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Before COVID-19, U.S. life expectancy was making a slight rebound

New federal data showed U.S. life expectancy was inching upward in 2019 before the deadly coronavirus pandemic hit, and after years of devastation brought on by the opioid crisis eroded the average American lifespan.

Life expectancy in the U.S. was 78.8 years in 2019, up a tenth of a year over 2018, said Robert Anderson, chief of mortality statistics at the National Center for Health Statistics.

The new report released Tuesday from the Centers for Disease Control and Prevention, through the National Center for Health Statistics, paints a picture of how Americans were living and dying before COVID-19 emerged in the U.S. and killed at least 320,000 in this country so far. To get that picture, researchers for the federal government gathered details from millions of death certificates.

2019’s small rebound doesn’t mean that drug overdoses became a thing of the past last year. Despite life expectancy beginning to stabilize after years of decline, tens of thousands of American deaths were linked to drug use in 2019, and early data from the CDC suggests those deaths have increased amid the challenges posed by COVID-19.

To public health researchers, it’s a reminder for the U.S. that it has “two epidemics, not one,” said Dr. Keith Humphreys, a psychology professor at Stanford University and scientist at the Veterans Health Administration.

What drove mortality in 2019

In total, more than 2.8 million Americans died in 2019, and the leading causes included heart disease, cancer and accidents and unintentional injuries, as was the case in 2018. Medical examiners and coroners determine these causes of death when filling out death certificates.

Fatal drug overdoses inflated the number of lethal accidents and injuries, as well as suicides, Anderson said. Last year, 70,630 Americans fatally overdosed on drugs, and those deaths grew fastest among people ages 35 to 44.

Chart by Megan McGrew/PBS NewsHour

With 2020 ushering in the coronavirus pandemic, those overdose deaths showed no sign of slowing down. A recent CDC report said a total of 81,000 people died from drug overdose between May 2019 and May 2020, the highest recorded death toll linked to drugs in any 12-month period.

Each time a young or middle-aged person dies, you lose decades of life. That may seem like an obvious conclusion, but the cumulative fatalities — tens of thousands of untimely deaths — can crater communities and punch holes in the economy and health care systems. Young people’s deaths also have a bigger effect on U.S. life expectancy.

So many have died as a result of the opioid crisis that it caused a multi-year dip in that statistic in the final part of the last decade. And even those deaths are likely an undercount, Humphreys said.

When asked what story data might tell about 2020, Anderson did not mince words: “It’s gonna look pretty bad.”

With 2020 fatalities mounting, researchers continue to gather data and death certificates, Anderson said. In the coming weeks, the CDC will publish a report that looks at six-month provisional data from the first half of 2020, which will help show how COVID-19 plowed through the country in the early months of the pandemic.

Those initial numbers will only show the first surge of U.S. coronavirus deaths in the spring and fail to capture the full picture of what the pandemic has done since then, Anderson said, but he expects to see “a substantial decline in life expectancy.”

“2019 can’t help but be overshadowed by what we’re dealing with now in 2020,” he said.

Is COVID-19 driving more drug-related deaths?

This year, social distancing measures designed to prevent further illness, loss of life and the collapse of the nation’s health care system have also resulted in millions of people feeling increasingly isolated, Humphreys said. And that could have a different effect on loss of life.

Chart by Megan McGrew/PBS NewsHour

For people who have been in recovery from substance use for a few years, stay-at-home orders are “not a big change and you can handle it,” but for those who had recently made the decision to enter recovery, Humphreys said the risk of relapse — a common occurrence for countless people — is heightened. Such dramatic isolation measures can “impair the things that help people get better,” he said, such as going to the doctor for medication-assisted treatment or finding fellowship with people who have struggled similarly.

With the launch of the U.S.’s vaccine campaign likely to push the population closer to herd immunity against COVID-19, Humphreys said he thinks managing the coronavirus will be easier in 2021 than managing ongoing substance use issues in the U.S.

“You could hardly design a worse situation for people who are dealing with drug problems than the one that we’re in right now,” Humphreys said.

Many of the deaths we’ll see from 2020 may not be directly tied to the coronavirus. While roughly 320,000 Americans have died from the virus, according to the latest data from Johns Hopkins University, those deaths have been disproportionately felt in Black communities and communities of color, and they are among 400,000 excess deaths overall, Anderson said. Excess deaths aree the difference between how many deaths usually happen in the U.S. during a given period of time and how many actually took place. Researchers think another factor could be people not seeking medical care. Cancer patients, for instance, might be forgoing treatment out of fear that they might catch COVID-19, and Anderson said those conditions could cut short someone’s life in a way that doesn’t result in the coronavirus being entered on their death certificate.

An uptick in overdose deaths and a possible increase in suicides could also be ramping up those numbers, said former Rep. Patrick Kennedy, D-R.I., who said he is under consideration to lead the Biden administration’s Office of National Drug Control Policy. Some experts recently suggested that after the pandemic, mental health issues caused by worry and stress could become the single largest pre-existing health condition nationwide, which would also put pressure on broadening affordable treatment options, too.

In response to this concern, Kennedy crafted a plan with the National Action Alliance for Suicide Prevention and Dr. Joshua Gordon from the National Institute of Mental Health aimed at policymakers. In it, they called for a need to strip stigma from conversations about mental health and suicide, and for more evidence-based treatment options for people grappling with mental health and substance use.

Kennedy, himself in recovery from alcohol and substance use, said he checks the obituaries in his local newspaper each day. There, he notices the telltale signs of what he described as a “public health crisis” of fatal overdose and suicide when young people are said to have “died unexpectedly” or “died suddenly.”

“If we don’t address this crisis now, dependencies will become addiction, and depression will become a serious mental illness,” he said. “There’s progression in these illnesses. We can’t wait.”

To reverse dire numbers that researchers are still figuring out, Kennedy said the U.S. needs “wholesale changes” and to confront long-running issues in access to mental health services. Kennedy, along with other members of President Donald Trump’s since-disbanded Presidential Commission on Combating Drug Addiction and the Opioid Crisis, made dozens of recommendations to curb the deaths tied to drug use. In response, Congress appropriated $6 billion to address those measures, up from $500 million, Kennedy said. That response remains a fraction of how the U.S. found money during the HIV-AIDS epidemic.

To make progress, Kennedy said the U.S. must enforce parity laws that ensure health insurance companies cover the costs of mental health treatment. That includes permanent coverage of telehealth services for mental health treatment. During the pandemic, insurance companies offered provisional coverage of these services because people were afraid they might spread the virus if they attended therapy in person.

“The numbers are all going in the wrong direction, but we still somehow think we can manage this along the margins,” he said.

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