Health care workers screen a patient for COVID-19 at a drive-through coronavirus testing site on March 18, 2020 in Arlington, Virginia. Arlington County and Virginia Hospital Center have opened a temporary drive-through coronavirus testing site for Arlington residents and county employees with a letter from a licensed health-care provider. The results for patients tested are estimated to be available in 5-7 days. (Photo by Drew Angerer/Getty Images)

New research from Virginia Commonwealth University shows that an additional 4,500 Virginians died between March and August over would be expected based on historical data — a measure known as excess deaths.

That’s an increase of 16 percent, according to Dr. Steven Woolf, the lead author on the paper and director emeritus of VCU’s Center on Society and Health. But only 52 percent of those excess deaths in Virginia during the COVID-19 pandemic were attributed to the virus itself as either the underlying cause or a contributing factor.

While it’s possible that coronavirus wasn’t accurately identified as a contributor in some of those deaths, Woolf said the most recent analysis — which builds on an earlier paper looking at excess deaths across the country in March and April — bolsters concerns that the pandemic is also causing a wave of secondary deaths due to ongoing disruptions in everyday life.

“We’re seeing the U.S. mortality rate for Alzheimer’s disease increased significantly during these five months,” he added. “Suddenly the national death rate for heart disease increased significantly. So, this is a real thing.”

Since early in the pandemic, experts in Virginia have been concerned that COVID-19 safety restrictions — including a stay-at-home order in late March and month-long ban on elective procedures — may be worsening chronic conditions or otherwise affecting public health. By late April, pediatricians were troubled by a precipitous drop in the state’s child vaccination rates. The Virginia Hospital and Healthcare Association reported that emergency room use declined by 52 percent within the first three weeks after Virginia reported its first confirmed case. 

Both ER and inpatient hospital discharges have rebounded slightly since the ban on elective procedures was rescinded in May, but are still far from the levels seen in previous years, according to a VHHA webinar last week. The state has also seen an increase in opioid overdoses during the same period — including a 123 percent increase in nonfatal overdose hospital visits at VCU.

“It’s likely that people who aren’t infected with the virus are being impacted in terms of physical and behavioral health issues,” Woolf said. “Various hospitals and clinicians are reporting delays in patients coming in for chronic illnesses. People were slow to respond to acute emergencies because they were scared of the virus. And conversely, there were increased admissions for drug overdoses.”

The study found that excess deaths increased by a total of 20 percent nationwide since March, with the highest per-capita rates in 10 states including New York, New Jersey and Arizona — some of the areas hit hardest by the virus. Deaths from non-COVID causes, such as heart disease, diabetes and Alzheimer’s, also spiked sharply in five states with the greatest numbers of coronavirus deaths.

But the updated report also analyzed the effect of reopening policies on excess death rates. New York, New Jersey and Massachusetts, three states with the highest total mortality rates, accounted for 30 percent of all excess deaths in the five-month study period. But Woolf said those states, which were hit early and hard by the virus, quickly implemented tight restrictions and kept them in place for months. That shortened the length of their epidemics compared to Sun Belt states that lifted restrictions early and experienced a surge in deaths over the summer.

“I’m referring to states like Florida, Texas, Arizona — their epidemic curve is totally different,” he added. “With these states, 90 percent of the deaths occurred over 16 or 17 weeks. So, this longer stretch of time means not only more excess deaths, but the extended disruption of the economy in those states. And the irony is that the economy was one of the main motivators for those governors.”

Woolf said Virginia’s method of lifting restrictions more gradually has been fairly successful at limiting the state’s number of both COVID-19 and excess deaths. But he cautioned that leaders across the country should be “staying the course” when it comes to restrictions over the fall and winter, when the risk of another surge is even greater.

One important consideration is that deaths from the coronavirus and from chronic conditions disproportionately affect people of color. “When we talk about excess deaths, it’s African American and Hispanic communities who are bearing the brunt of this,” Woolf added.

He also highlighted that countries who have been most successful at managing the virus implemented extended safety restrictions as they developed a strong testing and contact tracing infrastructure. The same measures haven’t always been taken in the United States, where a fragmented approach has largely defined the response to the pandemic.

“It’s very important that our elected officials take a strong position on the need to continue these lifestyle changes,” Woolf said. “Otherwise, I think we’re going to see a very large loss of life and the economy is going to be further devastated.”

Virginia Gov. Ralph Northam, recovered from his own bout with COVID-19, announced at Tuesday news conference that he currently had no intention of loosening the state’s current Phase Three restrictions until metrics improved even further.