COVID-19 Death Toll in US Significantly Undercounted, Study Finds

The official record of lives lost to Covid-19 in the United States during the pandemic’s first two years significantly underestimated the true toll, according to a fresh study published Wednesday in the journal Science Advances. Researchers estimate that roughly 155,000 Covid-19 deaths went uncounted between 2020 and 2021, representing nearly 20% of reported fatalities. This finding underscores the challenges in accurately tracking a rapidly evolving public health crisis and highlights disparities in how deaths were investigated and recorded across different communities.

The study, led by researchers at Boston University, utilized machine learning techniques to analyze national death certificate data. They examined patterns in deaths of individuals with confirmed Covid-19 infections, particularly those who died in hospital settings, and then applied those patterns to death certificates of individuals who died outside of hospitals, where testing was less readily available. This approach allowed them to identify deaths likely attributable to Covid-19 but not officially recorded as such. The full study details the methodology and findings.

Disparities in Undercounting

The analysis revealed that the undercounting of Covid-19 deaths was not uniform across the population. The researchers found that Hispanic individuals and other people of color were disproportionately affected, with a higher likelihood of their deaths going unrecorded. This disparity was particularly pronounced in states in the South and Southwest, including Alabama, Oklahoma, and South Carolina. This finding builds on existing research demonstrating how systemic inequities can impact health outcomes and access to care.

Steven Woolf, a researcher at Virginia Commonwealth University who was not involved in the study, emphasized that these disparities persist. “People on the margins continue to die at disproportionate rates because they can’t access care,” he told STAT News in a recent interview. Access to healthcare, a long-standing issue in the U.S., continues to be a critical factor in health outcomes.

Challenges in Accurate Death Reporting

A key factor contributing to the undercount was the limited availability of testing, particularly during the early stages of the pandemic. Many individuals who became ill and died outside of hospital settings were not tested for Covid-19, either because at-home tests were not widely available or because they lacked access to testing altogether. Elizabeth Wrigley-Field, one of the study’s authors from the University of Minnesota, explained that routine testing of hospital patients contrasted sharply with the situation for those who died at home or in other non-hospital settings.

Beyond testing limitations, the study as well points to variations in death investigation practices across the country. Some areas rely on elected coroners, who may not have the same level of specialized training as medical examiners. Research has suggested that partisan beliefs could also have influenced testing practices and death investigations, with some families requesting that Covid-19 not be listed as a cause of death. Andrew Stokes of Boston University, the senior author of the paper, noted that the “antiquated death investigation system” played a significant role in the inaccurate counts, particularly outside of major metropolitan areas.

The Broader Context of Pandemic Mortality

The Centers for Disease Control and Prevention (CDC) currently reports more than 1.2 million Covid-19 deaths in the U.S. Since the start of the pandemic in early 2020, with over two-thirds of those deaths occurring in 2020 and 2021. Though, this number has been the subject of debate, with false claims circulating on social media alleging that the death toll was inflated. The new study adds to a growing body of evidence suggesting that the opposite may be true – that the official count significantly underestimated the true impact of the virus.

It’s important to note that the pandemic also resulted in deaths indirectly related to Covid-19. For example, individuals with other medical conditions may have died because they were unable to access routine care due to overwhelmed hospitals. Others may have succumbed to drug overdoses exacerbated by social isolation and disruptions in treatment access. While the Boston University study focused specifically on deaths directly attributable to Covid-19 infection, other research has attempted to account for these indirect effects when estimating the overall pandemic death toll.

Understanding Excess Mortality

One approach to estimating the total impact of the pandemic is to examine “excess mortality” – the number of deaths exceeding what would normally be expected based on historical trends. From March 1, 2020, through the end of 2020, the U.S. Experienced 522,368 excess deaths, representing a 22.9% increase compared to the expected number of deaths during that period. According to data from Wikipedia, this suggests that the pandemic’s impact extended beyond confirmed Covid-19 cases and deaths.

Implications for Public Health Surveillance

The findings from this study have important implications for public health surveillance and preparedness. Accurate and comprehensive death reporting is crucial for understanding the true burden of disease, identifying vulnerable populations, and informing public health interventions. The study highlights the need for improvements in the U.S. Death investigation system, including increased funding for medical examiner offices, standardized training for coroners, and enhanced data collection and analysis capabilities.

The CDC continues to refine its methods for tracking Covid-19 deaths and other public health threats. The agency’s National Vital Statistics System (NVSS) collects and reports annual mortality statistics, and provisional data are released regularly to provide an early estimate of trends. The CDC’s MMWR reports provide detailed information on provisional mortality data and emerging health trends.

Looking ahead, strengthening the nation’s public health infrastructure and investing in robust surveillance systems will be essential for effectively responding to future pandemics and protecting the health of all Americans. Further research is needed to understand the long-term consequences of the pandemic, including the impact of Long Covid and the ongoing disparities in health outcomes.