Since the beginning of the pandemic three years ago, more than 1.12 million Americans have died of COVID-19 infection, according to the Centers for Disease Control and Prevention (CDC). New York was one of the hardest hit cities, with the number of total and probable deaths more than 45,000. But how do we know that those were deaths from COVID and not deaths with COVID?
As of March 31, 2023, 38,764 of the 45,156 deaths in NYC were confirmed with a positive molecular test, which detects genetic material of the virus, while the remaining deaths —classified as “probable” — had “COVID-19 or similar” listed as cause of death without confirmation. This type of death reporting has led to some confusion about whether people are actually dying from COVID, or if COVID is listed on death certificates even if it was not the infection that resulted in death.
There are good reasons for this confusion. For example, how can we be sure hospitals are reporting accurately? And what about people who die at home without taking a COVID test — how are they accounted for?
This confusion has, in turn, sown unwarranted doubt over whether COVID really is deadly — emphasized in a recent opinion piece in the Washington Post by Dr. Leana Wen, who supports the claim that COVID deaths are overcounted. The evidence suggests, however, that COVID-19 is indeed deadly — and that deaths may, in fact, have been undercounted.
One way of understanding the death toll is looking at how many extra deaths have happened during the pandemic, using a measure called excess mortality, or excess deaths. In an interview with the AmNews, Dr. Yea-Hung Chen, an epidemiologist at the University of California, San Francisco, described one way of thinking of excess mortality: “It’s this thought exercise of imagining this magical world where the pandemic never happened…..It asks the question of ‘Had the pandemic not occurred, how many deaths would we have expected to see?’”
Dr. Jonathan Wakefield, a biostatistician at University of Washington and member of the Technical Advisory Group of the World Health Organization (WHO) COVID-19 Mortality Assessment Group, explained in an interview with the AmNews why excess mortality is a more “robust measure” for assessing pandemic deaths.
“In general, it is not straightforward to unambiguously define a COVID death. Not only do COVID death assignment procedures vary from country to country, they also vary in time within countries as, for example, testing capabilities change, so to establish a COVID death is not always straightforward… Scientifically, excess mortality is more justifiable because it’s a much easier quantity to estimate: it’s more clear-cut, instead of ambiguous, and also can’t be politicized so easily.”
The data do show that COVID is causing excess deaths on the population level. Wakefield emphasized that “there is no question that there were a huge number of excess deaths in the United States.” The WHO estimates he worked on indicated that in 2020 and 2021, there were 932,458 excess deaths in the United States. As of this writing, the CDC places the total number of excess deaths in the pandemic period in the U.S. at 1.31 million: 215,527 more than the official death count from COVID.
Globally, Wakefield’s research suggests that there were 14.91 million excess deaths in the years 2020-2021, with most of these likely attributable to COVID. That is 2.75 times the deaths reported as COVID deaths. Evidence also suggests that undercounting is more common in Black, Hispanic, and Native American communities.
Data in this chart is from August 2020.
One counter argument suggests that some of these deaths may result from other COVID-related events, such as restrictions put in place at accessing hospitals as a result of lockdown measures. Even if some excess deaths may have resulted from other pandemic-related issues, both researchers emphasize that COVID is the main culprit. Chen explained that the timing of excess deaths matters: According to the CDC, excess deaths that are not classified as COVID deaths “peak at around the same time as excess deaths,” a pattern that would be expected only if COVID is driving these deaths.
Another argument claims that hospitals are misreporting COVID deaths. The argument suggests that people are dying with COVID, rather than from COVID. Dr. Chen responded to this theory by saying: “If you look at out of hospital settings, you see this massive, massive difference between COVID deaths and excess deaths, and we think that is very indicative of underreporting of COVID, to the extent that even if there are isolated cases of this with COVID or from COVID being an issue in hospitals, it is far outweighed by the home deaths’ underreporting and also the likelihood that in-hospital reporting probably, in general, follows the CDC guidelines.”
Wakefield allowed for the potential of discrepancies in reporting, noting that across states and countries it is difficult to accurately count COVID deaths. He emphasized that this is why excess mortality is a valuable measure, particularly in a country with death records as relatively robust as the United States: “It’s impossible that this excess mortality doesn’t exist… The science is quite clear here. There was a huge excess.”
For additional resources about COVID-19, visit www1.nyc.gov/site/coronavirus/index.page or call 311. COVID-19 testing, masks, and vaccination resources can also be accessed on the AmNews COVID-19 page: www.amsterdamnews.com/covid/.