Perspectives offered on COVID-19’s ‘true’ toll

Valley health experts say stress, overdoses, suicide part of equation

To put COVID-19 into perspective, the number of Mahoning Valley residents who have died so far this year from the virus is about the same as the number dying each year here from stroke and diabetes combined.

The true pandemic toll from associated factors such as stress, overdoses and suicides, however, would add to the total, local mental health and recovery experts and some reports indicate.

During about nine months this year in Mahoning County, 311 people have died from COVID-19. That compares to 193 who died in 2006 -- the most recent year for which data could be found -- from stroke and the 101 who died from diabetes, according to the Ohio Department of Health.

In Trumbull County, 221 people have died from COVID-19, which compares with 172 people who died in 2006 from stroke and 75 who died from diabetes.

In Columbiana County, 115 people have died from COVID-19 compared to 61 who died in 2006 from stroke and 42 who died from diabetes.

Heart disease was the leading cause of death in all three counties in 2006, followed by cancer, chronic lower respiratory ailments, stroke, unintentional injuries and diabetes.

The number of people who died of cancer in each county in 2006 was two to three times higher than number of people who have died so far of COVID-19 in each county.

HEADLINES

Many news outlets recently had headlines saying COVID-19 had become the leading cause of death in the United States. That is misleading, though most outlets explained that in the text of their reporting.

WebMD said Dec. 7, "COVID Passes Heart Disease as Top U.S. Killer." But it it explained in the story that the virus was the leading cause of death only for the previous week.

The website Live Science even called it the "leading cause of death in the United States" back on April 10, referencing a specific day that month in which COVID-19 deaths exceeded the number of deaths from heart disease.

A good explanation was contained in the Dec. 4 release from the Institute for Metrics and Evaluation, which said COVID-19 killed 11,820 people in the United States that week, ranking it No. 1.

That week, heart disease, which is normally the leading cause of death in the United States, ranked second at 10,724. Stroke was fifth at 3,643 and diabetes was 10th at 1,495.

OBITUARIES

The obituaries in this newspaper have helped educate a large number of people about COVID-19. For example, they provide clues into whether area families are choosing to hold private or public funeral services.

Another piece of information gleaned from obituaries is the number of deaths occurring. That can be accomplished by simply counting them, especially on a Sunday, which is the biggest day of the week for obituaries. Funeral directors say many people prefer to have their loved one's obituary appear on Sunday because of the amount of readership that day.

The number of Sunday obituaries also has risen this year because there is less of a need for obituaries to be published soon after the person's death because many funerals are closed to the public.

For this story, the newspaper compared the number of obituaries that have appeared during the past 2 1/2 months to the number that appeared during that same period in 2019, before anyone in the Mahoning Valley had officially died from COVID-19.

Combining both The Tribune Chronicle and The Vindicator, as of last Sunday, there were 499 Sunday obituaries during the past 2 1/2 months of 2020 and 306 during those weeks in 2019. It means there were 63 percent more Sunday obituaries during the last 2 1/2 months than during that period in 2019.

Does that mean Mahoning Valley deaths increased 63 percent because of COVID-19?

Probably not.

COVID-19 deaths in the Mahoning Valley this year have made up only about 10 percent of what would be considered the normal number of annual deaths.

Here's how that determination was made:

As of last week, 311 people had died of COVID-19 this year in Mahoning County. The 311 deaths are 10 percent of the 3,115 Mahoning County deaths recorded in 2018 -- during what you might call a "normal" year.

As of last week, 221 people had died of COVID-19 in Trumbull County. The 221 deaths in Trumbull County are 8.3 percent of the 2,655 people who died in Trumbull County in 2018.

And as of last week, 115 people died of COVID-19 in Columbiana County. The 115 deaths are 9.1 percent of the 1,267 people who died in Columbiana County in 2018.

So tracking the number of obituaries in the Sunday paper may not be a good way of seeing the big picture when it comes to the toll of COVID-19.

