Now that the 2020 figures have been properly tallied, there is still no convincing evidence that strict lockdowns reduced the death toll from COVID-19. But one effect is clear: more deaths from other causes, especially among the young and middle-aged, minorities and the less affluent. The best gauge of the pandemic's impact is what statisticians call excess mortality, which compares the overall number of deaths with the total in previous years. That measure rose among older Americans because of COVID-19, but it rose at an even sharper rate among people aged 15 to 54, and most of those excess deaths weren't attributed to the virus. Preliminary reports point to some obvious lockdown-related factors. There was a sharp decline in visits to emergency rooms and an increase in fatal heart attacks because patients didn't receive prompt treatment. Many fewer people were screened for cancer. Social isolation contributed to excess deaths from dementia and Alzheimer's. Researchers predicted that the social and economic upheaval would lead to tens of thousands of "deaths of despair" from drug overdoses, alcoholism and suicide. As unemployment surged and mental-health and substance-abuse treatment programs were interrupted, the reported levels of anxiety, depression and suicidal thoughts increased dramatically, as did alcohol sales and fatal drug overdoses. The number of excess deaths not involving COVID-19 has been especially high in US counties with more low-income households and minority residents.