COVID-related deaths in U.S. counties underestimated by 20%, study estimates

BOSTON, Mass. — To this point, doctors say COVID-19 is responsible for nearly 600,000 American deaths. Unfortunately, researchers from Boston University warn many related deaths are going unnoticed. Their findings reveal death certificates may not be properly attributing up to 20 percent of COVID-related deaths during the pandemic.

Study authors used data from the National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) to assess excess deaths in 2,096 counties from January to December 2020. They discovered that for every 100 excess deaths health officials directly link to COVID-19 in a given county, another 20 excess deaths go without any official ties to the virus. That means 20 out of every 120 excess deaths (17%) don’t have any documentation linking them to COVID.

Miscounting is more common in poorer communities

Notably, counties with lower average socioeconomic status and less formal education tended to have more unattributed excess deaths, as well as areas located in the South and West. Counties with a high proportion of African-American residents also had high numbers of misreported excess deaths.

“Our findings suggest that the impact of the COVID-19 pandemic on mortality has been substantially underestimated in many communities across the US,” says study lead author Dr. Andrew Stokes, assistant professor of global health at BUSPH, in a university release. “Several factors, including severe testing shortages, overwhelmed health care systems, and a lack of familiarity with the clinical manifestations of COVID-19 has likely led to significant underreporting of COVID-19 on death certificates, especially early in the pandemic. Official COVID-19 death tallies also fail to capture the pandemic’s profound social and economic consequences, including the downstream effects of interruptions in receiving health care, loss of employment, evictions, and social isolation and loneliness.”

People can still die from COVID without contracting the virus

The report finds some of these deaths factually have no direct link to COVID-related symptoms. However, some passed away due to indirect connections, like being afraid to visit the hospital during lockdown.

“Counties with high levels of COVID-19 mortality also had exceptionally high levels of mortality in 2020 from other causes of death. This result suggests that the epidemic is responsible for many more deaths than are attributed to COVID-19 alone,” notes study senior author Dr. Samuel H. Preston, professor of sociology at the University of Pennsylvania.

“Racial and socioeconomic inequities in U.S. mortality have widened significantly as a result of the COVID pandemic, especially when considering total excess deaths. To protect public health, policymakers must act decisively to address structural racism and reduce income inequality,” adds study co-author Dielle Lundberg, a research fellow at BUSPH.

Study authors conclude many U.S. counties did a poor job of accurately tracking the death toll linked to COVID-19. Meanwhile, as of May 19, 2021, the CDC reports the weekly average number of deaths from coronavirus sits at just under 500 Americans.

“A more complete accounting of COVID-19 deaths in local communities using excess deaths could lead to increased public awareness and vaccine uptake, particularly in areas where the official death counts suggested the pandemic had a limited impact,” Stokes concludes.

The study appears in the journal PLOS Medicine.