'TRUE PANDEMIC TOLL'

The New York Times has started to track what it calls the "true pandemic toll," which is higher than the number of deaths reported in the United States.

The Times said about 300,000 people have died in the United States from COVID-19, but the number of deaths in the country has actually been about 377,000 higher than normal (19 percent from March 15 to Dec. 2).

The Times theorizes that the additional deaths may be the result of stress on society from the pandemic and disruptions in the health care system causing people to delay treatment for non-COVID-19 illnesses. It also reported June 1 that by looking at 44,000 deaths "above normal" for New York and New Jersey from mid-March to May, COVID-19 was the leading cause of these excess deaths.

But more people also had died from causes such as heart disease, diabetes and Alzheimer's disease than for the same period in previous years.

Mahoning Valley health officials who were asked whether they are seeing anything similar here declined to comment.

MENTAL HEALTH

But local mental health experts agree that COVID-19 has probably caused additional deaths from drug overdoses and possibly from suicides.

Mental health experts, including Jody Klase of Valley Counseling, have said the pandemic has hurt people's mental stability, including people who normally manage their affairs pretty well.

"We are seeing different populations of people that are reaching out to us for help," she said earlier this year.

Individuals with substance-abuse issues have struggled through challenges brought on by the pandemic, officials with the Mahoning and Trumbull counties mental health and recovery boards say.

April Caraway, executive director of the Trumbull County Mental Health and Recovery Board, said she sees a correlation between overdoses and the virus.

"Isolation has resulted in some people dying from an opiate overdose because no one was around to administer the overdose antidote, naloxone," Caraway said.

"Also, unfortunately, relapses are up in Trumbull County and across the state for a number of reasons -- anxiety, job losses, housing insecurity, fear of contracting the virus, financial and family stressors and other issues."

She said 12-step meetings for those with a substance abuse issue are almost all virtual now, and the loss of face-to-face contact and support has been "very difficult for some of the recovery community."

Her agency increased the use of billboards, direct mailings and commercials to "engage people into mental health services," Caraway said.

OVERDOSES

The number of accidental drug overdoses in Trumbull County so far this year is estimated to be 107, including 90 confirmed overdose deaths and 17 suspected drug-overdose deaths, said Kathy Meszaros, chief forensic investigator for the Trumbull County Coroner's office. The county had 92 overdose deaths in 2019, 76 in 2018 and 135 in 2017.

There have been 22 completed suicides in Trumbull County in 2020, which is one more than in 2019, Caraway said.

"Fortunately we have not seen an increase in suicides the way that some other Ohio counties have experienced," Caraway said. "Across the state, communities are seeing an increase in completed suicides by veterans."

Trumbull officials "work closely with the air base and Suicide Prevention Coalition to try to engage our military both in active service and veterans to get them the help they need," she said.

Brenda Heidinger, associate director of the Mahoning County Mental Health and Recovery Board, said the county has had 116 drug overdose deaths this year as of the end of November. Mahoning County has likewise seen increase in "deaths occurring when a person is using drugs while alone," she said.

MCMHRB has ramped up programs such as Peer Recovery Supporters at Mercy Health hospitals and treatment such as detoxification, outpatient services, recovery housing and 12-step fellowships, she said.

This year in Mahoning County, there have been 116 accidental drug-overdose deaths through the end of November, Heidinger said. The county had 106 in 2019, 117 in 2018 and 112 in 2017.

Heidinger said the number of people who have completed suicide in Mahoning County is not available.

"While we do not have numbers, we also expect, like most areas of Ohio, we may see an increase in the number of deaths by suicide, due to the isolation and stresses of COVID-19," she said.

The Help Network of Northeast Ohio has not seen an increase in calls to the suicide hotline, but it has seen a 150 percent increase in calls for food, an 11 percent increase in calls for rent assistance and 17 percent increase in reassurance calls, Heidinger said.

Vince Brancaccio, chief executive officer for the suicide hotline has explained that "mental health reassurance" is "basically people calling who are having anxiety."