Official U.S.tallies likely undercount COVID-19 deaths

By Angela Betsaida B. Laguipo, BSNJul 3 2020

The United States is the hardest-hit nation amid the coronavirus pandemic, with its case toll has topping 2.73 million. The death toll in the official tally has reached 128,742. Now, a new study published in the journal JAMA Internal Medicine suggests that the coronavirus disease (COVID-19) deaths between March and May in the country were likely 28 percent higher than the official tally reported.

A team of researchers from Yale University analyzed data from the National Center for Health Statistics and the U.S. Centers for Disease Control and Prevention (CDC) to determine the extent and magnitude of the coronavirus disease at the start of the U.S. epidemic.

In this cohort study, the number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths. Image Credit: People Image Studio / Shutterstock

More deaths than reported

They found that in the first three months, between March 1 to May 30, there were about 781,000 all-cause deaths in 48 states, wherein 95,235 were attributed to COVID-19. They revealed that there were 122,300 more deaths than usually expected during the period, which is 28 percent higher than the number of reported deaths from COVID-19.

“In this cohort study, the number of deaths due to any cause increased by approximately 122,000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths,” the researchers said.

The team added that in several states, the deaths occurred before the government has increased the availability of COVID-19 diagnostic tests, which means the deaths were not counted in official COVID-19 death tally.

“There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths,” the team added.

For instance, the all-cause deaths reported in New York City were seven times higher than baseline at the pandemic peak, with about 25,100 excess deaths. About 26 percent of these deaths were not tied to COVID-19. In other New York areas, excess deaths were only twice as high as the baseline, with about 12,300 excess deaths.

In other states, there were increased numbers of excess deaths, including Louisiana, Illinois, New Jersey, Massachusetts, and Michigan. On the other hand, in smaller central states, there were only a few or no excess deaths reported.

Increased testing

At the start of the pandemic, there was a limited supply of diagnostic tests across the globe. When testing was ramped up, the true magnitude of the disease surfaced. From there, thousands of cases were reported each day.

In the United States, it was not until April that testing for COVID-19 has increased. The research team also noted in the study that the discrepancies of the excess deaths and recording could be due to the timing and intensity of increased testing. For instance, the all-case death rates in Texas and California occurred many weeks before COVID-19 testing was widely available.

On the other hand, in states where the gaps were smaller such as Michigan and Massachusetts, testing was increased before or at the same time as the number of excess deaths increased.

Another potential reason for discrepancies was due to guidelines on the recording of deaths of suspected but not confirmed cases caused by COVID-19

“Monitoring syndromic causes of death can provide crucial additional information on the severity and progression of the COVID-19 pandemic. Estimates of excess deaths will be less biased by variations in viral testing, but reporting lags need to be properly accounted for,” the team explained.

“Even in situations of ample testing, deaths due to viral pathogens, including SARS-CoV-2, can occur indirectly via secondary bacterial infections or exacerbation of comorbidities. There can also be secondary effects on mortality due to changes in population behavior brought about by strict lockdown measures and an aversion of the health care system,” they concluded.

The team added that monitoring excess mortality could provide an essential tool in evaluating the impact, extent, and magnitude of the coronavirus pandemic.

The disease has now spread to many countries across the globe and has infected more than 10.86 million people worldwide. Following the U.S., Brazil has topped the 1.49 million case milestone, and the number is still increasing. Now, Brazil has a staggering 61,884 deaths. Other countries, such as Russia, India, Peru, and the United Kingdom also report skyrocketing cases.