March 8, 2021 -- Another coronavirus surge may be on the way in the U.S. as daily COVID-19 cases continue to plateau around 60,000, states begin to lift restrictions, and people embark on spring break trips this week, according to CNN.

Outbreaks will likely stem from the B.1.1.7 variant, which was first identified in the U.K., and gain momentum during the next 6-14 weeks.

“Four weeks ago, the B.1.1.7 variant made up about 1% to 4% of the virus that we were seeing in communities across the country. Today it’s up to 30% to 40%,” Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told NBC’s Meet the Press on Sunday.

Osterholm compared the current situation to the “eye of the hurricane,” where the skies appear clear but more storms are on the way. Across Europe, 27 countries are seeing significant B.1.1.7 case increases, and 10 are getting hit hard, he said.

Life Expectancy Data Confirms Disproportionate Impact of COVID-19WebMD's Chief Medical Officer, John Whyte, MD, speaks with Elizabeth Arias, PhD, Director, US Life Tables Program, National Center for Health Statistics, about the impact of COVID-19 on life expectancy data. 811

[MUSIC PLAYING]

JOHN WHYTE: Welcome, everyone.

I'm Dr. John Whyte,

chief medical officer at WebMD.

And you're watching Coronavirus

in Context.

There was a very important

report released recently on life

expectancy.

It showed a decrease from 78.8

years to 77.8 years, the biggest

drop since the Second World War

and for Black Americans three

times what it was

for white Americans.



So to help unpack the data

and provide some insight,

I've asked Dr. Elizabeth Arias,

one of the lead researchers

of the report and the director

of the US Life Tables Program

at the National Center

for Health Statistics.

Dr. Arias, thanks for joining.



ELIZABETH ARIAS: OK, well, thank

you for having me.

It's my pleasure.



JOHN WHYTE:

It's overall a decrease in one

year on average but greater

decrease in minority

populations.

Can you walk us

through the data?



ELIZABETH ARIAS: Yes.

What we saw was a decrease

of one year in life expectancy

at birth for the total US

population

and a decrease of 2.7 years

for the non-Hispanic Black

population

and 1.9 years

for the Hispanic population.

And we haven't seen decreases

like that in decades.

The last time we saw a decrease

of greater than one year

was during the Second World War

when life expectancy decreased

by 2.9 years between 1942

and 1943.



JOHN WHYTE: And this is only

for the first half of the year.

What do you expect to see when

you average it all together

for the entire year?



ELIZABETH ARIAS: Well, that

depends.

So what this measure was

basically the increase in what

we call excess deaths

during the first six months

of the year.

So we have the expected number

of deaths--

I mean, mortality is pretty

stable from year to year--

And the excess number of deaths

added to the total number

of deaths, which is what we use

to produce the life

tables, which is what gives us

the life expectancy estimate.



If we have higher numbers

of excess deaths

during the second part

of the year that would be July

through December,

everything else remaining

unchanged from previous years,

then we should expect to have

an even higher decrease

in or greater decrease in life

expectancy

at birth for the full year

than for the first half.

If the excess numbers of deaths

remain similar to what we saw

during the first half

of the year, then

we may see the same numbers.

Or we may see if the number

of excessive deaths

are lower than the first half

of the year, everything else

remaining unchanged,

then we should see a lower

decline in life expectancy.



JOHN WHYTE: Do we think

this decrease in life expectancy

is a direct result of the COVID

pandemic?

Is it because people did not get

care?

Is it because the total number

of deaths?

Is it because increase

in overdoses?

What do you think explains

this decrease?



ELIZABETH ARIAS: Well, we

do know we did a study that we

published recently that looked

at the number of excess deaths

in the US

from January through October.

And there were approximately

300,000 excess deaths.

And of those, 2/3 were

due to the COVID pandemic.

So therefore, there was a third

of those excess deaths that were

due to other causes.



So those included increases

in drug-involved mortality

and increases in our standard--

I should say standard

with our chronic disease causes

of deaths that we see every year

increases in heart disease

deaths, cancer deaths.

So overall, the COVID-19 deaths

were the leading factor

in the increases

in excess deaths.

And so when we estimate the life

tables, we estimate them based

on all deaths.

And so it includes deaths

from COVID and from all

the other causes.



JOHN WHYTE: Does this surprise

you, this decrease in life

expectancy?



