How tragic is the COVID-19 pandemic compared to other causes of death?

Today I undertake a morbid and probably misguided analysis of the depth of the COVID-19 tragedy in America, examining the number of years of life lost.

Trigger warning: this post discusses causes of death including suicide.

Why would I undertake such a task?

We are all reeling from the shocking numbers here. Half a million deaths is a lot of people — about one in every 650 people in the United States. And of course it’s not just deaths, there are lots of people suffering to various degrees, including chronic cases of “long COVID,” and an unprecedented degree of economic damage.

But if someone forced you to quantify the damage from COVID and compare it to other diseases we have to deal with, what would you do?

You might analyze the number of expected years of life that were lost. That’s what I set out to do.

Analyzing lost years due to COVID

Every death is a tragedy, especially those that might have been prevented. But looking at the raw actuarial calculus of it, younger people who die have lost more than older people. If you got a chance to love your dad until he was 98, his death would be sad, but it is much worse if your dad died when he was 49. Is it twice as bad?

Of course, you can’t quantify loss like this. But you can quantify years lost.

To undertake this analysis, I used the following:

  • The average life expectancy in the US is 78.7 years.
  • A CDC chart that shows the deaths from leading causes in the US by age in the year 2017. Across all ages, the leading causes were heart disease, cancer, accidents, and chronic respiratory diseases. If we were to add COVID-19 to this chart, it would rank third, just behind cancer and ahead of accidents.
  • CDC data on deaths from COVID-19 through 24 February.

There are some sources of uncertainty and error here. The charts show deaths by age cohorts, so I had to round each cohort as if all deaths occured at the midpoint. I didn’t account for how life expectancy changes as you get older (for example, people in their late 70s still have a life expectancy even though they may have surpassed the average life expectancy in the US). The time period for COVID deaths is slightly more than a year, although nearly all those deaths occurred in a one-year period.

And perhaps most importantly, based on excess deaths reported, there are significantly more COVID-19 deaths than the statistics would indicate.

Even so, this rough analysis gives us a quantitative measure of the impact of people dying from COVID-19 versus other causes.

Quantifying the tragedy

COVID-19 was responsible for about 13% of all deaths over the course of a year.

During that year, all deaths accounted for approximately 36 million years of life lost. COVID-19 is more deadly for older people, but also kills some younger people. COVID-19 accounted for 3.3 million years of life lost, or about 9% of all the lost years of life during the time it was killing people.

Here’s a chart showing the number of years of life lost to different diseases and causes of death.

How does this compare to other diseases and causes of death, using the year 2017 for comparison purposes?

  • Heart disease is the top cause of death in the US, killing 647,000 people in 2017. It cut short 7 million years of life, or 20% of all the years lost.
  • Cancer killed 599,000 people. It also cut short nearly 7 million years of life, or 19% of all the years lost.
  • Accidents were the third leading cause of death, with 174,000 deaths. In contrast to these other diseases, accidents affect young people to a greater degree. As a result, accidents accounted for 14% of all years of life lost.
  • Suicide resulted in 47,000 deaths, but since many deaths by suicide are in younger people, they account for 4% of the years of life lost, slightly more than chronic respiratory disease.
  • Chronic respiratory disease killed 160,000 people, accounting for 4% of years of life lost.
  • Influenza and pneumonia are way down the list. While they were the eight-leading cause of death in 2017, causing 56,000 deaths, they only account for 2% of all years of life lost. If you are still thinking that COVID-19 is “just like the flu,” you’re off by at least a factor of six — over the course of this year, people lost six times as many years of life to COVID-19 as they would in a normal year to influenza and pneumonia. (And not all of those pneumonia deaths were due to flu.)

This analysis suggests that if lost years of life is your metric, COVID-19 is about half as tragic as cancer or heart disease, but more tragic than chronic respiratory disease or suicide. It’s not quite as tragic as accidents; it kills a three times a many people, but many of them are older.

Why are we so upset about COVID-19?

Every year of a loved one’s life that is lost is tragic for those that love that person. Three million lost years of life for those people is a terrible thing to contemplate. If this disease has affected the ones you love, my heart goes out to you.

Reviewing all this you have to wonder: what is it about COVID-19 that has made us all so fearful? And why do some people see it as extremely tragic, and others as overblown and not a big deal?

I think there are four reasons.

First of all, it is new. If you look at the causes of death year by year, very little changes. It is unusual to have a new disease go from zero to being the third-leading cause of death in a single year. We are far more scared of the unknown, and compared to diseases like heart disease and cancer that we have dealt with for many decades, there is far less medical experience with treating COVID-19.

Secondly, we are dying from a communicable disease. In America, we’re not used to people dying from communicable diseases — we think we know how to treat and prevent them. With the exception of AIDS, which took decades to manage, there have not been deadly diseases circulating around America without effective treatments or cures. Even in the case of AIDS, you could far more easily protect yourself from it than you can from COVID-19, which made people believe they could be safe. The word “pandemic” was not something most of us thought about before last year.

Third, it is, at least in theory, preventable, but not easily. Masks and social distancing help. They are also a complete shift in the way we interact with each other, and have upended everything from work to shopping to travel to family holidays. This makes the prevention controversial, since the methods used to control it are so new, scary, and disruptive.

