percent, down from about 50 percent just over a year ago. Population immunity and vaccination have reduced the severity of illness such that most patients found to be PCR-positive now upon admission are not being treated for COVID-19.

Accurately reporting the cause of death will provide public health officials with more trustworthy data that can be used to demonstrate who can benefit most from vaccination. Doron says it is time for a “campaign of honesty” to restore public trust in health officials.

Excess Mortality Estimates Are in Their Infancy

Excess mortality is the number of deaths over and above what would normally be expected had a pandemic not occurred. These excess mortality estimates vary widely by country, depending on different baselines.

In other words, to compute excess mortality, one must estimate what the expected mortality would have been without COVID-19. Then the actual observed death count should be compared to this estimate. If the count of deaths is higher than expected, then excess mortality has occurred. However, the difference between observed and expected mortality is not so simple to measure if the expected rate is difficult to predict.

Excess mortality estimates for Japan published in a recent letter to The Lancet offer a good example of how unreliable the reported numbers are. The COVID-19 Excess Mortality Collaborators estimated an excess mortality of 111,000 in Japan between January 2020 and December 2021. This was ten times higher than a separate estimate by The Economist (12,000). A third dataset found a negative excess mortality estimate (-13,000), which suggested that had the pandemic not occurred, there would have been a drop in death counts. The letter also pointed out that The World Mortality Dataset’s negative excess mortality calculation failed to account for the historic trends. Underestimating the expected deaths would inflate the excess deaths attributable to COVID-19.

With such a wide disparity in estimates for a single country—from negative deaths to a surplus of ten times more than expected—it is clear that excess death estimates are rather unreliable.

Public Health Restrictions, Not Disease, May Have Caused Excess Deaths to Surge

Another recent U.S. study of excess deaths attempted to “disentangle” the direct effects of SARS-CoV-2 illness from the indirect effects of public health restrictions. The study found that the direct effects of COVID-19 illness caused 84 percent of the excess deaths overall, but the excess mortality among people younger than 45 could not be ascribed to COVID-19.

Of the 112,000 excess deaths among people aged 25 to 44 years old, for example, COVID-19 was tied to only 30 percent as the cause of death in official statistics. The variable that best explained these deaths was the stringency of public health interventions. The authors rightly note that as an ecological study, it is not possible to prove causality. In other words, simply seeing two variables travel together is not enough to prove that one caused the other. This is why the Bradford Hill criteria introduced in Part 1 are helpful in discerning whether causality exists.

The real question is rather, how many doses and for whom is mRNA vaccination protective? And is there still reason to consider annual boosters for otherwise healthy adults? Experts in epidemiology and vaccinology are far from convinced. In his New England Journal of Medicine Perspective article, “Bivalent COVID-19 Vaccines—A Cautionary Tale,” Paul Offit, MD concludes: “In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later.”

Vaccine-Attributable Deaths Require More Study

The causality of a single death, let alone millions of lives lost, is difficult to prove in the postmortem of the pandemic. It is rather like finding a great deal of circumstantial evidence in a criminal case, but being unable to prove guilt beyond a reasonable doubt.

The same is true for vaccine-associated injuries. It is difficult to prove causality unless scientists and policymakers are willing to do the hard work of investigation and officials shoulder the even more arduous work of taking responsibility for harm.

An autopsy study conducted in Germany provides an example of research beginning to elucidate this question. Standardized autopsies were performed on 25 people who died unexpectedly within 20 days of mRNA vaccination. In four patients, evidence of acute myocarditis was found in the absence of any other likely cause of death.

Myocarditis can be a lethal complication following mRNA SARS-CoV-2 vaccination, but as discussed in Part 1, the proportion of deaths in Australia attributable to mRNA injections is far from conclusive.

Perhaps a campaign of honesty is beginning in some areas. Australia recently acknowledged a booster-associated death.

One of the young people forced to get a booster during the January 2022 campaign passed away nearly a year ago on March 27, 2022. Natalie Boyce, 21, died of myocarditis resulting in cardiac arrest six weeks after her government-mandated mRNA booster. The morning after the booster, Natalie fainted in her bedroom and hit her head. For the next six days, she had stomach pain, vomiting, and fever.

The family had sought treatment, transferred to a different hospital, and demanded that the young woman’s cardiac condition be evaluated. By the time they reached the right level of care, it was too late.

Ms. Boyce had a somewhat rare condition which may have elevated her risk. Antiphospholipid syndrome (APS) is an autoimmune condition that increases the production of abnormal proteins in the blood which can cause dangerous clotting. The condition affects women approximately five times more often than men and is typically diagnosed between ages 30 to 40 years.

The U.S. Centers for Disease Control and Prevention (CDC) does not currently list APS as a contraindication or precaution for mRNA vaccination.

The Australian Therapeutic Goods Administration (analogous to the CDC) linked the death to myocarditis caused by the mRNA-1273 (Moderna) vaccine. This is the first official acknowledgment of mortality linked to the COVID-19 vaccines. In its acknowledgment, the Australian officials noted that community awareness is high regarding the excess risk of myocarditis among young men, but may be less so among young women.

Similarly, the CDC’s reassurances that myocarditis and pericarditis are “mild” and resolve quickly may have unintended consequences. Young people and parents of young children who are unaware of the symptoms may not seek timely care. Several cardiologists have publicly stated that while most cases of myocarditis resolve, some cases can result in scarring which is permanent, and may cause problems. This unpredictable risk is being downplayed by the CDC, which could be part of the reason for public mistrust.

The CDC encourages patients to seek care for symptoms of myocarditis or pericarditis such as:

• Chest pain, shortness of breath, or tachycardia (fast heart rate) after vaccination, particularly in the week following vaccination.
• In younger children, symptoms of myocarditis might also include non-specific symptoms such as irritability, vomiting, poor feeding, tachypnea (fast breathing), or lethargy.

Public officials may be reluctant to acknowledge a causal association between stringent public health restrictions and excess deaths, or between a mandated vaccine and unanticipated harms among otherwise low-risk young adults. However, transparency and accountability are vital to restoring public trust. Broad scientific consensus must be established around the case definition of COVID-19 deaths and vaccine-associated deaths so that a true accounting of pandemic-related harms can begin.

◇ References:

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