COVID-19 on track to be among SC’s leading causes of death this year
If the coronavirus pandemic had taken place in 2019, it would have cracked the top 10 in causes of death in South Carolina — in just four months.
In fact, the novel virus, which causes the sometimes fatal respiratory disease COVID-19 and spreads through respiratory droplets, is on pace to become the third leading cause of death of South Carolinians this year, trailing only heart disease and cancer.
That reality comes as debate continues on social media and opinion pages about the dangers of COVID-19 and how the disease compares to other threats to public health.
To determine just how deadly COVID-19 is in South Carolina, The State analyzed data for the state’s leading causes of death and talked to epidemiologists and health experts about what the trends say.
COVID-19 deaths in South Carolina were steady for the first couple months of the pandemic. However, in June daily death counts began to increase. As of Thursday, COVID-19 had killed 1,294 people in South Carolina and likely has claimed the lives of 40 more.
The disease has killed more people per capita in South Carolina than in a neighboring state that reopened more slowly and fewer people per capita than a state that reopened more quickly, suggesting a correlation between shutdown orders and deaths.
And, The State also found, COVID-19 is far more deadly in South Carolina than the flu, contrary to misinformation pushed by some, including the president early on in the pandemic and protesters against economic restrictions.
In fact, in South Carolina, only 149 people have died of the flu during the first six months of the year, the Department of Health and Environmental Control said.
And COVID-19 has not slowed down in the summer as some thought it would.
“Flu tends to stop in the summer, but COVID … seems to be going on through the summer and is just continuing,” said Kathleen Cartmell, an assistant professor of Public Health Sciences at Clemson University.
“There doesn’t seem to be any stopping point for COVID, unless we take preventive actions or get a vaccine. From the numbers alone, COVID has blown the flu out of the water.”
Climbing the ranks
As of Thursday, nearly 1,300 people in the state had died because of the virus, roughly four months after South Carolina saw its first case of COVID-19, DHEC reported. The raw number alone would have made the cause of death number eight in South Carolina in 2019.
If coronavirus cases continue to surge in South Carolina, resulting in more deaths, COVID-19’s death toll in the state could surpass 3,000 this year, said Anthony Alberg, the chairman of USC’s Arnold School of Public Health, citing what he sees as a conservative, or potentially low, estimate.
Surpassing 3,000 deaths would put COVID-19 in the running for the third highest killer of South Carolinians, competing with accidents (in third in 2019 with 3,062 deaths), and more deadly than chronic obstructive pulmonary disease, strokes, Alzheimer’s, diabetes and kidney disease. Only heart disease and cancer — claiming 10,049 and 10,015 lives, respectively, in 2019 — would be more deadly to S.C. residents if last year’s trends hold true this year, according to The State’s analysis.
“It’s sad and it’s tragic, I think anytime you identify such a huge cause of death,” said state Rep. Micah Caskey, R-Lexington, who added the numbers are “worrisome.”
Caskey added, however, that many of the deaths are in people who had underlying health conditions, which also may have contributed to their death. He called on people to do activities that help improve their health — something that hasn’t been encouraged to his frustration in public discussions about the coronavirus.
”(I)n addition to wearing a mask, social distancing, washing hands, people should be engaged in what we know improve health outcomes, like drink water, like exercise, like don’t eat sugar, take vitamins,” Caskey said. “These sorts of things can help improve your lives. In the face of a pandemic, I think it’s even more important to do those things.”
COVID-19 cases in the state have grown exponentially in recent months, a trend that could continue if people don’t take precautions, Cartmell said.
“If we keep seeing that, I suspect COVID could be at least the number three cause of death after heart disease and cancer at the rate that we’re going,” Cartmell said.
Through July 1, COVID-19 had killed 757 South Carolinians, according to DHEC. When comparing COVID-19 deaths through July 1 to leading causes of deaths for the first six months of 2020 in South Carolina, COVID-19 would rank eighth ahead of kidney disease, pneumonia and influenza combined, and liver disease. However, DHEC has not included COVID-19 in the leading causes yet, because there is no guidance from the Centers for Disease Control and Prevention on whether to include the disease in a broader category.
Health experts say the numbers should be cause for alarm — a call to action for residents and state leaders to do something to reverse the trend.
Universal face coverings, social distancing and possibly rolling back reopenings in the economy would slow the spread of the virus, said Alberg, the USC school of public health chairman.
“From the public health perspective, all options should be on the table,” Alberg said. “We’re talking about alarming statistics now and they could get worse.”
Comparing state COVID-19 death rates
When compared to neighboring states, South Carolina is between North Carolina and Georgia when it comes to COVID_19 deaths per 100,000 people, according to Centers for Disease Control. North Carolina, which has a statewide mask mandate in place, has 16.4 deaths per 100,000 people. South Carolina has 25.3.
Georgia, where the governor moved more quickly to reopen parts of the economy and has taken steps to prevent mask rules — namely, suing local mayors — has 31.7 deaths per 100,000 people.
