Are we over-counting Covid deaths?

Data and Metrics Data Literacy

No. Sadly, we are most likely still UNDER-counting Covid-19 deaths.

Among the most persistent COVID-19 myths is the idea that COVID-19 deaths are being over-counted, which recently resurfaced in a Washington Post editorial.

We’ve all heard stories of COVID positive motorcycle accident victims being counted or the saying that people are dying *with* COVID-19 rather than *of* COVID-19.

It’s definitely true that some deaths have been miscoded, and some COVID-19 deaths happen in people who would have died soon anyway. But we don’t have to speculate how much this affects the true COVID death toll- we can estimate what we data nerds call “excess mortality.” I know, I know… TALK DATA TO ME!

As the name suggests, excess mortality counts the number of deaths ABOVE & BEYOND those that would have been expected based on previous years. The benefit of this measure is that it does not rely on how COVID-19 deaths are coded—it counts deaths from ANY CAUSE- which most high-income countries are pretty good at counting (they don’t want to pay out that social security longer than they have to).

While there are some statistically fancier ways to do this, in essence, “excess mortality” uses the average number of deaths each week in previous years as the baseline for “expected” deaths. So, this baseline already includes all the deaths that would “normally” occur due to heart attacks, strokes, accidents, etc. These baseline deaths are the counterfactual—meaning what would deaths have looked like in a bizarro world *without* COVID-19?

How many MORE deaths have we seen during the pandemic compared to previous years?

In the US the CDC estimates that since Feb 1, 2020 there have been 1.27 million excess deaths, compared to 1.1 million official COVID deaths. This strongly suggests that COVID deaths are UNDER rather than over-counted. Excess deaths were highest in 2020 and 2021 during the major COVID waves. But since the summer of 2022, the US is still seeing around 10% higher weekly deaths than expected. This excess is *higher* than the number of confirmed COVID deaths.

As always, there are nuances to interpreting these data. Some deaths from other causes may have increased during the pandemic due to strained hospitals or avoidance of care. But counterbalancing this, deaths due to influenza and other infectious diseases dropped nearly to zero in the first two years of the pandemic, creating fewer than expected deaths from those causes. While deaths related to drugs and alcohol increased during the pandemic, this made up only a small portion of the overall U.S. excess compared to previous years. Deaths by suicide *decreased* slightly during the pandemic. As the pandemic wears on into its fourth year, we may also be seeing excess deaths due to longer-term effects of COVID infection- some studies have found an elevated risk of heart attacks and strokes for many months after infection.

You can rest assured that the data nerds (this Nerdy Girl Jenn included) are knee-deep in it trying to understand what’s already happened and what might happen next with COVID mortality.

BOTTOM LINE: We are NOT systematically over-counting COVID deaths.


Some of our Nerdy demographer friends, Andrew Stokes and Elizabeth Wrigley-Field, did a great deep dive in response to the recent WaPo drama based on their work on US excess mortality; I encourage you to read it here.

Also a great rebuttal to the Washington Post article from Dr. Jeremy Faust and Benjy Renton

Data sources:

US Excess mortality

US Official COVID-19 mortality

Link to Original FB Post