What is the real death toll due to COVID-19? Are we OVER or UNDER counting deaths? Wouldn’t a lot of these people have died anyway?

A: The death toll has been HIGH (specifics below),

-We are likely UNDER counting deaths due to COVID-19.

-While some deaths attributed to COVID-19 would have occurred during this period anyway, we can calculate “EXCESS MORTALITY” – the number of deaths above and beyond those that would have been expected based on previous years.

Deaths due to specific causes are notoriously challenging to count, and COVID-19 is no exception. People often have multiple factors contributing to deaths due to chronic disease, and death certificates capture both primary and contributing causes of death. Obviously, there is room for error here, in both directions of under and over counting COVID-19 deaths.

A good overview of the challenges in measuring COVID-19 specific deaths from Live Science.

From the beginning of the pandemic, epidemiologists and demographers were eagerly awaiting updated weekly ALL-CAUSE mortality, which we consider much more reliable. In developed countries the reliability of overall death registration is quite good….governments don’t want to pay social security and pensions any longer than they have to .

From all registered deaths, we can calculate “excess mortality.” The simplest way to calculate this is count how many more deaths there have been compared to an average of the previous few years over the same time frame.

The benefit of “excess mortality” is that it likely picks up “direct” COVID-19 related deaths that were not registered as such, especially early on when testing rates were low. It will also pick up any “indirect” deaths that may have happened due to the impact of the pandemic on overwhelmed hospitals or being deterred from seeking out needed health care. Deaths due to some causes such as car accidents, may have declined during lockdown, counteracting some of the positive “excess” deaths.

Several websites have been providing great data visualizations of excess mortality during the pandemic, including the Financial Times for many countries and the New York Times for U.S. States.

By this most simple approach to excess death calculations (from the FT):

The US has seen almost *150,000* excess deaths during the pandemic period, *23%* higher than typical mortality over the same time period.

The UK has seen around *65,000* excess deaths, *45%* higher than typical mortality.

The country-level numbers mask even higher excess mortality in COVID-19 hotspots for example:

New York City saw over *27,000* excess deaths, *208%* higher than typical mortality.

Madrid saw over *16,000* excess deaths, or *157%* higher than typical mortality.

Importantly, for those who are worried about over counting of COVID-19 deaths in hospitals or counting people who happened to get COVID-19 but were going to die soon anyway…

EXCESS mortality accounts for this and only counts deaths ABOVE AND BEYOND WHAT IS EXPECTED, so it gives us the most accurate picture of the mortality burden due to COVID-19.

It is clear that this mortality burden is HIGH, and has happened over only a short period of time.

Because there are changes over time in the age composition of populations and other underlying trends in mortality, demographers prefer to model the baseline of “expected” mortality based on these trends rather than just taking the average of previous years. This has led to slightly fine-tuned but qualitatively similar estimates for excess mortality in the U.S. and UK. Some links to these model-based estimates:

In the US and the UK, excess mortality estimates are roughly 30% higher than counts of official COVID-19 deaths, suggesting we are almost certainly UNDER rather than over counting COVID-19 related deaths.

So, it’s important to remember that while some people who died of COVID-19 would have died anyway over this period of time, this is not the norm and does not explain the huge increases in overall mortality we have seen in COVID-19 hit cities and countries.

#StaySMART #MaskUP