South Carolina’s COVID-19 death rate still trails the nation’s rate, driven by spikes in heavily populated states where the pandemic bloomed first.
The country has an overall 43.07 deaths per 100,000 people due to COVID-19, according to Johns Hopkins University.
Had the South Carolina moved more slowly with its reopening, the COVID-19 cases would have been better under control, Alberg said.
“I think there’s no doubt we would have better control of COVID-19 right now if we had been slower,” Alberg said. “I think as part of the reopening process, it’s to occur in different phases and to really look at the data for each phase to see what’s happening with rates of disease, and I think we could have been more conservative if we had followed that approach.”
Early in the pandemic when case counts were low and the world was learning more about the disease, Gov. Henry McMaster ordered schools closed, limited restaurants to delivery and take out, and closed close-contact businesses such as gyms and salons along with tourist attractions, while taking other precautions to slow the spread of the virus.
With guidelines on how to reopen safely, created by his COVID-19 task force of business leaders and health officials, McMaster began lifting restrictions to help jumpstart the economy, including allowing tourist attractions to reopen and restaurants to allow people to dine in. Since Memorial Day case counts, as well as the percentage of tests coming back positive each day, have drastically increased.
McMaster’s office maintains the governor took the right steps.
The governor “set the state on a course to very methodically and deliberately lift restrictions off of businesses after a very thoughtful process that started with Accelerate SC to determine how businesses could operate in a safe way,” said McMaster’s spokesman Brian Symmes.
McMaster has yet to allow movie theaters and other clubs and entertainment venues to reopen and recently took one step back, ordering bars and restaurants to stop serving alcohol after 11 p.m. every day.
Debate continues over whether McMaster should issue a statewide mask mandate, which the governor has declined to do, saying it would be impossible to enforce. However, McMaster has encouraged residents to take personal responsibility by wearing masks. Several municipalities around the state instead of have instituted their own in mandatory mask ordinances in response to the high case counts.
The White House released guidelines in April for reopening, which included seeing two weeks of declining case numbers or a decline in the percentage of coronavirus tests with positive results. It’s one guideline South Carolina did not meet.
“What was being looked for was a continuous decline in the new cases of COVID-19 diagnosed per day for 14 straight days,” Alberg said. “We definitely never achieved that, but that was true nationwide.”
Alberg said he understands the need to keep the economy in mind, noting the “harm to society that could occur” in shutting businesses down.
“It definitely involves a mix of balancing the public health and medical science with the economic considerations.”
COVID-19 is not the flu
Health officials say there are obvious reasons the flu is less deadly than the coronavirus.
Fewer people have died from the flu than COVID-19 because people already have built up immunity to it from getting vaccinated every year or from having been sick from it in the past. There also are treatments for influenza such as anti-viral medications like Tamiflu.
“With COVID, we have nothing for your body to prepare to say ‘hey this is something that I could be able to fight off,’” Cartmell said.
COVID-19 has similar symptoms to the flu, which could lead to some comparing the seriousness of each illness. However, the flu is seasonal and tends to be worse in the winter. Annual vaccines also prevent people from catching the illness or at least lessen the sickness.
Ken Rudo, a retired toxicologist with North Carolina’s health department, said the more than 1,000 COVID-19 deaths in South Carolina are hard to compare to deaths from other diseases because so much still is not known about the coronavirus. But having that many deaths from a disease since March is nothing to dismiss, he said.
“This occurs because we don’t know a lot about what to do,’‘ said Rudo, who now lives in Summerville. “We are struggling to treat it. Folks are passing away in a horrifying death. And their families can’t come and see them.’‘
COVID-19: A top SC killer?
The coronavirus, which causes the sometimes severe respiratory disease COVID-19, has killed 1,203 South Carolinians since early March when the pandemic hit the state. By some estimates, it could kill 3,000 or more by year’s end. Here’s how it compares to other leading causes of death in South Carolina:
In 2019
10,049 — Heart disease
10,015 — Cancer
3,062 — Accidents
2,813 — Chronic obstructive pulmonary disease, such as emphysema and bronchitis
2,583 — Stroke
2,261 — Alzheimer’s
1,557 — Diabetes
950 — Kidney disease
820 — Sepsis
805 — Suicide
In 2020
Through July 1, COVID-19 caused 757 people to die in South Carolina, according to the Department of Health and Environmental Control. However, for 2020, DHEC has not included COVID-19 in its 10 leading causes of death in the state through July 1 because the Centers for Disease Control and Prevention has yet to issue guidance on how to categorize the disease and whether it should be included in a broader category.
4,903 — Heart disease
4,823 — Cancer
1,456 — Chronic obstructive pulmonary disease, such as emphysema and bronchitis
1,342 — Accidents
1,234 — Stroke
1,169 — Alzheimer’s
851 — Diabetes
447 — Kidney disease
397 — Pneumonia and influenza
389 — Chronic liver disease and cirrhosis
Reporter Sammy Fretwell contributed to this article.
This story was originally published July 24, 2020 at 5:00 AM.
