Older Americans Account for an Overwhelming Share of the Deaths from Covid-19

It is well known that older individuals are more likely than younger individuals to die from Covid-19 should they become infected with the virus.  What some might not be aware of is how much this higher vulnerability by the older population has translated into older individuals accounting for the overwhelming share of those who have died from this terrible disease.  More than 95% of all those who have died from the disease in the US were age 50 or older.

This was not due to older individuals being more likely to get the disease in the first place.  As we will see below, the distribution of those coming down with Covid-19 is broadly similar to the distribution of population shares, and for those 50 and older, the share of this age group of all those who came down with the disease is almost identical to their population share.  Rather, the cause is that when an older individual comes down with the disease they are far more likely to die from it.

This short post will review the figures, basically through a series of charts.

The chart at the top of this post shows the shares of those who died from Covid-19 in the US by each age group (where the sum across age groups will be 100%).  These are based on totals since the start of the pandemic in February 2020.  The data comes from the CDC, which now reports on this each day.  Deaths and the causes of those deaths are regularly reported to the CDC by the US health system, and while reports with details on age and similar information will lag (the totals in these CDC figures come only to 71% of the total number of deaths from Covid-19 that the CDC also reports), for these share estimates the partial figures will be fine.

The CDC numbers on confirmed cases of Covid-19 by the same age groups are:

Note the scale, where those aged 50 and older made up just 35% of all those who had a confirmed case of Covid-19.  This is far from the 95% of deaths from the disease.

The shares of individual age groups varied, but this is not surprising as the share of the population of the US by each such age group also varies widely.  The interesting question is whether the shares of those coming down with the disease were different from the population shares.

And in broad terms they weren’t:

This chart shows the ratio of confirmed cases of Covid-19 of each age group to the share of the US population of that age group (using Census Bureau numbers).  By definition, that ratio will be 1.0 for the population as a whole.  Interestingly, for those age 50 and older, the ratio is very close to 1.0.  That is, those 50 and older accounted for 35% of cases in the US of Covid-19, and they similarly account for about 36% of the US population.  In practice, at least, they were only as likely to pick up the disease as their overall population share.

For the other individual age groups the ratio varies by about +/- 20 to 30% around equal shares (a ratio of 1.0), and there might be some simple explanations for that variation.  The ratio is about 0.8 for those between the ages of 65 and 84, where this might be because most of those in this age bracket are retired and can isolate themselves from much exposure to others.  In contrast, a significant share of those aged 85 and older might reside in nursing homes or may otherwise need assistance, thus exposing themselves to others.  The ratio for that age group is 1.2.

The ratios are also above 1.0 for those of working age below age 50, as many in these age groups will work and this may necessitate exposure to others.  Finally, the far lower ratios for children through to age 17 might well be anomalies due to limited testing.  Those in these age groups are far less likely to die (as we will discuss immediately below), and will often also show only limited symptoms should they get the disease (and may indeed often be totally asymptomatic).  As a result, many in those age groups may have not been tested even if they had the disease, as they did not exhibit symptoms.  The young may still get the disease, and indeed often do, and it may be a devastating disease for a significant number of them.  But the shares appear to be well less than for other age groups.

Broadly, therefore, the distribution of confirmed cases of Covid-19 by age group is similar to the population share of that age group (with the possible exception of those age 17 and below, although this may be a testing issue).  The data suggest that if one is exposed to the virus then similar shares of the population, regardless of age, get the disease.  Certain age groups, and in particular the elderly, do not appear to be more susceptible than others.

Why then do the elderly account for the overwhelming share (95% by those age 50 and above) of those who have died from Covid-19?  It is because it is far more deadly for them should they get it:

More than one in five (22%) of those aged 85 and older die from Covid-19 should they come down with the disease.  This is incredibly high for a communicable disease.  But the mortality rates then fall steadily for younger age groups.  It is still high at more than one in ten (11%) of those between ages 75 and 84, and about 5% for those between 65 and 74.  But it then falls to just 0.01% for those between 5 and 17, and 0.02% for those 0 to 4 (and with wider testing, leading to a higher number of confirmed cases, it might in fact be less than this).  Put another way, the mortality rate from Covid-19 is 2,000 times higher for those aged 85 and older than it is for the young.

These figures provide the rationale for prioritizing the elderly in the distribution of vaccinations.  Once one is able to vaccinate the 36% of the population aged 50 and above, one would have vaccinated the age groups accounting for 95% of the deaths from Covid-19.  The similar figures for those aged 65 and above are that they make up 16.5% of the US population (54 million people), but account for 81% of Covid-19 deaths.  And as I write this (on February 16), the CDC reports that 55 million doses of the vaccine have so far been administered in the US, with almost 40 million having received at least the first dose (and 15 million the second dose as well).

