U.S. Coronavirus Death Toll May Be Almost 30 Percent Higher Than Officially Thought

The COVID-19 death toll in the U.S. may be almost 30 percent higher than previously thought, according to a study. Writing in the journal JAMA Internal Medicine, researchers said the estimated gap may partly be explained by an initial lack of widespread testing.

Six months into the COVID-19 pandemic, over 10.6 million COVID-19 cases have been confirmed worldwide, according to Johns Hopkins University. The U.S., which has been hit by a recent uptick in cases in the South and West, has the most cases at 2.6 million, and the most deaths, at over 128,000.

The researchers estimated the number of undocumented COVID-19 fatalities by counting what are known as "excess deaths." This is a common way for experts to measure the impact of a new infectious pathogen, such as a pandemic flu, when there is a lack of comprehensive testing, according to the team.

They did this by calculating a baseline number of expected deaths in the U.S. between March 1 and May 30 in years prior to 2020. They then subtracted the expected number of deaths each week from the documented deaths between March 1 to May 30, 2020, when the COVID-19 pandemic had hit.

Daniel M. Weinberger, associate professor of epidemiology at the Yale School of Public Health, and colleagues included 48 states and the District of Columbia in the study, but excluded North Carolina and Connecticut due to issues with data.

The data accessed on June 12, 2020 revealed approximately 781,000 people died in the U.S. between March 1 to May 30, 2020, including 122,300 excess deaths compared to previous years.

There were 95,235 excess deaths attributed to COVID-19, meaning that 28 percent of the 122,300 excess deaths from any cause have not been attributed to the disease.

The team noted that the National Center for Health Statistics, from where they drew some of the data, could be incomplete due to delays in reporting.

The death toll and the completeness of data varied "markedly" between states, the study revealed.

In Texas, Arizona, and California approximately 55 percent, 53 percent and 41 percent of excess deaths were not attributed to COVID-19, respectively.

States including New Jersey, Massachusetts, Louisiana, Illinois, and Michigan also saw a rise in excess deaths. But others, particularly in smaller central U.S. states and northern New England, had small or negligible increases. For example, 12 percent of excess deaths in Minnesota were not attributed to COVID-19.

The timing of when COVID-19 testing started and increased in a particular location may explain the discrepancies, the team said. In states such as Texas and California, the excess deaths came several weeks before widespread COVID-19 testing was rolled out, while testing intensity increased before excess deaths in states such as Massacushetts and Minnesota. Guidelines on how to record deaths related to COVID-19 when a person hasn't tested positive for the coronavirus, and whether a person died at hospital or at home, may also play a role.

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Medical personnel move a deceased patient to a refrigerated truck serving as a make shift morgue at Brooklyn Hospital Center on April 09, 2020 in New York City. Getty

Over the course of the pandemic, excess deaths and reported COVID-19 deaths have "become better aligned," perhaps because of more testing and better recognition of COVID-19 symptoms, the authors said.

The data might be skewed by the pandemic changing how people seek healthcare and how conditions are recorded, the team acknowledged. The findings were limited because they were based on provisional data which was incomplete due to reporting delays in some states.

But the researchers still believe the study suggests that estimating death tolls based on excess deaths may be "more reliable" than reported deaths, particularly in areas which lack widespread testing.