The Covid death toll in the US is likely to be at least 16% higher than the official count, according to a new studyand researchers believe the cause of the undercount goes beyond overburdened health systems to a lack of awareness of Covid and low levels of testing.
The second year of the pandemic also had nearly as many uncounted excess deaths as the first, the study found.
According to official, more than 1.1 million Americans have died from Covid records. But the real number is sure to be higher, given the high rates of excess deaths. Demographers wanted to know how much could be attributed to Covid, and they drilled into county-level data to discover patterns in geography and time.
There were 1.2 million excess deaths from natural causes – excluding deaths from accidents, firearms, suicide and overdose – between March 2020 and August 2022, the researchers estimated, and about 163,000 of those deaths were in no way due to Covid not attributed – but most of them should have been, say the researchers.
Once they determined how many more people had died than expected, more questions arose.
“Everybody wanted to know: why did all these extra deaths happen?” asked Elizabeth Wrigley-Field, associate professor in the department of sociology and the Minnesota Population Center at the University of Minnesota and one of the study’s authors.
To get closer to that answer, they first looked at when and where excess deaths occurred.
The researchers thought they could see the deaths happening at the height of major outbreaks or soon after, when health systems were overwhelmed and health workers themselves were exhausted and sick.
Instead, the excess deaths began to increase in the previous month, leading to large increases.
“The non-Covid deaths start a little bit before the official Covid spikes start and peak a little bit sooner,” Wrigley-Field said.
This indicates that some people did not realize their illness was Covid, due to a lack of awareness about its prevalence and low levels of testing. There has also been an increase in deaths outside the hospital – for example in homes and nursing homes – making it more difficult to determine the cause of death.
The researchers also thought they would see underreporting of Covid deaths mainly in the early months of the pandemic, as other research has indicated. It was still a new virus then, and not everyone knew the symptoms or had access to tests.
“On the contrary, we find during the first 30 months of the pandemic that there remained serious gaps in surveillance,” said Andrew Stokes, associate professor of global health and sociology at Boston University and one of the study’s authors.
“Even though we’ve gotten much better at testing for Covid, we’ve still missed a lot of official Covid deaths” in the US, said Jennifer Dowd, professor of demography and population health at the University of Oxford, who was not involved in this research. . .
The phenomenon “underlines how badly the US has fared as the pandemic continues,” Wrigley-Field said. “This deeply reflects the failures in the public health system.”
As for where the deaths occurred, “there was marked regional variation,” Stokes said. Hardest hit were non-metropolitan counties, particularly in the west and the south – areas that don’t have as many resources to investigate deaths, and which had lower levels of testing for Covid, he said.
These differences are also likely explained by different state-level policies, how jurisdictions count Covid deaths, and the politicization of the crisis down to the local level, where beliefs about Covid may have influenced the cause of death listed on certificates.
“Every jurisdiction does it differently, and that’s why it’s such a mess,” Stokes said.
The US should invest in more complete and timely death reporting, the experts agreed.
While Covid deaths have now declined from soaring heights seen earlier in the pandemic, the virus is still deadly. “If we really want to know the impact, yes, that Covid continues to have on deaths, we still have to look at this excess over time,” Dowd said.
“We will probably use these numbers for many reasons to try to understand what went right and what went wrong with Covid – and how we can do better for the next pandemic,” she said.
Knowing death rates helps authorities allocate resources, including vaccines, treatments and extra health workers, to the hardest-hit populations and regions, and it can help individuals make more informed decisions about taking precautions.
Understanding the true death toll from Covid – and elucidating the reasons for undercounting – is important for current responses to infectious diseases as well as preparing for the next pandemic, the researchers said.
“What does it take to be able to respond to a disaster as it unfolds?” asked Wrigley-Field. “Where are the places that, when there was a crisis, were really unable to keep people alive?”