The prioritization of the elderly makes sense.  Covid-19 appears to spread similarly across age groups, but mortality from it is concentrated to a shockingly high degree among those who are older.

The Percentage Increase in the US Death Rate in 2020 Was Higher than in the Worst Year of the Spanish Flu

The Covid-19 pandemic this year has often been described as the worst public health crisis in the US since the Spanish Flu of 1918.  And there has certainly been nothing since then that compares.  But early estimates indicate that the increase in deaths this year may have even been worse than during the worst year of the Spanish Flu.

Population has of course grown, so the relevant figures to compare over time are death rates – the share of the population that died each year.  In addition, while it should not make much of a difference to the annual percentage changes, for longer-term trends one should look at the age-adjusted figures, which control for changes in the age structure of the population (as older people are more likely to die in any given year).

The National Center for Health Statistics, part of the CDC, provides such figures for the years 1900 to 2018.  The CDC also has separate figures for deaths and population for recent years, up to 2019, and hence the crude (not age-adjusted) death rate can be calculated for 2018 and 2019.  From this one can estimate what the percentage change in the death rate was for 2019, which should be close to the percentage change in the age-adjusted rate as the population age structure changes only slowly over time.

Finally, the estimate for what deaths in 2020 will be was obtained from a December 22 Associated Press article reporting on recent CDC figures.  It reports that the US “is on track to see more than 3.2 million deaths this year”.  And this may be a conservative estimate.  It would imply an increase of 345,162 over the number of deaths in 2019.  But as I write this, the number of deaths reported by Johns Hopkins from Covid-19 alone was 345,271.  While a share of those who have died due to Covid-19 this year would have died later in the year from other causes, analyses of “excess deaths” have consistently found that the increase in deaths this year has been well in excess of the number that has been attributed specifically to Covid-19.  For example, a CDC study in October estimated that for the period from late January (when Covid-19 was first recognized in the US) to October 3, there were 299,028 more who had died than one would have expected under normal conditions, while (over that period) only 198,081 deaths were directly attributed to Covid-19.  That is, the increase in the number of deaths during the period (over what would have been expected had this been a normal year) was 51% higher than the number of recorded deaths due to Covid-19.

We will not have the final figures for 2020 for some time.  But even accepting the conservative estimate of 3.2 million deaths in the US in 2020, the percentage increase in the number of deaths in the US per 100,000 of population was about the same as (and indeed very slightly higher than) in 1918, the year of the Spanish Flu.  In both years, the increase in the death rate was close to 12%.

I was surprised that the increase in the death rate this year was anywhere close to what it was during the Spanish Flu.  It is truly astounding.  But it is especially surprising given that, as the AP article cites, the number of deaths of Americans in 1918 rose by 46%.  How can that be consistent with the 12% increase in the death rates?  There are several factors that account for this.

To start, the increase (using another CDC table) was from 981,239 deaths in 1917 to 1,430,079 in 1918, or an increase of 448,840 (or 45.7%).  But note that a footnote to that CDC table indicates that these figures include military deaths in World War I.  This differs from the practice in later years, where military deaths are excluded.   World War I military deaths totalled 116,516 (according to official Department of Veterans Affairs figures), and almost all came in 2018.  While some share of these were due to soldiers dying from the Spanish Flu, I do not have figures for what those might have been.  Leaving that aside, the increase in non-military deaths in 1918 would have been close to 34%, and adjusting for US population growth in those years the increase in the death rate would have been 32%.

That is still significantly higher than the close to 12% increase in the death rate in the CDC figures.  There are two reasons for this.  First, note, as was discussed above, these CDC figures adjust for changes in the age structure of the US population over the century, and use population weights of the year 2000.  The US age structure has shifted markedly since 1918, with a far higher share of the population now in the older age groups.  Had the age structure in 1917 and 1918 been the same as it was in 2000, the base overall death rates in those years, excluding the impact of the Spanish Flu, would have been higher.  Second, the Spanish Flu was especially lethal for those in the middle age groups – those in their 20s, 30s, and 40s.  The young and the old were less affected.  But those in the middle age groups account for a smaller share of the age structure using the weights of the year 2000 than they had in 1918.  While I do not have the data to allow me to decompose the specific numbers, simple simulations with plausible parameters suggest that at the year 2000 population shares, the increase in the age-adjusted death rate of 12% can be consistent with the 32% increase observed in 1918 when military deaths are excluded, or the 46% overall increase when military deaths and population growth are included.

