(JAMA) Since February 2020, the coronavirus disease 2019 (COVID-19) pandemic has led to at least 200 000 deaths in the US and 1 million deaths worldwide. These numbers probably underestimate COVID-19 deaths by 50%, with excess cardiovascular, metabolic, and dementia-related deaths likely misclassified COVID-19 deaths.1 In this issue of JAMA, Woolf and colleagues1 update their previous estimate, suggesting that the number of excess deaths between February and August 2020 attributable to COVID-19 is estimated to be about 225 000.
This devastating pandemic has affected nearly every aspect of daily life. While nations struggle to manage the initial waves of the death and disruption associated with the pandemic, accumulating evidence indicates another “second wave” is building: rising rates of mental health and substance use disorders. This imminent mental health surge will bring further challenges for individuals, families, and communities including increased deaths from suicide and drug overdoses. As with the first COVID-19 wave, the mental health wave will disproportionately affect Black and Hispanic individuals, older adults, lower socioeconomic groups of all races and ethnicities, and health care workers.