North Carolina continues to grapple with COVID-19. During the early days of the pandemic, the state’s strategy was clear.

North Carolina, like other states, needed to restrict movements and interactions to reduce the rate of the spread of the virus. No one seriously thought the virus could be stopped, but by “flattening the curve” at least our health care facilities could be saved from the fate witnessed in Italy when their health care system was simply inundated.

The curve has long been flattened, but now the strategy is far less clear. There seems to be a hope in North Carolina that the restrictions in place now will lead to the total eradication of the disease, or at the very least be helpful. In fact, neither appears to be true.

Are North Carolina’s COVID-related restrictions helpful?

First, let’s look simply at whether the restrictions in place in are helpful. What can be considered helpful in the context of COVID?

Is it a reduced spread of cases? A reduced severity of the disease? Probably the clearest metric for “helpfulness” is not the simplest to measure, but it would be a reduction in the number of fatalities due to COVID.

The difficulty with measuring COVID deaths has been discussed here in the past. Those who succumb to the disease are often suffering from other medical conditions, and so the actual cause of their death may be difficult to pinpoint. A patient may ultimately succumb to pneumonia, heart failure, or other causes that may or may not have been exacerbated by the virus.

The Centers for Disease Control and Prevention has recognized this difficulty in the context of the flu generally, and it keeps track of all deaths on a weekly basis and compares the numbers with previous years. By looking at the number of deaths in a state or the country for the same week over the past five years, the CDC can estimate whether the number of deaths reported for the week indicates an additional cause of death has emerged.

Using statistics, the CDC can predict what number of deaths would represent a 20-year high. If the weekly total exceeds that one in 20 chance, the CDC labels those additional deaths as “excess deaths.”

The term excess deaths simply means that something unusual and beyond the norm is causing deaths to occur. The unusually bad flu of 2017-18, for example, resulted in a few weeks of excess deaths.

Lockdowns and other causes of excess deaths beyond COVID-19

The advantage of using the broad metric of all deaths is that no judgment on the ultimate cause of death is needed. The disadvantage is that, whenever excess deaths are indicated, the tendency is to assign all of the excess deaths to a single cause, such as the flu.

While that may make sense in a well-defined flu season, COVID is proving to be more tenacious. Over a longer period of time where excess deaths are being reported, it may well be that not all of the excess deaths are due exclusively to COVID.

There are increasing reasons to think there may be other causes to North Carolina’s excess deaths than simply COVID. Studies are emerging that show that lockdowns and other COVID-related restrictions are causing people severe health problems and even death.

For example, the CDC recently reported that 25% of young adults (18–24 years old) had seriously considered suicide in the past 30 days. (It’s a particularly ironic finding given that age group is one of the least affected by COVID.) Other studies show suicides are increasing, owing to economic and social pressures amid the pandemic.

Meanwhile, there are increasing reports of people succumbing to heart disease, cancer, and other illnesses because they postponed checkups and hospital visits out of fear of contracting COVID. There have also been reported spikes in the incidence of domestic violence, overdoses and substance abuse, mental and emotional distress, and depressive and anxiety disorders.

Is our cure as bad as the disease?

North Carolina may be witnessing an unusual number of deaths from other causes. It would be so unusual, in fact, that they may be causing the weekly death count to exceed the one in 20 value – that is, deaths from other causes are causing excess deaths. Recent studies have estimated that 22% to 35% of excess deaths are not due to COVID.

All this might argue that the cure may be as bad or worse than the disease. It also means that the CDC’s excess death metric is losing its value in helping to assess the severity of COVID.

North Carolina’s leaders need to be acutely aware of these potential other causes of excess deaths alongside the virus, so that they can be more responsive to alleviate policies and orders that could well be contributory.

Unfortunately, the N.C. Department of Health and Human Services is notoriously delinquent in reporting deaths data. It has consistently made North Carolina last in the country in reporting deaths to the CDC. The state’s numbers may now be too late to be of any help.