San Antonio Express-News (Sunday)
» Death numbers lagging?
The number of people reported to have died of the novel coronavirus in the United States surpassed 100,000 last week, a grim marker of lives lost directly to the disease, but an analysis of overall deaths during the pandemic shows that the nation probably reached a similar terrible milestone three weeks ago.
Between March 1 and May 9, the nation recorded an estimated 101,600 excess deaths, or deaths beyond the number that would normally be expected for that time of year, according to an analysis conducted for the Washington Post by a research team led by the Yale School of Public Health. That figure reflects about 26,000 more fatalities than were attributed to COVID-19 on death certificates during that period, according to federal data.
Those 26,000 fatalities were not necessarily caused directly by the virus. They could also include people who died as a result of the pandemic but not from the disease itself, such as those who were afraid to seek medical help for unrelated illnesses. Increases or decreases in other categories of deaths, such as motor vehicle accidents, also affect the count.
Such “excess death” analyses are a standard tool used by epidemiologists to gauge the true toll of infectious-disease outbreaks and other widespread disasters.
The Yale-led team used historical death data to estimate the expected number of deaths for each week this year, adjusting for such factors as seasonal variation and the intensity of flu epidemics. To calculate excess deaths, the researchers subtracted their estimate of expected deaths from the overall number of deaths reported by the National Center for Health Statistics.
The COVID-19 death toll, a key data point in shaping the public-health response to the pandemic, has become a political flash point. Allies of President Donald Trump have claimed that the government tally is inflated, saying it includes people with other medical conditions who would have died with or without an infection.
The Yale-led analysis, however, suggests that the actual number of people who have died because of the pandemic is far greater than the official government death tallies. The researchers estimated that the number of excess deaths between March 1 and May 9 was most likely between 97,500 and 105,500.
“It’s clear that the burden is quite a bit higher than reported totals,” said Daniel Weinberger, the Yale professor of epidemiology who led the analysis.
The state-by-state analysis indicates that, as testing has become more widely available, COVID-19 deaths have accounted for larger and larger percentages of the excess deaths. It also suggests that the gap between excess deaths and official COVID-19 tallies has been particularly pronounced in several states that have the least restrictive social distancing rules.
Nationally, between March 1 and May 9, COVID-19 deaths accounted for about 74 percent of excess deaths. The gap between excess deaths and those attributed to COVID-19 has narrowed significantly since the early weeks of the outbreak. In the week ending March 28, only about half of the excess deaths were attributed to COVID-19. In the week ending May 2, the proportion had risen to 81 percent.
That is a common pattern in an epidemic, said Robert Anderson, chief of mortality statistics at the National Center for Health Statistics.
“In the early stages, when physicians are less familiar with the disease and not looking or testing for it, cases are more likely to be misdiagnosed and attributed to other causes,” he said. “As the epidemic progresses and physicians see more and more cases, they are increasingly likely to correctly diagnose the disease and report it accordingly.”