Article Critique of: Hospital Avoidance and Unintended Deaths During the Covid-19 Pandemic by Jonathan Zhang

A 2021 article by Jonathan Zhang titled “Hospital Avoidance and Unintended Deaths During the Covid-19 Pandemic” explores excess deaths due to people avoiding hospitals in the first several weeks of the Covid-19 pandemic. In the late winter and spring of 2020, a novel Coronavirus became a world-wide pandemic and was rapidly spreading across the US.

The pandemic caused widespread anxiety which led to changes in behavior and sudden, drastic changes to the economy. During periods of economic recession and distress, morbidity and mortality generally increase. Initially, Emergency Department (ED) utilization in the Veterans Administration (VA) decreased as fear of Covid caused people to avoid or delay care.

The question here is, due the changes in behavior, and excluding Covid-19 deaths, did people who use the VA system experience excess death above and beyond what was expected.

The study used VA data and looked at deaths between March 18 and May 5, 2020. Initially, ED utilization decreased in March of 2020 but by May 5, 2020 cases of Covid-19 were decreasing and ED utilization in the VA had increased for two to three weeks signaling an end of the first wave.

ED visits were used as a proxy for patient demand since acute inpatient hospital admissions are a supply-side demand. The author used three sets of counties — 1) all counties where residents reside, 2)…