Deaths of Despair and COVID-19: What We Know So Far

The COVID-19 pandemic has wrought an incredible toll on America, with more than 300,000 official deaths over 2020. Unfortunately, a year of unprecedented upheaval has likely led not only to deaths from the novel coronavirus, but to deaths caused by the effects of mass unemployment and the isolation of lockdown.

Deaths by suicide, drug overdose, and alcohol abuse—often called "deaths of despair" after the 2015 coinage by economists Anne Case and Angus Deaton—have been a hot topic of discussion for years, as steady increases in the rates of each augurs poorly for America's social health. Amid COVID-19, however, they have taken on new significance as measures of the social disarray America is currently experiencing.

Recent efforts to measure the scale of increase in these deaths, which are based on very limited data, suggest large increases in death rates, anywhere from 10 to 60 percent. National-level data from which a more comprehensive picture can be produced will not be available until at least later this year, and in the meantime, such analyses are mostly an exercise in making assumptions. 

Nonetheless, preliminary evidence offers a partial picture of deaths of despair in 2020. It suggests that Americans are using more drugs and alcohol and are more depressed; but it is unclear if these trends are translating into more deaths, over and above pre-COVID trends.

Drug deaths account for the largest percentage of deaths of despair, and data offer the most comprehensive picture of that situation. The CDC found that as of June, 13% of Americans had started or increased drug use to cope with the pandemic. That has likely translated into more deaths: Preliminary data from the CDC show a projected 81,230 OD deaths between May 2019 and May 2020, an 18% increase over the same period of 2018 to 2019. 

More local data confirm this trend. Departments of health are reporting record high OD deaths in cities like Los Angeles (particularly among the homeless) and San Francisco, and in states like Maine and Ohio. They are up as much as 150% in San Diego and Chicago.

That may be due to the stress of the pandemic, or to macroeconomic circumstances. A 2017 review found that rising unemployment increased illegal drug use, while declining income did not—an indicator, the authors argue, that the psychological distress of job loss may be a major driver of drug use. This combination seems uniquely tailored to the current crisis, when both unemployment and disposable personal income hit record highs. More cash in people's pockets, combined with the stress of COVID may make a deadly combination.

At the same time, drug overdose deaths have been rising exponentially for years. Right now, it is impossible to rule out the possibility that any surge in drug ODs is simply a continuation of pre-2020 trends.

It is also plausible to believe that the pandemic would cause a spike in suicides: economic stress and social isolation from the pandemic and ensuing lockdowns were identified as suicide risks in one review. Americans are certainly experiencing decreased mental well-being —the CDC has found that 41% of Americans experienced at least one "adverse mental or behavioral health condition," including 30% with anxiety or depression, and 11% contemplating suicide. (Data published by IFS showed an opposite effect among teenagers, specifically.) The largest surge in gun purchasing on record would plausibly contribute to a suicide spike.

But whether all this translates into actually higher suicide rates is unclear. An international review updated in November found that the limited data available show overall suicide rates in developed countries either flat or down in 2020. But that may obscure a "pulling together" effect, whereby rates fall thanks to a rising sense of social solidarity, but then rise as the pandemic wears on. This has happened in past pandemics, the authors note, and is reflected in Japan's data, where a 20% decline in suicides early in the pandemic was replaced by a 7.7% increase in August. 

Similarly, rising alcohol use does not necessarily mean rising alcohol deaths. Nielsen found that alcohol sales spiked 54% nationwide as lockdowns began in March; a survey conducted by the RAND Corporation found a 14% increase in alcohol consumption, including a 41% increase in heavy drinking among women. 

Whether or not this behavior will translate into more deaths is unclear—it generally takes several years of overconsumption to develop fatal liver cirrhosis, which drives the majority of alcohol-associated deaths. It is not a given that rising consumption in extraordinary circumstances will translate into long-term dependence after the end of the pandemic.

In short: we can reasonably say that the COVID-19 pandemic has harmed Americans' mental and emotional well-being, increasing their proclivities to drink, use drugs, and contemplate suicide. But it is much harder to conclude that there has been an increase in suicide and alcohol deaths, and while there is a measurable increase in drug OD deaths, it is difficult to determine if that is a product of COVID-19 or pre-2020 forces.

Charles Fain Lehman is a staff writer for the Washington Free Beacon, where he covers crime, law, drugs, immigration, and social issues. Reach him on twitter @CharlesFLehman.