Leading Cause of Death Long-term effects Vaccine

Deaths and the vaccine…

It’s extremely important that epidemiologists (and for those trying to understand epidemiology) understand the difference between correlation and causation.

When I teach this topic to my graduate students, I start with a classic example…When ice cream sale go up, drownings increase. Does ice cream cause drowning? No. It’s tempting to assume that one pattern causes another. However, correlation might be coincidental or it might be a result of both patterns being caused by a third factor. The third variable here is a hot summer day, which boosts ice cream sales AND swimming, and thus drownings. In other words, correlation (ice cream sales and drownings) does not imply causation (ice cream sales cause drownings).

The same can be applied to a wide variety of public health issues, including the latest hot topic…deaths and vaccines.

As of this morning, Norway reported that 33 people (aged 75+ years) died a few days following their COVID19 immunization. Germany is also investigating 10 deaths. After reading headlines, it’s easy to make the assumption that the vaccine caused the fatal outcome. However, there is a very important third factor… frail, older adults die, and die more often. In Norway, an average of 45 people die each day in nursing homes because of underlying issues. The 33 deaths after vaccination do not represent an excess of deaths. When there’s a mass vaccination campaign, the overlap of vaccination and death is going to happen. It just is.

However, I don’t want to undermine the importance of investigating causation. Norway is investigating 13 of these deaths. And while the Norwegian Medicines Agency and the National Institute of Public Health are still not certain of causality, they did state the possibility that the vaccines’ side effects (like fever) may have exacerbated underlying medical issues that are not dangerous in fitter, younger populations. Dr. Madsen (Director of the Norwegian Medicines Agency) stated: “We are not alarmed or worried about this, because these are very rare occurrences and they occurred in very frail patients with very serious disease”. As of today, 48,000 Norwegian nursing home residents have been vaccinated and did not die.

These deaths will have no impact on Norwegian Medicines Agency’s vaccination strategy. They are still going to first offer vaccinations to those 75+ in nursing homes. But they do urge 80+ patients and their families to discuss the risks and benefits of vaccination with their doctor prior to vaccination.

Love, YLE

Update: Many of you are confusing temporal correlation with direct causation. COVID19 and death is a direct causation evidenced by excess death analyses (search “excess deaths” in my blog). In other words, if COVID19 didn’t infect the patient, they would still be living.

Data Sources:

Hospitalizations Leading Cause of Death Long-term effects National changes


In February 2020, the WHO reported that we’re not only fighting COVID-19, but also an infodemic. “An overabundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Information overload.

Which can (and does) cause anxiety, even if the information is true. The problem is if people get the wrong information from unreliable sources we are going to have a hard time stopping this virus. And we are in the United States.

In fact, scientists just published an article showing how the infodemic (and specifically misinformation) has impacted mortality, public health interventions, and treatment. They examined rumors, stigma and conspiracy theories circulating on social media between December-April 2020.

What did they find?
• Misinformation was present in 87 countries and 25 languages
• Of this misinformation, 89% were rumors, 8% were conspiracy theories, and 4% were stigma
• 24% of claims had to do with transmission and mortality; 21% public health interventions; 19% treatment and cure; 15% origin of the disease
• Countries with the highest rate of misinformation (in order): India; United States; China; Spain; UK

Their conclusions?
• Misinformation can have severe implications on public health if prioritized over science
• “Health agencies must track misinformation associated with COVID19 in real-time, and engage stakeholders to debunk misinformation”

Love, your local epidemiologist

Data Source: Islam et al., (2020) COVID19 related infodemic and its impact on public health: A global social media analysis. Am. J. Top. Med. Hyg. 

Deaths Leading Cause of Death Texas update

Leading Cause of Death

I’ve seen lots of comments about the low COVID19 fatality rate in Texas.

Although 2% seems low, it’s relatively high compared to other causes of death in Texas. If we stay on our trajectory, COVID19 will be the 7th leading cause of death in Texas this year. COVID19 would average 20 deaths per day compared to, for example, stroke that caused 30 deaths per day in Texas in 2019. This is impressive considering stroke and diabetes and heart disease take YEARS to develop. COVID19 has only been around for 109 days and is contagious.

There are a few things that can/will change Texas’ COVID19 rank this year:

1) Overflow hospitals. Many Texas metroplex hospitals are opening up “surge” units and scrambling for qualified staff. Less people will survive due to less quality of care. This will INCREASE COVID19’s rank.

2) Spread among populations. As I said in my previous post, CFR is decreasing in TX because of spread among younger populations. However, the far reach of this disease may start impacting the circles of younger populations, including those at high risk and kids. This will INCREASE or DECREASE COVID19’s rank. We just don’t know yet.

3) Other deaths will shift. The figure is comparing COVID19 deaths to 2019 deaths rates for other diseases, which isn’t necessarily an accurate comparison. A global pandemic WILL have impact on how we die other ways too. For example, some of the chronic lung disease deaths that WOULD have been in this category are now in the COVID19 category. On the other hand, unintentional injury (like motor vehicle crashes) have decreased. These shifts will INCREASE or DECREASE COVID19’s ranking, we won’t know HOW until the end of the year.

4) Counting “deaths”. This is very complicated. In short, the number of “COVID19 deaths” could (and are likely) off. The only way to “truly” know is through examination of death certificates. This is done each year by national organizations, but certainly not at a pace that the public wants. The problem is that states and hospitals and counties count covid19 deaths differently. Also, in the beginning of the pandemic, no one was getting tested for COVID19 but still dying, so we think the deaths could be underestimated. Again, this will INCREASE or DECREASE COVID19’s ranking, we won’t know HOW until more time passes.

If we stay on our trajectory in the US, COVID19 will be the 3rd leading cause of death. In other words, COVID19 would average 1118 deaths per day compared to heart disease (which killed 1,774 people per day in 2019) and cancer (which killed 1,641 people per day in 2019).

Translation: As for now, Texas’ COVID19 rank in terms of leading causes of death IS lower than the US as a whole. We should keep it this way by taking the Texas epidemic seriously.

Love, your local epidemiologist

Data source: 2019 data is from the National Center for Health Statistics at the CDC. COVID19 data is from DSHS (Texas) and Johns Hopkins (US). Graphs/analysis by yours truly.