Fourth, it is ongoing, even endless. A deadly earthquake, flood, or terrorist attack is tragic, but over quickly. We mourn the dead, but eventually move on. We’re not pummeled with news about it every day. The slow, steady, numbing, draining nature of the COVID-19 pandemic is very hard on all of us. We can’t “get past it” because it is still happening.

This unique combination of qualities makes COVID-19 an emotional and political challenge unlike any cause of sickness and death we’ve ever faced before. That’s why it’s a big deal. And it’s why, even if it is quantitatively “not as tragic” as cancer or heart disease, it’s awful in a way that we’re not really equipped to deal with.

9 responses to “How tragic is the COVID-19 pandemic compared to other causes of death?

  1. Thanks for this thoughtful analysis. The number of years lost is not something I would have thought of. If it is true that if someone had heart disease or cancer and also had Covid when they passed they were classified as a Covid death, then when the 2020 numbers are studied, heart disease, cancer and others will show unusually low numbers and Covid will look very, very bad. This will help justify the political class in demanding sacrifices from the American people beyond what the virus might really required now and in any future breakouts. Follow the science, they say. But when the data that science uses has a political agenda in its formulas, the science may lead us in the wrong direction.

  2. Using life expectancy at birth biases your estimates of years lost downward–probably a lot. If you use that method for all the comparison groups (cancer, hear disease, etc.) the comparison becomes more challenging because of comorbidities. People with cancer, heart disease, diabetes are more likely to die from COVID-19 than otherwise healthy people. They probably have shorter life expectancy (before considering COVID) than others, so just using population averages for life expectancy at each age would overstate years lost, but I don’t know how it would affect the comparison between COVID and other deaths since, for example, diabetes raises the risk of heart disease. If you want to play with this some more, you can find what SSA calls the “period life table,” which has remaining life expectancy at each age and sex. I think they also have breakdowns by race and ethnicity (which also complicate matters).

    I think part of the tragedy is how the pandemic upended our lives. We have had to radically curtail time spent with family and friends. We lost a year that could have been devoted to adventures and new experiences. For old people like us, we may have few years left to do things that require physical fitness and mental acuity, so the loss of a year is significant even if the disease doesn’t get us. The biggest tragedy may be the way those 500,000 people died–most in hospitals surrounded by people in space suits, connected to a ventilator, and able to communicate with the loved ones only via video. My heart breaks for the scared, lonely victims and their families.

  3. I think I’ve got a sixth factor to add, too!

    The nature of the death caused by the disease. Intubated in an ICU on a respirator; not alone; but not with people of your choosing, unable to communicate. No other leading American cause of death considered in the analysis kills people in that way or gives them that fate. I thought that kind of fate was in the past, like TB sanitariums, some disease that modern medicine took from lethal to treatable. Nature gave us a new one.

    I’m glad the various vaccine’s measures of efficacy are the vaccine’s ability to prevent that kind of death.

  4. Another way to measure the impact is quality adjusted life years (QALY). Adjusted for that, I imagine the impact would be even less as a percentage of total.

    There are several differences between COVID and the others scythes of the Grim Reaper.

    First, it could have been much worse absent the public health measures taken albeit at gigantic cost.

    Second, the ICU healthcare system was overwhelmed by the surge, exacerbating the death rate early on.

    Third, the system had no science to effectively treat.

    Fourth, there was a clear path to a virtual viral panacea in the form of vaccination.

    All of these argued for buying time through extraordinary public health measures.

    Cancer, heart disease, suicide and accidents on the other hand are chronic, endemic issues with no clear magic bullet solution. No politically and socially acceptable draconian public health measure could dramatically reduce incidence, morbidity, or mortality. Due to their magnitude and persistence, the healthcare system resources match up well with demand, which is not prone to sudden, exponential spikes.

    1. Terry, your last paragraph poses an interesting dichotomy that I was contemplating, that being the difference between deaths caused by chronic vs acute outcomes. Certainly cancer, coronary & respiratory diseases are considered chronic. I wouldn’t consider suicide chronic – perhaps some of environmental issues. However, at this point deaths from Covid could be considered acute, like that of suicide, accidents, or other avoidable deadly trauma. In my example, it would appear that covid would far outstrip the other acute causes of death quite significantly. If there are associated long term ailments associated with covid as a cause, then in years to come, morbidity to covid may well be, unfortunately, designated as a chronic condition. Tragic on all counts.

  5. The only actual “tragedy” is that people fell for this fake pandemic BS to begin with. Everything else is secondary!

  6. 2.8 million deaths worldwide, and probably many more unattributed to COVID-19. My heart breaks thinking of all the people suffering painful, lonely deaths and their relatives who could not be by their side or properly celebrate their lives after their deaths.

    And it is unspeakably sad to think of all the willfully ignorant people who don’t have the critical thinking skills to reject the wackadoodle conspiracy theories that support their bleak alternative worldview. Did the entire medical establishment and the media worldwide conspire to invent and promote a fictitious pandemic with the goal of crippling the economy and making life miserable for people? No. A lot of people disliked the former president, but even if we were that amoral and cynical, nobody could create or maintain such a conspiracy.

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