Few expected when Covid-19 was first detected in the US that the death rate this year would be anywhere close to what it was during the Spanish Flu.  But it has been.  Sadly, the crisis was severely exacerbated by the singularly incompetent management of the Trump administration.  The Washington Post had a particularly good summary of the many things the Trump administration got wrong in addressing Covid-19 this year in a December 26 editorial.  Or one can compare the US record to that of other countries.  The US this year had 1,040 deaths due to Covid-19 per million of population.  Canada had 412 per million, or 40% of the US rate.  If the US had simply matched what its neighbor to the north was able to do, the US would have had 137,000 deaths instead of more than 345,000, or 208,000 fewer deaths.  And others have done even far better.  New Zealand has had only 5.0 deaths per million, and Taiwan just 0.3 per million.

Better management would have been possible.  But the Trump administration failed, and hundreds of thousands of Americans have died.  As the Post editorial noted:

“It was always going to be hard. But the worst did not have to happen. It happened because Mr. Trump failed to respect science, meet the virus head-on and be honest with the American people.”

The Pattern of Unemployment: Fewer on Temporary Layoff, but More of the Rest

A.  Introduction

The economic downturn this year has been unprecedented in many ways.  Millions were laid off in March and April as the country desperately went into lockdowns to limit the spread of the virus that causes Covid-19, following the failure of the Trump administration to recognize the extent of the crisis.  But it was always known that those lockdowns would be temporary (albeit with differing views on how long they would be needed), and hence those laid off in March and April were generally put on temporary layoff.

The number on temporary layoff then started to decline in May, with this continuing (although at a diminishing rate) through November.  This has brought down the headline figure on total unemployment – the figure most people focus on – from 14.7% in April to 6.7% as of November.  But while that focus on the overall rate of unemployment is normally appropriate (as the number on temporary layoff has usually been steady and low, while the labor force has fluctuated little), the unusual conditions of the downturn this year have masked important aspects of the story.  Unemployment is a good deal worse than the traditional measures appear to suggest.

One key issue is what happened to those who were unemployed but not on temporary layoff.  The Bureau of Labor Statistics (the source of the data used here) defines those on temporary layoff to be those who are unemployed but who either have been given a date for when they will be able to return to their job, or expect to return to it within six months.  All other unemployed (defined by the BLS as being in the labor force but not employed, not on temporary layoff, and have taken concrete actions within the previous four weeks to look for a job), include those who were permanently laid off, who completed some temporary job, who left a job by choice (quit), or have newly entered (or re-entered) the labor force actively seeking a job but do not yet have a job.

That distinction – treating separately the unemployed on temporary layoff and the rest – will be examined in this post.  Also important to the story is how many are counted in the official statistics to be in the labor force at all, as that has also changed in this unprecedented downturn.  That will be examined as well.

B.  The Unemployed on Temporary Layoff Spiked Up and Then Came Back Down, but Other Unemployed Rose Steadily

The chart at the top of this post shows the unemployment rates (as a percent of the labor force) for all who were unemployed (in black), for those on temporary layoff (in blue), and for all others who were unemployed (in red).  Unemployment surged, at an unprecedented rate, in March and April of this year.  The increase in those on temporary layoff accounted for this – indeed for all of this in those months in the estimated figures.  The total increase in unemployment in March and April compared to February was 17.25 million; the increase in those on temporary layoff was almost exactly the same at 17.26 million.  (But keep in mind that these figures are estimates based on household surveys, and thus that there will be statistical noise.  That the numbers were almost exactly the same was certainly in part a coincidence.  Still, they were definitely close.)

The total unemployment rate then came down sharply from its April peak of 14.7% to 6.7% as of November.  It was led, once again. by changes in those on temporary layoff, but this time the number unemployed for reasons other than temporary layoff rose.  Their rate was 3.0% in February, which then rose to 5.0% by September.  It has kept at roughly this rate since (although so far with data for only two more months).

That increase – of 2.0% points – is significant but modest.  With all the disruption this year, one might have expected to see more.  Certainly important and effective in partially alleviating the crisis was the $3.1 trillion in several packages approved by Congress in March and April (of new government spending, tax cuts, and new loan facilities).  While adding to the public debt, such spending is needed when confronted with a crisis such as this.  The time to reduce the fiscal deficit would have been when the economy was at full employment.  But Trump added to the fiscal deficit in those years (with both higher spending and massive tax cuts) instead of using that opportunity to prepare for when a crisis would necessitate higher spending.

C.  But the Number in the Labor Force Also Fell, Which Had a Significant Impact on the Reported Unemployment Rates

There is, however, another factor important to the understanding of why the unemployment rate (for those other than on temporary layoff) rose only by this modest amount.  And that is that the number in the labor force abruptly changed.  This was another unusual development in this unprecedented crisis.

The labor force (formally the civilian labor force, as those on active military duty are excluded) changes only slowly.  It is driven primarily by demographic factors, coupled with long-term decisions such as when to retire, whether to attend college rather than seek a job, whether both spouses in a married couple will seek to work or whether one (usually in this society the wife) will choose to remain at home with the children, and so on.

