As if the death toll from COVID-19 wasn’t bad enough, a new study estimates the actual number of pandemic-related deaths in America is up to 28% higher than the official count.
That means that for every 3.5 known victims of COVID-19, another American lost his life as a result of the coronavirus outbreak.
“Official counts probably underestimate deaths from the virus,” researchers reported in JAMA Internal Medicine on Wednesday. The extent of this insufficient count varies “markedly across states,” they added.
Between March 1 and May 31, the number of COVID-19 deaths reported to the National Center for Health Statistics was 95,235. But there are good reasons to suspect that this number is an insufficient count, the study authors explained.
The country did not have enough coronavirus test kits to make a definitive diagnosis for all those suspected of having COVID-19, especially in the early days of the pandemic, they wrote. Furthermore, the tests that were available were sometimes incorrect, causing people who were actually infected with the coronavirus to receive the news that they did not have it. And some states have not compiled their death certificate data as quickly as others.
To get a more reliable count of coronavirus-related deaths, a team led by Yale epidemiologist Daniel Yinberger set out to determine the number of “excess deaths” that occurred in the United States in March, April, and May.
They started by gathering weekly death counts for each state, beginning in January 2015 and ending in January 2020. They then used that data to project what the weekly death counts would be until the end of May 2020 if the pandemic hadn’t happened. That gave them a baseline of expected deaths for 48 of the 50 states, along with the District of Columbia. (North Carolina and Connecticut were not included because some of their mortality data was missing.)
The researchers then calculated the actual number of deaths reported in each state between March 1 and May 30. The difference between expected deaths and actual deaths gave them the number of excess deaths.
Actual deaths exceeded expected deaths in all but seven of the states they analyzed. In other words, 41 states and the District of Columbia had at least some excess deaths.
In California, for example, historical trend suggested that the state would have about 65,600 deaths in March, April, and May. Actually, there were 72,407, a difference of just over 6,800 deaths. However, the state attributed only 4,406 deaths to COVID-19 during that period, suggesting that the official count did not capture the true number of pandemic victims in the Golden State.
Looking at the California data week by week, the study authors noted that excess deaths began to appear several weeks before the state began widespread coronavirus testing. That could help explain the deficit in the official count, they wrote.
The researchers also calculated that for every 100,000 California residents, there were 17.2 excess deaths in the period from March to May. That put the Golden State well below the national figure of 37.3 excess deaths per 100,000 people.
Topping the list was New York. In New York City alone, there were 299.1 excess deaths per 100,000 people; In the rest of the state, there were 111.4 excess deaths per 100,000 inhabitants. Neighboring New Jersey came in second, with 182.3 excess deaths per 100,000 residents.
The seven states that bucked the trend by having fewer deaths than expected were North Dakota, Wyoming, West Virginia, Alaska, South Dakota, Hawaii, and Maine.
The longer the pandemic continues, the smaller the gap between excess deaths and official COVID-19 deaths, the study authors wrote. That is probably the result of many factors, including more generalized testing.
Not all excess deaths are a direct result of coronavirus infection, the researchers wrote. Some people suffered indirectly by staying away or being rejected by overwhelmed hospitals and doctors’ offices, even though they needed care.
In fact, a report released last week by researchers from the Centers for Disease Control and Prevention found that the number of patients who went to the emergency room for treatment for a heart attack decreased by 23% in the 10 weeks after the United States declared a national emergency in March 13. Stroke emergency room visits decreased by 20%, and visits by diabetes patients in the midst of a life-threatening hyperglycemic crisis decreased by 10%, according to a study in the CDC Weekly Morbidity and Mortality Report.
“Even in extensive testing situations, deaths due to viral pathogens, including SARS-CoV-2, can occur indirectly,” Weinberger and colleagues wrote. “Monitoring excess mortality provides a key tool to assess the effects of an ongoing pandemic.”
