Official counts undercut death toll in U.S.

A coroner in Indiana wanted to know if the coronavirus had killed a man in early March but said that her health department denied a test. Paramedics in New York City say that many patients who died at home were never tested for the coronavirus, even if they showed telltale signs of infection.

Across the United States, even as coronavirus deaths are being recorded in terrifying numbers, the true death toll is likely much higher.

More than 9,000 people with the coronavirus have been reported to have died in this country as of this weekend, but hospital officials, doctors, public health experts and medical examiners say that official counts have failed to capture the true number of Americans dying in this pandemic. The undercount is a result of inconsistent protocols, limited resources and a patchwork of decision-making from one state or county to the next.

In many rural areas, coroners say they don’t have the tests they need to detect the disease. Doctors now believe that some deaths in February and early March, before the coronavirus reached epidemic levels in the United States, were likely misidentified as influenza or only described as pneumonia.

With no uniform system for reporting coronavirus-related deaths in the United States and a continued shortage of tests, some states and counties have improvised, obfuscated and at times backtracked in counting the dead.

Late last week, the Centers for Disease Control and Prevention issued new guidance for how to certify coronavirus deaths, underscoring the need for uniformity and reinforcing the sense by health care workers and others that deaths have not been consistently tracked.

In infectious outbreaks, public health experts say that under typical circumstances it takes months or years to compile data that is as accurate as possible on deaths. The reporting system during an epidemic of this scale is particularly strained.