But it was different in this crisis:

The number in the labor force fell abruptly in March and April – by 8.1 million compared to February, or 4.9% of the labor force.  There has never before been such an abrupt fall, at least since 1948 when such data first began to be collected.  The largest previous two-month fall was just 1.0 million, in 1953 when this was 1.6% of the labor force.  (And the month to month “squiggles” seen in the chart above should not be taken too seriously.  They likely reflect statistical noise in the household surveys.)

Those who drop out of the labor force are not counted as unemployed, as formally defined by the BLS, as they are not actively seeking a job.  And the sharp collapse in available jobs in March and April probably contributed to some dropping out of the labor force, as that scarcity of jobs would, by itself, induce some not even to try to find a job if they lost one.  But probably more important in this unprecedented crisis is a parent (and usually the wife) dropping out of the labor force in order to take care of their children when the schools and/or daycare centers closed.  This has never happened before.

Since April, the number in the labor force has recovered some but only partially.  Compared to what the labor force likely would have been by November 2020, based on a simple extrapolation of the January 2015 to January 2020 trend (growth at an annual rate of 0.95%), the labor force in November was 5.4 million less than what it otherwise would have been.

This will have a significant impact on the unemployment figures.  Since the number unemployed are, by definition, equal to the difference between the number in the labor force less the number employed, the number unemployed will be substantially higher if one counts those who abruptly dropped out of the labor force to take care of their children.  These, including others who dropped out of the labor force but would prefer to be employed if labor market conditions were more hospitable, should be counted when assessing how much slack there may be in the economy.  And they can be considered as part of those who are unemployed for reasons other than temporary layoff (as they are similar in nature to those who had, or in this case would have, re-entered the labor force but do not have a job).

Counting such individuals as among those who are in fact unemployed, the labor market does not look to be nearly as strong as the headline figures would suggest.  Assuming that the labor force in 2020 would have continued to grow at the trend rate of the previous several years, that the number employed would have been the same as was recorded, and that the number on temporary layoff would have also been as recorded, the chart on unemployment rates then becomes:

Superficially, this chart may appear similar to that at the top of this post.  But there are two important differences.  First, note the scale is different.  Instead of peaking in April at an overall unemployment rate of 14.7%, the unemployment rate would instead have reached over 19%.  Furthermore, it would still be at 9.7% as of November, which is high.  It is not far from the peak 10.0% rate reached in 2009 following the 2008 economic collapse.

Second, both the path and the levels of the unemployment rate for those other than on temporary layoff are now quite different.  That rate jumps abruptly in March and April to 8.2% of the labor force, from 3.1% before, and then remains at around 7 1/2 to 8% since then.  This a much more worrisome level than was seen above when no correction was made for what has happened to the labor force this year.  There is also no downward trend.  All the gains in the reduction of overall employment since April would have been due to the reduction in those on temporary layoff.

D.  Conclusion

The economy remains weak.  And president-elect Joe Biden is certainly correct that a necessary (although not sufficient) condition for the economy to recover fully will be that Covid-19 be addressed.  Australia, New Zealand, and the countries of East Asia have shown that this can be done, and how it could have been done.  Simply wearing masks would have been central.  Dr. Robert Redfield, the head of the CDC, has noted that wearing a mask could very well be more effective in stopping the spread of the virus that causes Covid-19 than some of the vaccines now under development, if everyone wore them.  But Trump has been unwilling to call on all Americans, including in particular his supporters, to wear a mask.  Indeed, he has even repeatedly mocked those who choose to wear a mask.

As a longer-term solution, however, vaccinations will be key.  But this also depends on most Americans (probably a minimum of 70 to 80%, but at this point still uncertain) being vaccinated.  Even under the most optimistic of circumstances, constraints on vaccine availability alone means this will not be possible before the summer.  But this also assumes that, once available, 70 to 80% of the population (or whatever the minimum share required will be) will choose to be vaccinated.  Given how the simple wearing of face masks was politicized by Trump (and turned into a signal of whether one supports him or not), plus controversies among some on both the left and the right on vaccinations that pre-dates Trump’s presidency, it is hard to be optimistic that such a vaccination share will soon be reached.

Hopefully a sufficiently large share of the population will at some point have chosen to be vaccinated to end the spread of the virus.  But until that happens, further support to the economy, and not least relief to those most affected by the crisis, needs to be passed by Congress and signed by the president.  The House passed such a measure already last May, but Mitch McConnell, the Republican Majority Leader in the Senate, has so far blocked consideration of anything similar.  As I write this, there appears to be a possibility of some compromise being considered in the Senate, but it remains to be seen if that will happen (and if Trump then will sign it).

It is certainly desperately needed.