Study Reveals Covid-19 Death Toll Likely Higher Than Official US Count
A groundbreaking new study published in the journal Science Advances suggests the early death toll of the Covid-19 pandemic was significantly higher than official United States counts indicate. Researchers estimate that as many as 155,000 additional deaths likely occurred outside hospitals during 2020 and 2021 that were not recognized as Covid-19 related.
Disparities in Undercounted Deaths
While approximately 840,000 Covid-19 deaths were officially reported on death certificates during those two years, the study indicates about 16% of actual Covid-19 fatalities went uncounted. The researchers utilized artificial intelligence and machine learning techniques to analyze death certificate patterns, revealing stark disparities in which deaths were missing from official tallies.
The undiagnosed dead were disproportionately Hispanic individuals and other people of color, particularly those who died during the first few months of the pandemic. Geographic analysis showed these uncounted deaths clustered in certain southern and southwestern states, including Alabama, Oklahoma, and South Carolina.
Systemic Barriers to Accurate Counting
Elizabeth Wrigley-Field, a University of Minnesota researcher and study co-author, explained that while hospital patients were routinely tested for Covid-19, many who became sick and died outside medical facilities were not tested. This was especially true early in the pandemic when at-home testing was not readily available.
The study highlights systemic issues in death investigation procedures. In many regions, elected coroners without specialized medical training handle death investigations, unlike medical examiners who typically have forensic pathology backgrounds. Some research suggests partisan opinions may have influenced whether sick individuals or their families sought Covid-19 testing, and whether coroners pursued postmortem coronavirus testing.
"Our antiquated death investigation system is one key reason why we fell short of accurate counts, particularly outside of big metropolitan areas," said Andrew Stokes of Boston University, the study's senior author.
Continuing Health Disparities
Steven Woolf, a Virginia Commonwealth University researcher not involved in the study, noted that six years after coronavirus swept through the US, barriers remain for many of the same marginalized populations. "People on the margins continue to die at disproportionate rates because they can't access care," he stated.
The Centers for Disease Control and Prevention data counts more than 1.2 million Covid-19 deaths since the pandemic began in early 2020, with more than two-thirds occurring in 2020 and 2021. The accuracy of these counts has been debated amid false claims on social media and political controversy, including former President Donald Trump retweeting a post in August 2020 claiming only 6% of reported deaths were actually from Covid-19.
Methodological Approach
The research team focused specifically on deaths of people infected by coronavirus, distinguishing their work from other studies that have estimated broader pandemic mortality including indirect deaths from overwhelmed healthcare systems or increased drug overdoses. Using machine learning, researchers analyzed death certificates of infected patients who died in hospitals, then applied observed patterns to evaluate death certificates of people who died outside hospitals with causes attributed to conditions like pneumonia or diabetes.
While scientific understanding of machine learning-reliant research continues to evolve, Woolf called this team's methodology "intriguing" and noted their overall findings align closely with estimates from other studies of pandemic deaths during the same period.
