Well into our fourth spring with COVID-19, signs abound that we have finally emerged from the pandemic. Last week, the World Health Organization declared an end to the global public health emergency. And on Thursday the United States and Massachusetts will end their emergency declarations, as well.
But despite those milestones, new data show that the threat is not completely over.
One key benchmark, so-called excess deaths, looks at the number of people who die over and above normal rates. A new analysis shows Massachusetts experienced soaring excess mortality during the first COVID wave, from March to May 2020; in the winter of 2020-2021; and during the first Omicron wave, from the fall of 2021 to February 2022. This past winter saw our lowest excess deaths of any pandemic winter, followed by a spring of “deficit mortality,” when fewer people have died than during a normal spring.
Dr. Jeremy Faust, an emergency medicine physician and public health expert at Brigham and Women’s Hospital, said that, while overall deaths this spring are slightly lower than expected, they would be lower still if not for the continued presence of the coronavirus.
“By now, I was hoping we would actually have a lot of deficit mortality,” said Faust, who analyzed Massachusetts mortality numbers for The Boston Globe. Deficit mortality occurs when surges of illness, like last winter’s COVID uptick, cause people to die sooner than expected, leading to a compensating period of fewer-than-usual deaths.
“That hasn’t happened,” he said. “And the reason for that is because this virus is still causing enough morbidity and mortality to overcome that.”
Faust and his colleague, Benjy Renton, analyzed several other sets of excess mortality data in collaboration with Yale’s Center for Outcomes Research and Evaluation that reflect how Massachusetts and the nation fared over the last three years.
Excess mortality is another way of showing COVID mortality and has followed the same pattern as COVID death rates over the last three years, Faust said. He prefers showing excess mortality rather than looking solely at COVID deaths, because it avoids controversies over how deaths are classified and coded on death certificates. “This gives us a clean depiction of increases in deaths associated with the pandemic,” he said.
Deaths in Massachusetts
Excluding the first COVID wave, from March to May 2020, Massachusetts had the fifth-lowest rate of excess deaths in the country. Even including the first wave, Massachusetts fared better than most states when it came to mortality rates.
“We were hit early and hit hard, which put us at a huge disadvantage,” Faust said. “And then during and after the first wave hit, we’ve done very well.” Reasons for our relative success, he said, include high vaccination rates, high rates of health insurance coverage, and sticking with mitigation measures longer than many other states.
A recent analysis published in the journal The Lancet found that states like Massachusetts with lower poverty rates, higher education levels, high vaccination rates, and access to quality health care saw lower COVID infection and death rates.
Jonathan Levy, chair of the department of environmental health at Boston University, said he finds the disparities among the states disheartening. “It shows that there were substantial opportunities nationally to do a whole lot better than we did,” Levy said.
Why racial disparities may have narrowed
The pandemic also spotlighted long-term racial and ethnic disparities in Americans’ health. Early in the pandemic, excess death rates among Black and Hispanic populations were higher than those among white people. Following the wave of the virus’s Delta strain in summer 2021, however, some disparities narrowed or even reversed. A similar pattern appeared in Massachusetts after the Omicron wave of late 2021 and early 2022, according to an analysis conducted for the Globe in February by Levy and his colleague Jacob Bor, an associate professor in global health and epidemiology at BU.
Reasons for those changes remain unclear, but may include improved access to vaccines and medications in communities of color as well as to deficit mortality that occurs when a catastrophic event temporarily increases death rates in a population and is followed by a period of lower mortality rates.
Another recent analysis lead by BU researchers and published in the journal JAMA Network Open found that most of the decrease in disparities could be explained not by reductions in mortality but by an increase in COVID deaths among white people, as well as the migration of the pandemic from large cities to rural and smaller urban areas. “While advancements toward racial and ethnic health equity have occurred, our study suggests that this work is not finished,” the authors concluded.
The gender divide
Throughout the pandemic, more men have died of COVID-19 than women. To Faust, that’s a significant but underreported story. “It’s been a rough couple of years for mortality with respect to men,” he said. Reasons include lower vaccination rates among men, poorer overall health, fewer primary care visits, and higher rates of working front-line and other essential jobs early in the crisis. The conversation around men dying younger and at higher rates than women is “one we need to have” as a country, he said.
The one time seniors were spared
Unlike the 1918 flu, which posed the greatest risk to people between the ages of 20 and 40, COVID-19 disproportionately killed those 65 and older with underlying conditions. The time that pattern changed most dramatically was in the spring of 2021, when seniors were among the first to get vaccinated, Faust said.
The CDC, based on combined forecasts from leading scientific groups, predicts that the number of daily COVID-19 hospital admissions will decrease nationally through May 29. In Massachusetts, the ensemble forecasts predict that the numbers of hospitalizations are likely to remain stable through the end of the month.
With the pandemic in remission for now, many experts agreed that it was a good time to let the public health emergencies expire.
“But that doesn’t mean that the virus is going away or is going to stop causing death and severe illness and profoundly affect the way society operates,” said Dr. Jacob Lemieux, an infectious disease physician at Massachusetts General Hospital.
There remains work to be done to make sure tests, vaccines, and therapeutics are available, especially for disadvantaged communities hardest hit by the pandemic, he said, and also to combat misinformation. But continuing emergency protocols forever would mean that “the word ‘emergency’ loses its meaning.”
Felice J. Freyer and Kay Lazar of the Globe staff contributed to this report.