Johnny, I Hardly Knew Ye
Johnny, I Hardly Knew Ye
By Brian W. Donnelly, M.D., F.A.B.M.
Mortality figures published in a recent issue of JAMA reveal some distressing information. In the USA between 2019 and 2020, the all-cause mortality rate for ages 1 to 19 years increased by 10.7%. It increased by an additional 8.3% between 2020 and 2021. These increases, the largest in decades, reversed the trend of steadily dropping mortality rates. American infants fared better during those time periods and did not suffer an increase in mortality rates.
The rise in rates is due mainly to the classification of “injuries.” Injuries include transportation deaths (such as motor vehicle accidents), firearm-related deaths, and poisoning (mostly drug overdoses). The other significant category of death in this age group — one that has been increasing since 2007 — is suicide.
Mortality rates had been increasing before the COVID-19 pandemic, but suffered a dramatic push upward since then. Injury mortality at ages 10 to 19 years rose by 22.6% between 2019 and 2020. Driving this surge were the increase in homicides (by 39%) and deaths from drug overdoses, which increased by 113.5%.
To place this in wider context, life expectancy in the U.S. dropped for the second year in a row between 2020 to 2021, from 77.0 to 76.1 years. In 2020, there had been a 1.8-year drop. That constituted the largest 2-year decline in life expectancy in a century (since 1921 to 1923). Also, the rate of death from drug overdoses has greatly increased in the U.S. since 2015, with about 70% of the victims being males. Fentanyl has supplanted heroin as the most commonly involved opioid in these fatalities.
The authors of the review correctly state : “A nation that begins losing its most cherished population — its children — faces a crisis like no other.”
To help counteract the epidemic of opioid abuse, there are efforts to make Narcan (or naloxone) more widely available. Naloxone blocks the effect of opioids, in particular the effect that suppresses breathing, so getting that substance into the victim’s nose “toot sweet” can potentially save that person’s life. Such an approach has limited efficacy, however. The timing has to be just right.
We need better answers and better prevention. There is an old parable of a man who sees a child flailing in the river, calling for help. The man swims into the water, pulls out the child and works to resuscitate him. Soon after, he hears another child’s call for help and needs to swim into the river again to effect another rescue. Shortly after, he hears another set of screams and repeats the rescue routine. His friend arrives and offers to help continue to take care of the kids. The exhausted rescuer thanks his friend and starts to leave. His friend asks where he is going. His angry response: “I’m going upstream to see who the hell is pushing these boys into the river!”
Upstream is where we need to go. Preventing these tragedies should be a national priority.
Dr. Brian Donnelly has a special interest in breastfeeding. He was the initial recipient of the Allegheny County Health Department’s Breastfeeding Advocacy Award. He is a Fellow of the Academy of Breastfeeding Medicine and can perform the frenulotomy procedure for tongue-tied infants who have trouble nursing. Dr. Donnelly sees patients at the AHN Pediatrics Northland office.
source https://www.thepediablog.com/2023/05/03/johnny-i-hardly-knew-ye/
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