How else do healthy people die of?

Because of Corona, death is omnipresent. We show the death rate compared to the most common causes of death in Germany - and why Corona arouses old fears.
Because of Corona, death is suddenly omnipresent. How else do people die - and how is that changing?

The sheer numbers are shocking: 360,840 people worldwide, 171,414 in Europe and more than 8570 people in Germany have so far died with the Sars-CoV2 virus in their bodies. Every death is tragic. Classifying the number of deaths is therefore even more difficult. Because individual human fates cannot be put into bare numbers. But also because some ways of dying have become rare in affluent societies. This becomes clear when you look at the death statistics in a larger context.

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I - Death in times of Corona

In purely mathematical terms, a person dies every 33 seconds in Germany. Has anything changed in that due to Corona? So far, surprisingly, hardly any. The weekly deaths in this country are overall slightly above the average of previous years. But for the fact that we are in a pandemic, the so-called excess mortality is low.

A comparison with other parts of the world shows that the number of victims the pandemic claims varies widely depending on the country. At times, twice as many people died in England and Wales as in the previous weeks. In the United States, currently the country with the highest number of deaths, mortality is also very high:

Counting how many people live in an area is one of the oldest forms of statistics. Later, people wanted to know how many people were born - and how many died. Early forms of pension insurance were a reason for this.

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Today dying is recorded more precisely. How many people die every year in Germany is surprisingly regular: a good 83 million people live here. Average life expectancy in Germany is now around 80 years, depending on the year of birth. Around one percent of the population dies every year. There were 954,874 people in 2018. And we also know what. Because a death certificate is filled out for everyone. There it is noted, among other things, what the cause of death was, classified according to an international "Classification of Diseases and Related Health Problems", ICD for short. This classification sorts diseases into groups, mainly according to the parts of the body affected or the type of diagnosis. The most common fatal diseases were:

Some of the assignments are surprising: Of the many psychological findings, most are "vascular dementia", that is, mental limitations due to vascular problems in the brain - but depression was also found on the death certificate 673 times as a direct cause. Obesity, for example, is one of the diseases of nutrition and metabolism, while alcoholic fatty liver disease is part of the digestive system. And the 32,593 unusual findings are so general that they do not fit into any other super-category, for example “death without the presence of other people” (7905 deaths) or even “restlessness and excitement” (one death).

Covid-19 will also be assigned to one of these groups in the ICD international disease classification. However, it has not yet been determined which one. Is it a respiratory disease like the flu? Or an infectious disease like AIDS? If Covid-19 were to be included in this list of 2018 as a single disease, it would land at number twelve in Germany - ahead of muscular and skeletal problems, such as osteoporosis.

However, the above figures apply to the whole of 2018. The first known case of a corona infection in 2020 did not occur until January 27, and the pandemic is not yet over. The virus has only been a cause of death for a third of the year. If the causes of death from 2018 are also downgraded to four months, Covid-19 would already be in 9th place by May 27.

It is noticeable that many of the major causes of death tend to come from within our body. There are hardly any external enemies that suddenly come upon us like the virus. Violent deaths, which are summarized in the ICD classification as “injuries, poisoning and certain other consequences of external causes”, are an exception: These include murder, manslaughter, suicide and accidents. If we again take a period of four months as a comparison, it shows that many more people have died of Covid-19 than have died in traffic accidents.

It is not only noticeable that there were around 28 times as many suicides as killings by other people. It is also clear that Covid-19 killed more people in a period of four months than in 2018 in a comparable period of time from traffic accidents or suicides combined.

The fear of corona is statistically at least as justified as the fear of an accident or even a murder. While some high-opinion polemicists describe containment measures as unnecessary, hardly anyone would say that measures against murders or traffic accidents are unnecessary - regardless of the age of the victims.

II - The return of the plague

The external causes of death are still rare compared to the total number of deaths. Today people die mainly of their own bodies - because blood vessels are blocked, the heart no longer beats, the cells of the body begin to proliferate in an uncontrolled manner. However, they usually do NOT die from contagious diseases. To be more precise: not anymore. A look at the history books shows how young this achievement is. It also provides strong reasons why the pandemic is a source of primal fears.

Historically, epidemics were what heart problems are today. Death certificates haven't been around that long, but other sources reveal something about the deaths of our ancestors. The physician Anja Spickereit has examined the causes of death mentioned in church registers in the city of Memmingen between 1740 and 1809. Spickereit has translated these historical names into the modern categories. For example, “mucous fever” corresponds to the bacterial infection typhoid. Today we would classify “plug flow” as heart failure.

Cancer, which kills one in four people in this country today, was only noted 71 times as a cause in the church registers and would therefore only make up the sixth largest group. Violence and accidents were mentioned even less often. Diagnoses at that time were of course much less precise. In one of the sermons quoted, for example, there is talk of “punitive deluxiones” as the cause of death. However, the term “deluxion” does not even exist, comments Spickereit. Probably this meant impairments after a stroke. Another “Seel. "Lord" was attacked by "stupidities" before he died. Apparently it was a calcification of blood vessels in the brain of the 69-year-old businessman. With age he was an old man at the time. According to Gesis Histat, the average life expectancy in Germany at that time was around 37 years.

