We are all very busy obsessing over the number of people who have died from or with COVID19 and within these discussions I often hear the phrase that each of the deaths is one too many. This seems to be absurd and I do not mean this as an insult but rather as a question about the sense of this phrase. Let us use this photo to think about a bit more especially because each death prevented comes with a huge cost (and sometimes this cost is another death) for everyone else as well.
What do people mean with “one death too many”?
Obviously we can only die once. So there can not be too many deaths at all. Life and death are in absolutely perfect balance with each other. It is very clear that people mean something else with this phrase. What they want to say is, that a particular cause of death is one too many. Maybe we should be more precise in our language then? So the first problem is down to linguistic impreciseness. But now the real problems start.
What makes one kind of death worse than others?
If we make the assumption that people want to say that a certain cause of death is one too many than we must ask “compared to what?” because in the end we all die sooner or later anyway. Maybe it is the “sooner rather than later” part that people want to express? Every death that is not natural but caused by something else is one too many. There is a problem with that too.
But let us make it a bit easier and open up two categories. Imagine grandma being 83 years old, bound to a wheelchair with chronic heart disease. Suddenly she has a heart attack and dies. At her funeral everyone would say that she lived a full live and that it simply was her time to leave this world. Would anyone say (and really mean) that her death was too soon or one too many? No.
Imagine Grandma being moved across the street in her wheelchair and being hit by a drunk driver. She dies. At her funeral people would say that despite her age and sickness she still had some time left to spend with her grandchildren and that this time was taken from her. Rightly so.
The first category can be called “expected death” the other one “unexpected death”. We deal with both categories differently. The first is easier to accept the second often demands action to prevent those deaths from happening again. What has this to do with deaths from or with COVID19?
COVID19 – Who died at what age and some statistics
Currently we treat almost every death from or with COVID19 (this from or with is an unfortunate muddling on top) as belonging to the second category. An avoidable tragedy that took away peoples lives too soon. A cause of death too many. But is this right? Maybe not for every victim of this disease. Maybe not even for most.
Except God no one knows beforehand when we will die and from what cause. In earlier times many people who died of old age actually died of some kind of disease, malfunction or organ failure. We just did not know it. Now we can say what caused a death and in theory many of these things are preventable until they are finally no longer preventable. You can only ever have so many heart attacks before one is fatal.
Still we do not know how long they would have lived. We can make some statistical analysis and compute an average of some months or years that was supposedly stolen by COVID19. Statistics from Germany tells us that an 80 year old man could expect another 8 years and a women of the same age another 9.5 years. Also average life expectancy for men is 78.6 years and for women 83.4 years. But these are statistical averages. In all honesty we do not know how long any particular person will live. We can only ever make educated guesses.
The City of Hamburg has, quite unique in Germany, performed postmortems on all COVID19 patients who died in 2020 [2, in German]. They did a postmortem on 735 deceased (Hamburg has 1.8 million people). In 618 cases did they ascertain COVID19 as a cause of death which they defined as someone dying with pneumonia or thrombosis and not just a positive virus test. About 50 were infected but showed no symptoms, the rest could not be fully autopsied or they lacked the relevant documentation from the hospitals.
On average the deceased were 83 years old. Three quarters were over the age of 76. A very high 88% suffered on average from three co-morbitities ranging from hypertension, chronic kidney disease, chronic lung damage, cancer, diabetes to serious obesity. Do these people seem to have eight or nine years of life left were it not for COVID19? We are talking average life expectancy here. Some live longer than eight years and some not. The deceased in this study seem unlikely to belong to the longer end of this average.
How do old people die?
It is a marvel how long people in modern countries can expect to live. But with age comes disease and frailty. No matter how good our medical knowledge is we can not stop the progress of aging. We grow older, weaker and eventually we succumb. But how exactly?
Some people have the privilege of just no longer living. Their hearts stop. They die peacefully. Something most people wish for when they are older. In reality we succumb to disease and sickness. People have heart attacks, strokes and organ failure. For many people though an infection pushes them over or leads to heart attacks, strokes and organ failure. Their bodies are either too weak to fight it off or the energy expended against the infection exacerbates their preexisting conditions which then ultimately cause their death.
A categorical error
I want to bring our 83 year old grandma back one more time. Imagine her family visits once a week and one of her grand kids has unbeknownst to the others some kind of stomach bug or a common cold. He infects grandma and her body is too weak to fight it off and she dies. Before we would consider this normal. We would not have bothered to ascertain where she got infected. No one in their right mind would even think about blaming the child. They would all say that Grandma was feeling sick (which she would have been a few times a year anyway) and this time she did not make it because she was simply too old and frail.
I think we should not treat every death from or with COVID as an avoidable accident that robbed people of valuable years of their life. An accident that then forces us to try to avoid it almost no matter the cost. For most people who died, COVID was what pushed them over but looking at how old and sick they were almost any infection would have done that. Sometimes there are more infections and more deaths, sometimes we get lucky and people live a bit longer because infections were low in a particular year.
While every death is a tragedy in itself in many cases it is unavoidable. Maybe they had a few months or even years left without the pandemic. Maybe instead of COVID we could have had a bad influenza season instead. Maybe not this year, maybe next. Only God really knows. The point is many of the deceased would have died sooner rather than later.
My heart goes out to everyone who died during the last year no matter from or with COVID, from being unable to get medical treatment, from depression and suicide, from violence, accidents, heart attacks and so on. We would do the dead and the living a good service to remember and discuss them all when we talk about the deaths caused by, with, from or due to COVID and what we should or should not do about this cause and all the others.
Using proper categories might help us determine how to spend our always limited time and resources. And maybe we should ask the people who are at risk of dying from a particular cause how much they want others to give up to prevent it. We should ask how much the latter are willing and able to give. Instead we have forced ourselves to suffer and sacrifice for something that might have been a huge categorical error in our perception.
In the coming months when all of this unravels remember one thing: When people suffer and sacrifice a lot it is very hard to accept that it may have been for very little or even nothing. There is going to be anger, denial, grief and despair. Mostly from those who really thought they would make a difference with their sacrifice. We should be kind to them.
I used this image in another post. If you want to read more about it click here.
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