ELIZABETH ARIAS: Well, I

expected to see a decrease

in life expectancy given

this increase in excess deaths.

And I expected to see

disparities between the groups

because they already exist.

But I was, I would say,

surprised at how large

the declines were particularly

for the African-American

population

and for the Hispanic population.



JOHN WHYTE: We're actually

increasing the difference

in life expectancy

for people of color

versus Caucasians.

Isn't that right?

There's greater difference

in life expectancy

than there is-- now than there

was several years ago.



ELIZABETH ARIAS: Yes, that's

right.

So if you go back to when we

started producing life

expectancy estimates,

that would be 1900.

And at that time, life

expectancy-- the disparities

in life expectancy

between the white and Black

population was over 14 years,

close to 15.

So the white population

had an advantage in life

expectancy of over 14 years.

And that declined gradually all

the way down to 4.1 years

of advantage

for the white population

in 2019.



And then in 2020, the disparity

went from 4.1 year to six years.

So now the advantage

of the white population

relative to the Black population

is six years.

We haven't seen such

a large disparity in a long time

in many years.



JOHN WHYTE: It shows COVID

in many ways

is making the situation worse,

not better,

and a greater urgency to address

disparities.

I want to ask you, though,

about this concept

of the Hispanic paradox.

On average, Hispanic population

actually lives longer

than any other minority group

population in the United States.

Yet, there's concern

about the traditional access

to health care

for that population.

Can you help explain why you

might see the longest life

expectancy

in the Hispanic community

compared to Caucasians

and the Black community?



ELIZABETH ARIAS: Yes, that's

basically termed

the Hispanic mortality paradox.

And it was identified

in the late 1980s

by some researchers that were

comparing mortality

between Mexican origin

population

and the non-Hispanic white

population in Texas.

And they found

that despite having lower

socioeconomic status,

the Mexican population has

significantly lower mortality.



We concurred in those findings

when we began producing life

tables

for the Hispanic population

with 2006 data.

And what we found at the time

was that the Hispanic population

indeed had lower mortality

and therefore higher life

expectancy

than the non-Hispanic white

population.

It was around 2.4 years or 2.1

years in 2006.

And that increased to three

years in 2019.



Now, there's been a lot

of research to try to identify

what are the causes

behind this Hispanic mortality

advantage.

And so there's three

main hypotheses.

One is that it's

due to selection.

So among immigrants or people

who immigrate tend to be

selected for better health,

hardier constitutions.



The other explanation

is cultural factors

such as behaviors related

to diet, smoking.

And then the other one

is something called the salmon

bias effect where you have

people who return

to their country of origin

when they're sick.

So then they are missed

in our statistics.

And then another one is what we

call data artifact or data

problems, which basically says

the data is bad.

And that's why you get

this advantage.



JOHN WHYTE: But I want to ask

you about that because there's

been criticism at times

on the collection of race

and ethnicity data.

We see that in other areas

of collection of data

by the government.

We see that in clinical trials.

A lot of data in terms of race

and ethnicity are missing.

And you talk about in the report

how you address those missing

data points, which could be very

important in terms

of the collection of life

expectancy.

Can you explain how you do that?



ELIZABETH ARIAS:

The misclassification on death

certificates

is a result of the incongruence

between what individuals self

identify with with what is put

down on their death certificate.

So say in a person who's self

identifies as American Indian is

then when they die identified as

white on the death certificate.

Now, this section of the death

certificate,

which

is the demographic portion,

is usually filled out

by the funeral director.

And many times,

the funeral director does not

ask the family informants

and decides what the person is

through observation.

Or even if they ask, the family

members may not be right in what

they think the person self

identified as.



So for example,

that's a big issue

for the American Indian

population.

So over 30% of American Indians

who self identify as American

Indians are classified

as something else on the death

certificate.

So then what that leads to

is an underestimation

of mortality.



Now,

for the Hispanic population,

that underestimation is around

3%.

For the non-Hispanic Black

population, it's very, very

small, less than like half

a percent.

And for the non-Hispanic white

population, there's barely

any misclassification at all.

So we took into consideration

those levels

of misclassification when we

estimated the life tables

in order to get the life

expectancy estimate.

So all the life tables

for the Hispanic, non-Hispanic

Black, and non-Hispanic white

populations were adjusted

to correct

for the misclassification.