At that time, a particularly large number of dead were sorted into the now rarer group of unusual findings. About half of them died in Memmingen from "old age disease". A rather imprecise diagnosis - but in 2018 the corresponding ICD designation "Senility" appeared almost 3,000 times on German death certificates. And despite much more precise diagnoses: 19,884 death certificates were so filled out in Germany in 2018 that the cause of death cannot be clearly assigned.

Epidemics remain one of the most common causes of death for a long time: in 1920, tuberculosis, triggered by bacteria, was still a feared killer in the then German Reich. Since then it has decreased as significantly as death from pneumonia. On the other hand, many more people in Germany are dying of cancer and cardiovascular diseases today.

So it took centuries to push back the contagious diseases so far that today we have the luxury of dying of old age. This fight is not over yet.

Millions of people worldwide continue to die every year from infectious diseases that are actually treatable. Tuberculosis is a sad leader. But malaria and HIV also kill thousands every week. Unfortunately, the coronavirus is catching up rapidly. If you compare the previous corona death rates (as of May 27, 2020) with an arithmetically equivalent period of four months for the largest contagious diseases in 2017, the coronavirus has already claimed more deaths than malaria and HIV.

It gets even more complicated: It is not yet clear what consequences the coronavirus outbreak will have on combating these diseases. In some countries, lockdown regulations have prevented offers of help from taking place. The "Stop TB Partnership" organization expects more than one million additional deaths from tuberculosis between 2020 and 2025. The organization has dedicated itself to combating tuberculosis.

That will likely widen the medical divide between states. The World Health Organization (WHO) compares how many deaths are due to infectious diseases for the countries of the world. In Germany in 2016 it was only one person in twenty, in Guatemala every fourth person. How people die often reflects the prosperity of societies: GDP per capita in Guatemala is around ten times lower than in Germany. In the Democratic Republic of the Congo, GDP per capita is ten times lower than in Guatemala. In 2016, six out of ten people there died of infectious diseases, childbirth or nutritional problems. Most of them would be preventable - or treatable.

That has a radical impact on how long people live. The largest group of fatalities in the DR Congo are infants under the age of five. In rich Germany, most of them die after a long life.

III - We mostly die of ourselves

The age distribution for the most common causes of death fits in with this. Within the largest group of cardiovascular deaths, most of the deceased in Germany were older than 80 years. For cancer, the second most common cause of death, the group of 60 to 80 year olds is slightly larger.

Even in violence and accidents, the elderly are the most likely to die. But here the statistics also show a larger proportion of younger deaths every year. In 2018, 839 people between the ages of 15 and 35 died in traffic accidents, and 13 children took their own lives before they turned 15.

The longer you live, the more time the environment and your own decisions have to affect your body. After a long life, the effects of lifestyle and quality of life become apparent. Dirty air and smoking, for example, increase the risk of lung cancer. The chronic narrowing of the airways COPD is colloquially often referred to as "smoker's lung". Both diseases killed more people than Covid-19 in an annual share of four months of 2018.

Excessive alcohol and sugar also become a risk. The dreaded sequelae of liver cirrhosis and type 2 diabetes are not as big a killer in our computational comparison as Covid-19 has been so far.

IV - Lockdown: lifesaver or death trap?

The longer the pandemic rages, the more important another question becomes: is the lockdown itself dangerous? Are virus deaths prevented, but other causes of death more common at the same time? Do people drink more alcohol? Is there more domestic violence? Don't heart patients dare to go to the hospital?

So far there is hardly any reliable data on this. In an interview with the Tagesspiegel, however, the death researcher Dmitri Jdanov from the Max Planck Institute warns of negative consequences. “People who need regular treatments cannot get them so easily now. Then there are serious long-term effects on mortality. ”At present, fewer people with strokes are going to hospital, reports the Ärzteblatt. It is mainly about easy cases. But those who have had a minor stroke are more likely to get a severe one.

In addition, nobody can predict how the psychological stress will affect, says Jdanov: “For example, on people who live alone or people with children. That is a big challenge. "

The president of the medical society for psychiatry and psychotherapy (DGPPN), Andreas Heinz, also fears this. He reports on the result of a still unpublished study: "It is quite clear that all anxiety disorders and depression become both more frequent and worse under social distancing." It is also assumed that social isolation is a major suicidal stress factor. We will only know in the coming months how dangerous it is.

Hopefully, by then, the measures will have prevented significantly more deaths. And not just coronavirus deaths ... The influenza wave apparently ended a little earlier due to the contact restrictions, so fewer people died from the flu. The lockdown may also have prevented some traffic fatalities. And you hear more and more often from people that the forced break from everyday life also had other positive consequences. People cook more themselves, often buy healthy food and there is also new freedom for their private lives during office hours. This not only makes life longer, but also more beautiful for some.