How many people have died in New Hampshire because of COVID-19?

That seems a straightforward question but it’s actually pretty complicated. One possible answer is: 440 more than we have counted.

As of late November the answer was about 500, according to the state’s official report of people who succumbed to COVID-19 based on death certificates and laboratory tests. But that’s not the whole picture.

Health officials know that pandemics can kill people indirectly. It makes them skip medical care for treatable diseases because they’re afraid to leave their house; it delays care because hospitals and doctors are too busy; it kills people through stress that leads to heart attacks and strokes, or by driving them to drink or drugs; it changes lives in ways that cause more fatal accidents.

On the other hand, a pandemic can also save lives. It keeps people off the road, for example. More importantly, it limits the impact of diseases that are spread by contact, especially respiratory diseases. The United States, for example, is going through an unusual mild flu season at the moment, probably because COVID-19 has kept some people isolated.

Health officials measure this indirect effect through counting “excess deaths.” If you compare the number who have died this year in the U.S. with the number of expected deaths, based on recent years, you’ll see that more than 300,000 excess deaths have been recorded. Only about two-thirds of those are known to have died of COVID-19.

As part of the Monitor’s tracking of COVID-19 in the state, we wondered what excess death data would say about the pandemic’s effect on New Hampshire’s mortality. So we calculated the number of people who died over the first 47 weeks of the year, compared to the number of expected deaths during that period based on deaths over the previous five years.

According to figures released each week by the CDC, through late November 943 more people have died in New Hampshire than the average at that point in the previous five years. Subtracting the 500 deaths directly caused by COVID-19, we’re left with about 440 excess deaths to explain.

Does this mean that 440 Granite Staters who died this year would have been alive if there had been no pandemic? Perhaps, but not necessarily.

“This is incredibly complex,” said Tricia Tilley, deputy director of the Division of Public Health.

For one thing, a change of 400 deaths or about 3% of the total is not unusual from year to year. In 2017, for example, the state saw 432 more deaths during the first 47 weeks than it had in 2016 without any pandemic happening.

So it’s quite possible that the excess deaths are just normal variations that have nothing to do with COVID-19.

For another thing, 2020 data is still incomplete.

“Approximately 10% of New Hampshire residents who die, die out of state, and we’re waiting for the final records for some proportion of these New Hampshire residents,” said Tilley. “It takes several months for that data to be collected and entered into the New Hampshire Vital Records system.”

Of course, that implies that when tallies are complete the number of deaths is going to rise, increasing the possibility that COVID-19 is taking more of a toll than we realize.

Whatever the answer, more certainty will be forthcoming, but probably not for a while as epidemiologists and health care workers struggle with the day-to-day reality of the pandemic.

“Epidemiologists have a lifetime of work in front them, digging down and looking at this data,” said Tilley.

She adding that one thing is very likely, however: Excess deaths won’t be felt evenly throughout society.

“As we look deeper into the data, we will likely see that COVID continues to have disproportionate impact on Black and Native American people, other minorities, and lower incomes,” she said.The numbers

Since early summer the Monitor has been tracking five goals to help determine the status of COVID-19 in the state. You can see the charts I update on weekdays (and some weekends) here: Daily new caseshospitalizationsdeaths.

As you probably know already, the coronavirus is spreading widely in the state. Most of our goals are no longer being met.

Goal 1: No sustained increase in number of new hospitalizations related to COVID-19. Have we met this goal? No.

As this is written, the number of people in the hospital with COVID-19 has hit a record five days in a row and is at 250, which is double the high point of the spring surge.

Goal 2: A two-week drop in new cases. Have we met this goal? No.

Goal 3: Fewer than four new cases per 100,000 people each day, or 54 new cases a day. Have we met this goal? No.

The number of new cases, as measured by the number of new positive test results, has soared: The two-week average has gone up by more than 50% just so far in December, with no sign of it slackening.

Goal 4: Conducting at least 150 PCR tests per 100,000 people each day, or 2,000 tests per day. Have we met this goal? Yes.

The number of tests has declined recently because UNH students have gone home so the Durham campus is performing about 1,000 fewer tests each day, but overall more than 7,000 PCR tests are conducted in New Hampshire daily.

Goal 5: A positive rate of PCR tests below 5%, indicating that we’re doing enough testing to get a good handle on how widespread the virus is. Have we met this goal? No.

The positive rate has been above 5% for most of December.

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