Excess U.S. Deaths Add to Pandemic’s Unofficial Toll
Thousands of deaths not attributed to Covid-19 were likely caused by the disease or indirect impacts of the pandemic, two new studies suggest
New analyses reveal considerable unexplained excess deaths during the coronavirus pandemic. Some of the deaths are likely due to Covid-19, the researchers say, and others may be indirectly related to the pandemic, caused for example by people not seeking medical attention for heart problems or other emergencies unrelated to Covid-19.
In the one study released today, published in the journal JAMA Internal Medicine, researchers examined national death data from March 1 to May 30 — the first three months of the U.S. pandemic. They found excess deaths above the norm for previous years and also beyond what’s been officially attributed to Covid-19.
The study counted 781,000 total deaths, which is 122,300 more than would be expected for the time period. Of those excess deaths, 95,234 were attributed to Covid-19, leaving 27,066 unexplained excess deaths. Some of these unexplained excess deaths, the researchers say, could have been caused by Covid-19 but not counted as such because testing for the disease was incomplete, especially early on.
“Excess deaths provide an estimate of the full Covid-19 burden and indicate that official tallies likely undercount deaths due to the virus,” conclude the researchers, from Yale School of Public Health, the National Institutes of Health and other institutions.
But that does not mean all 27,066 excess deaths were necessarily caused by Covid-19. The separate study, also out today, sheds some light on this.
In the separate study, of a nearly two month period this spring, researchers counted 505,059 American deaths, 87,001 more than the average for the same period over the past five years. About two-thirds of those “excess deaths,” or 56,246, were officially attributed as Covid-19. The rest of the excess, some 30,755 deaths, were said to be from other causes.
These findings, covering the period March 1 to April 25, also suggest “the Covid-19 death counts reported to the public underestimate the true death toll of the pandemic in the U.S., the researchers conclude today in the Journal of the American Medical Association.
But the research went deeper into possible explanations.
The typical causes of the excess deaths reveal unusual spikes for diseases that are normally consistent over time, including heart disease, diabetes, cerebrovascular disease and Alzheimer’s disease. The increase was particularly stark in states with the most deaths during the study time period: Massachusetts, Michigan, New Jersey, New York and Pennsylvania.
“There are several potential reasons for this undercount,” said this study’s lead author, Dr. Steven Woolf, a professor of family medicine and population health at Virginia Commonwealth University’s School of Medicine. “Some of it may reflect under-reporting; it takes a while for some of these data to come in. Some cases might involve patients with Covid-19 who died from related complications, such as heart disease, and those complications may have been listed as the cause of death rather than Covid-19.”
That would support other evidence suggesting Covid-19 deaths have been understated, since infectious-disease experts say that a person with an underlying health condition of dies with Covid-19 dies of Covid-19, since they would not otherwise have died at that time.
“But a third possibility, the one we’re quite concerned about, is indirect mortality — deaths caused by the response to the pandemic,” Woolf says. “People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship or emotional distress.”
In fact, in a Kaiser Family Foundation poll conducted in mid-May, “48% of Americans said they or a family member has skipped or delayed medical care because of the pandemic, and 11% of them said the person’s condition worsened as a result of the delayed care.”
Among specific reasons for some of the unexplained excess deaths, the researchers involved with the study led by Woolf, is some mix of the following:
- Fear of getting the virus, even in a medical emergency.
- Overloaded hospital staffs and inadequate resources for handling all emergencies in a timely manner.
- Chronic conditions exacerbated by the mental stress of job loss or social isolation.
The findings “confirm an alarming trend across the U.S., where community members experiencing a health emergency are staying home — a decision that can have long-term, and sometimes fatal, consequences,” says Dr. Peter Buckley, interim CEO of VCU Health System, which is affiliated with Virginia Commonwealth University. “Health systems nationwide need to let patients know it is safe and important to seek care in a health emergency, whether it’s through telehealth or in person.”
In a separate opinion article addressing the two new studies, Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, stresses the importance of ongoing measurement of excess deaths.
“These studies underscore the importance of continuing to measure excess deaths in the months and years ahead to gain a more complete understanding of the pandemic’s overall death toll, especially by race and ethnicity, and to guide more effective strategies to limit this toll,” Ayanian writes.
Editor’s Note: This article was updated to include the results of the Yale-led study and the comment by Dr. John Ayanian.