How bad was Covid in New York? Here is a timeline of death rates over 200 years
A wave of disease hit New York without warning. Soon, this sent the death rate skyrocketing.
It was 1834. New York City had just extended its first railroad line. The penny press was flourishing. Cholera had struck. And smallpox was resurgent.
It would be almost 200 years before another earthquake shock, when the coronavirus pandemic in 2020 caused the death rate in new york again climbing about 50% from a year earlier, according to new data released Friday by the city’s health department.
Throughout the 19th century, periodic epidemics of cholera, smallpox, and other infectious diseases drove up the death rate in the city. But by the turn of the 20th century, vaccines, improved sanitation, and various advances in public health — from disinfecting drinking water to pasteurizing milk — had largely brought this cycle of epidemics under control. The city’s death rate began to see declines and plateaus, a trend that has largely held true for more than a century — through 2020.
The story of the city’s falling death rate and how Covid reversed that trend is instantly shared in a well-known table published regularly by the New York Department of Health, and now updated to include the first year of the pandemic.
Titled “The Conquest of the Plague in New York,” it showed how advances in public health finally brought the epidemics of the 19th century under control. Over the past century or so, the death rate – measured as the number of deaths per 1,000 people – was relatively stable or falling, until the disastrous first wave of the pandemic in early 2020.
The city’s death rate spike in 2020 looks like something “from another era”, the city’s health commissioner, Dr. Ashwin Vasan, said in an interview. “When you see this spike, there’s a feeling of, ‘Have we backed off? “”
In 2019, the city recorded 6 deaths per 1,000 people, which rose to more than 9 deaths per 1,000 people in 2020, an astonishing increase of around 50% that has only happened a few times before. Later in history, the typical death rate was much higher.
Throughout the 19th century, even in years without epidemics, the death rate was around 25 deaths per 1,000 population. That’s about four times more than in today’s New York just before the pandemic.
But at the start of the 20th century, the death rate began to drop precipitously. Another significant decline in the death rate has occurred over the past 30 or so years, attributable to a decline in smoking, the introduction of effective HIV drugs, and a host of other advances.
Health Department calculations conclude that Covid-19 killed 241.3 people per 100,000 New Yorkers, while the 1918 flu pandemic – the most severe pandemic of the 20th century – killed 228.9 people per 100,000.
Covid-19 tended to kill older people, while the 1918 flu was exceptionally deadly for adults under 40.
Also, the number of influenza deaths in 1918 seen in the “Conquest” table and used in the Health Department’s death rate calculations may imply a dramatic undercount. At the time, the health department often distinguished between deaths from the initial flu infection and the bacterial pneumonia that often followed. Health Department calculations comparing 1918 to 2020 appear to include only the first category.
Additional data released Friday by the health department showed that citywide life expectancy fell from 82.6 years in 2019 to 78 years in 2020, a drop of 4.6 years.
“It’s a pretty dramatic drop in a short period of time,” Dr. Vasan said.
Covid no longer poses the same deadly threat as in 2020, but Dr Vasan said he fears life expectancy will not rise to pre-pandemic levels in the coming years. The pandemic has had a “ripple effect” as chronic diseases, mental illness to diabetes, went unmanaged for many people, he said. Drug overdoses have increased.
The decline in life expectancy has not been felt uniformly. For white New Yorkers, the average life expectancy has dropped by three years to 80.1 years, while life expectancy for black New Yorkers has dropped by about five years to 73 years. For Hispanic New Yorkers, the decline was 6 years, to 77.3 years. (Asian New Yorkers were not included in the analysis due to data issues.)
This is partly because white New Yorkers had lower known infection rates during the first killer wave in the spring of 2020, and tended to have lower rates of some of the chronic conditions – like diabetes, hypertension or kidney disease – that increase the risk of dying from Covid-19.
Racial disparities have also been strongly informed by data describing the main causes of premature death, that is, the deaths of people under the age of 65. For Hispanic, Asian and Black New Yorkers in 2020, Covid-19 was the leading cause of premature death.
But it didn’t register in 2020 as even the number one or even number two cause of premature death among white New Yorkers. These continued to be cancer and heart disease.
In Brownsville, Brooklyn – a poor, predominantly black neighborhood with a high concentration of public housing – the premature death rate was nine times higher than in Greenwich Village and SoHo, predominantly white and affluent neighborhoods of Manhattan.
Adjusted for age, the 2020 premature death rate for Hispanic New Yorkers increased by 73%, 56% for Asian New Yorkers, 50% for Black New Yorkers and 21% for white New Yorkers.
Covid caused most of the loss in life expectancy in 2020, but not all of it.
“You obviously see Covid as the main driver, but that doesn’t tell the whole story,” Dr Vasan said.
A lot people went without seeing doctors or receiving medical attention when Covid-19 arrived. Deaths from heart disease, for example, were almost 20% higher in 2020 than the year before.
To some degree, the pandemic has blurred cause-of-death trends in modern New York. Diabetes, for example, rose in the rankings of causes of death, as did drug overdoses, while the flu declined.
“This is just the beginning of our understanding of these data,” said Dr. Gretchen Van Wye, the department’s deputy commissioner for epidemiology. “This is just the beginning for many people who have been studying this for a long time to really understand what happened.”
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