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Under-counting Deaths from COVID-19

Published on May 1st, 2020

The coronavirus has already claimed the lives of more than 64,000 Americans. But experts fear that number could be far higher at this point in the outbreak — perhaps by tens of thousands — once the pandemic subsides enough for officials to go back and make a true accounting of the dead.  Experts are urging the Trump Administration to take measures  to preserve data and medical specimens so that science has the chance to determine the precise number of people who died as a result of one of the most severe global pandemics in history.  The confusion and complications inherent in tracking pandemics have left a weary nation wondering just how high the actual U.S. death count may be — and how bad things really are.

“Under-counting deaths in this particular epidemic is happening all over,” said Dr. Daniel Lopez-Acuna, an epidemiologist and former top World Health Organization official, who spent 30 years at the organization. “It’s almost inevitable.”

Calculating the precise number of COVID-19 deaths is remarkably complicated for a number of reasons. But leading epidemiologists, pathologists, medical examiners, medical history professors and local, state, federal and global health officials contend that testing is the single most important factor in determining an accurate national death count. Less than 2% of all Americans have been tested for the coronavirus to date, according to White House figures — nearly 5.5 million people. It’s a figure that experts say is far lower per capita than where the U.S. should be at this point.

“We need to have the testing available because the big question now with COVID-19 is the denominator — of anything,” said Dr. Alex Williamson of the College of American Pathologists. “How many people get it? How many people recover? How many are hospitalized? How many died? We don’t know the true denominator. More testing is the most important thing we need to do.”

Ongoing testing kit shortages in cities and states nationwide means that only clearly symptomatic patients are currently being tested in many places. There also is no uniform national system in the U.S. for investigating deaths, and until two weeks ago, the U.S. was only counting Americans who lab-tested positive, before or after death, for COVID-19. Left out of the tally are people who died without being tested and those who died at home or some other non-healthcare facilities before they could seek medical care.  Due to the lack of a uniform U.S. system, the NCHS system lags about two weeks behind in reporting said, Dr. Robert Anderson, chief of mortality statistics.

 

“I’ve never – none of us have ever – seen an infection like COVID-19, that literally stopped the world,” said Williamson.

Daniel Weinberger, an epidemiologist from the Yale School of Public Health, analyzed NCHS death count data to estimate how many COVID-19 deaths may have gone uncounted during the five-week period from March 1 to April 3.

He concluded the official death toll in the U.S. is “probably a substantial underestimate of the true number by tens of thousands.” The actual figure, he said, may be “in the ballpark of double the reported cases.”

COVID-19-related deaths in non-hospital settings — especially nursing home deaths — are also fueling revised death counts in some U.S. regions and nations around the world. While the U.S. is not currently counting nursing home deaths nationally, it’s estimated that thousands have died from or with COVID-19 complications in these facilities across the U.S.

Last week, scientists at Yale School of Public Health published a scholarly paper, which has yet to be peer-reviewed, that estimated that the actual death count in New York and New Jersey could be up to three times higher than the official tally of confirmed COVID-19 deaths or deaths that would be expected normally this time of year with respiratory diseases. The final factor that undermines a complete COVID-19 death count, according to experts, is that many if not most of the people who have died had at least one additional underlying chronic medical condition that contributed to the deaths – particularly obesity, diabetes and hypertension.

 

 

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