HOW MANY HAS COVID-19 KILLED?

Virginia may be significantly undercounting the coronavirus’ real death toll — and we’re not alone

Virginia’s official coronavirus death total could be significantly undercounting the pandemic’s real toll on the state, according to a Virginian-Pilot analysis. Compared to a typical year, overall deaths in Virginia are up by roughly 17% since March 14, when the state announced the first COVID-19 death in the commonwealth, according to federal data.

From mid-March to mid-May, roughly 2,200 more people died than normal. During that time, officials reported just shy of 1,200 coronavirus deaths, leaving a gap of roughly1,000 unaccounted deaths.

“It’s a safe assumption that the numbers we’re seeing on the news are an undercount,” said Steven Woolf, professor at the Virginia Commonwealth University School of Medicine.

While many of these deaths are likely caused by the novel coronavirus itself and went unnoticed due to a lack of testing, the shutdowns themselves could’ve also contributed, experts said.

Calculating excess deaths is a common method that public health researchers use to measure the full impact of major natural disasters, wars and other catastrophes, said Sara Ratcliffe, associate chair for research for the University of Virginia’s Public Health Sciences Department.

The Virginian-Pilot compared this year’s weekly death counts with a five-year average, a straightforward calculation that experts said was sound. It is not a precise method since it’s a simpler comparison to an average rather, than the range of expected deaths normally seen across five years. But “the main takeaway is really the same,” Woolf said.

In the Pilot’s analysis, the number of deaths above normal steadily rose until the week of May 2, when there were 1,604 death records — roughly 30% more than the 1,240 average deaths during that week in prior years.

The number of COVID-19 deaths and total deaths are not modeled or predicted; they are deaths that have been recorded in the state. The

counts, which are current as of Wednesday, are still provisional and are likely to rise in the coming weeks as more death certificates are filed. The more recent the week, the more likely that the numbers will increase. As of Wednesday, known COVID-19 deaths make up roughly 54% of the excess deaths in Virginia during that two-month window.

The trend in Virginia isn’t unusual, and several states have been hit harder. The United States as a whole has seen roughly 72,000 more deaths than expected between March 21 and May 2, according to data from the Centers for Disease Control and Prevention’s National Center for Health Statistics.

There is a general pattern: For every three deaths that are attributed to the new coronavirus, there are another two deaths that are unexplained, said Woolf, who has studied excess deaths related to COVID-19.

“Almost every state in the country, except for four or five, has experienced this,” he said.

The Virginia Department of Health is reviewing all death certificates for indications of association to COVID-19, and is actively updating their records based on the identification of a previously uncounted death, a state spokeswoman said.

In Woolf’s study, Virginia had the 12th highest number of excess deaths among the 50 states and D.C. Some states, like New Jersey and New York, have been hit especially hard, seeing double typical death rates certain weeks. Several southern states have seen about the number of expected deaths.

The reason for the above-normal deaths isn’t exactly clear. The excess death analysis looks at allcause mortality and does not indicate how each individual person died.

In many cases, experts said, it’s likely that they are COVID-19 cases that went uncounted, whether it was due to insufficient testing, an issue Virginia long struggled with, or another reason.

“It’s going to take some time for the science to catch up with the pandemic and understand what are all the different complications that people would experience,” he said.

But Woolf was also concerned that the shutdowns themselves could be leading to more deaths, whether it is tied to people avoiding hospitals, lacking food and income, or due to elevated stress levels. In March, Gov. Ralph Northam Virginia also ordered hospitals to stop handling elective care to ensure there were enough beds and equipment for people with the coronavirus.

These deaths would still help measure the indirect impacts of coronavirus, Ratcliffe said. If more people are dying of heart attacks because they were afraid of going to the hospital, the coronavirus is still contributing to that death.

“While COVID did not directly cause the heart attack, COVID contributed to the heart attack leading to death,” she said.

For these excess deaths, like the confirmed COVID-19 deaths officials have reported so far, the impact might not be equal throughout the state.

Virginia has reported a total of 1,428 coronavirus deaths, as of Wednesday. And the groups who have been bearing the brunt of the impact — the elderly and communities of color — could also be seeing a higher share of these excess deaths. The CDC data is only available at the state level, and cannot be broken down by county and city.

People who are more than 80 years old make up 52.4% of the state’s deaths. And long-term care residents, including those in nursing homes and other assisted-living facilities, make up about 56% of the state’s deaths.

In Virginia and elsewhere, early data indicates that black people make up a disproportionate number of cases and deaths — which experts said is likely the case for these extra deaths as well.

“These excess deaths are more likely to impact people of color and low-income communities,” Woolf said.

“These excess deaths are more likely to impact people of color and low-income communities.”

— Steven Woolf