JOHN WHYTE: And, finally, I want

to ask you about one

other interesting data point.

And it says here that males,

their average life expectancy

now is 75.1.

Females is 80.5, the biggest gap

that we've seen in many years.

Dr. Arias, are women

the stronger sex?



ELIZABETH ARIAS: Well, we have

seen that throughout our history

and in most populations,

women have higher life

expectancy than men

and except for earlier

in the 20th century

and before that when

maternal mortality was higher

than it is now.

But consistently, women have had

higher life expectancy than men.

And then, in this case

of the COVID pandemic,

we have seen that mortality is

higher for men

than for women as a result

of the pandemic.

So we saw the gap between men

and women in life expectancy,

which had been declining mainly

due to improvements in mortality

for men, actually increased.

So it's now larger than it was

last year or 2019, for example.



JOHN WHYTE: Dr. Arias, I want

to thank you for sharing

these important insights.

It has exposed again

the disparities that exist here

in the United States

and really is an urgent call

to action to address it.

So thank you

for this important data.



ELIZABETH ARIAS: You're welcome.

It was my pleasure.



JOHN WHYTE: If you have

questions, you can send them

my way to [email protected] as

well as post them on Facebook,

Instagram, and Twitter.

Thanks for watching.



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John Whyte, MD, MPH, Chief Medical Officer, WebMD.<br>Elizabeth Arias, PhD, Director, US Life Tables Program, National Center for Health Statistics./delivery/aws/ef/05/ef059e02-a76f-327b-b5f3-29225a1d8151/Arias_022321_v7_,4500k,2500k,1000k,750k,400k,.mp403/03/2021 12:00:0018001200Arias_022321_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Arias_022321_1800x1200.png091e9c5e8212c5b5

“What we’ve seen in Europe, when we hit that 50% mark, you see cases surge,” he said. “So right now, we do have to keep America as safe as we can from this virus by not letting up on any of the public health measures we’ve taken.”

In January, the CDC warned that B.1.1.7 variant cases would increase in 2021 and become the dominant variant in the country by this month. The U.S. has now reported more than 3,000 cases across 46 states, according to the latest CDC tally updated on Sunday. More than 600 cases have been found in Florida, followed by more than 400 in Michigan.

The CDC has said the tally doesn’t represent the total number of B.1.1.7 cases in the U.S., only the ones that have been identified by analyzing samples through genomic sequencing.

“Where it has hit in the U.K. and now elsewhere in Europe, it has been catastrophic,” Celine Gounder, MD, an infectious disease specialist with NYU Langone Health, told CNN on Sunday.

The variant is more transmissible than the original novel coronavirus, and the cases in the U.S. are “increasing exponentially,” she said.

“It has driven up rates of hospitalizations and deaths and it’s very difficult to control,” Gounder said.

Vaccination numbers aren’t yet high enough to stop the predicted surge, she added. The U.S. has shipped more than 116 million vaccine doses, according to the latest CDC update on Sunday. Nearly 59 million people have received at least one dose, and 30.6 million people have received two vaccine doses. About 9% of the U.S. population has been fully vaccinated.

States shouldn’t ease restrictions until the vaccination numbers are much higher and daily COVID-19 cases fall below 10,000 -- and maybe “considerably less than that,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told CNN last week.

Several states have already begun to lift COVID-19 safety protocols, with Texas and Mississippi removing mask mandates last week. Businesses in Texas will be able to reopen at full capacity on Wednesday. For now, public health officials are urging Americans to continue to wear masks, avoid crowds, and follow social distancing guidelines as vaccines roll out across the country.

“This is sort of like we’ve been running this really long marathon, and we’re 100 yards from the finish line and we sit down and we give up,” Gounder told CNN on Sunday. ‘We’re almost there, we just need to give ourselves a bit more time to get a larger proportion of the population covered with vaccines.”

WebMD Health News Brief

Sources

CNN: “Here's how close the US is to a possible Covid-19 surge, expert warns,” “Fauci: US shouldn't loosen coronavirus restrictions until daily new cases fall below 10,000.”

NBC News: Meet the Press, March 7, 2021.

CDC: “Emergence of SARS-CoV-2 B.1.1.7 Lineage — United States, December 29, 2020–January 12, 2021,” “US COVID-19 Cases Caused by Variants,” “COVID-19 Vaccinations in the United States.”

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