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COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The US has experienced more deaths from coronavirus disease 2019 (COVID-19) than any other country and has one of the highest cumulative per capita death rates.1,2 An unanswered question is to what extent high US mortality was driven by the early surge of cases prior to improvements in prevention and patient management vs a poor longer-term response.3 We compared US COVID-19 deaths and excess all-cause mortality in 2020 (vs 2015-2019) to that of 18 countries with diverse COVID-19 responses.

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Article Information

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Medical Ethics and Health Policy, 423 Guardian Dr, Blockley Hall, Ste 1412, Philadelphia, PA 19104 (MEHPchair@upenn.edu).

Accepted for Publication: October 2, 2020.

Published Online: October 12, 2020. doi:10.1001/jama.2020.20717

Author Contributions: Ms Bilinski had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design; acquisition, analysis, or interpretation of data; and drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Emanuel.

Statistical analysis: Bilinski.

Obtained funding: Emanuel.

Administrative, technical, or material support: Emanuel.

Supervision: Emanuel.

Conflict of Interest Disclosures: Dr Emanuel reported receiving personal fees and nonfinancial support from Blue Cross Blue Shield Minnesota, Bergen University, United Health Group, Futures Without Violence, Children’s Hospital of Philadelphia, Washington State Hospital Association, the Association of Academic Health Centers, Blue Cross Blue Shield of Massachusetts, Lumeris, Roivant Sciences, Medical Specialties Distributors, Vizient University Health System Consortium, the Center for Neurodegenerative Disease Research, Genentech Oncology, the Council of Insurance Agents and Brokers, America’s Health Insurance Plans, the Montefiore Physician Leadership Academy, Medical Home Network, the Healthcare Financial Management Association, Ecumenical Center–UT Health, the American Academy of Optometry, the Associação Nacional de Hospitais Privados, the National Alliance of Healthcare Purchaser Coalitions, Optum Labs, the Massachusetts Association of Health Plans, the District of Columbia Hospital Association, Washington University, Optum, Brown University, McKay Lab, the American Society for Surgery of the Hand, the Association of American Medical Colleges, America’s Essential Hospitals, Johns Hopkins University, the National Resident Matching Program, Shore Memorial Health System, Tulane University, Oregon Health and Science University, Blue Cross Blue Shield, and the Center for Global Development, as well as nonfinancial support from the Delaware Healthcare Spending Benchmark Summit, Geisinger Health System, RAND Corporation, Goldman Sachs, The Atlantic, Village MD, and Oncology Analytics. Dr Emanuel is also a venture partner at Oak HC/FT, and a partner at Embedded Healthcare LLC and COVID-19 Recovery Consulting. Ms Bilinski reported no disclosures.

Funding/Support: This research was partially funded by the Colton Foundation.

Role of the Funder/Sponsor: The Colton Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank David Cutler, PhD, of the Harvard University Department of Economics, for helpful feedback, for which he received no compensation.

Additional Information: Data and code are publicly available on GitHub.

COVID-19 data. European Centre for Disease Prevention and Control. Accessed September 25, 2020. https://www.ecdc.europa.eu/en/covid-19/data
Viglione  G .  How many people has the coronavirus killed?   Nature. 2020;585(7823):22-24. doi:10.1038/d41586-020-02497-wPubMedGoogle ScholarCrossref
Lyu  W , Wehby  GL .  Shelter-in-place orders reduced COVID-19 Mortality and reduced the rate of growth in hospitalizations: study examine effects of shelter-in-places orders on daily growth rates of COVID-19 deaths and hospitalizations using event study models.   Health Aff (Millwood). 2020;39(9):1615-1623. doi:10.1377/hlthaff.2020.00719PubMedGoogle ScholarCrossref
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Maani  N , Galea  S .  COVID-19 and underinvestment in the public health infrastructure of the United States.   Milbank Q. 2020;98(2):250-259. doi:10.1111/1468-0009.12463PubMedGoogle ScholarCrossref
Chaudhry  R , Dranitsaris  G , Mubashir  T , Bartoszko  J , Riazi  S .  A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes.   EClinicalMedicine. 2020;25:100464. doi:10.1016/j.eclinm.2020.100464PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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