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Somewhere around 100,000 to 110,000 Americans may have already died as a result of the COVID-19 pandemic Image Credit: AFP

Many supporters of US president Donald Trump believe that the figures for coronavirus fatalities are inflated, and Trump himself shared a tweet doubting the accuracy of some virus figures.

He’s right that the death toll seems off — but not in the direction he would suggest. We’ve crunched the numbers, state by state, and it appears that somewhere around 100,000 to 110,000 Americans have already died as a result of the pandemic, rather than the 85,000 whose deaths have been attributed to the disease, COVID-19.

That’s my estimate reached with the help of a Harvard statistician, Rafael Irizarry, based on a comparison of death rates this spring with those in previous years.

The starting point is that the cause of death is often uncertain. Most people who die don’t get an autopsy, and many never had a coronavirus test. The precise number who died from COVID-19 is in some sense unknowable


Some states have been largely unaffected — death rates in some even appear to have dropped, perhaps because of less driving and fewer car accidents — but others have seen huge surges in deaths.

Overall, in a bit more than two months, the United States lost more Americans to the coronavirus than died over seven decades in the Korean, Vietnam, Arabian Gulf, Afghanistan and Iraq Wars.

The starting point is that the cause of death is often uncertain. Most people who die don’t get an autopsy, and many never had a coronavirus test. The precise number who died from COVID-19 is in some sense unknowable.

Excess deaths

Still, one standard approach to measure the impact of a pandemic like this is to look at “excess deaths,” meaning mortality greater than the average for a particular time period.

For example, for the seven weeks ending April 25 in the United States, about 70,000 more Americans died than is normal for those weeks (death is seasonal and normally declines over the course of spring and summer). In the period we looked at, the undercount also diminished.

Initially, there were more than twice as many excess deaths as reported coronavirus deaths, but by April 25 there were only 40% more. If the undercount thereafter were 10%, that would add a few thousand to the total, possibly bringing it closer to 110,000.

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Medical staff wearing personal protective equipment (PPE) transport a COVID-19 patient at Stamford Hospital in Stamford, Connecticut, US Image Credit: AFP

These numbers are uncertain, but the implication is that somewhere around 25,000 more Americans died as a result of the pandemic than are recorded in the death tallies.

This kind of analysis can’t determine if they died directly from the virus or indirectly. Some presumably perished from heart attacks or strokes because they feared going to hospitals and delayed calling 911, or because ambulance services were stretched thin. In other words, a modest number presumably died of the virus without being infected it.

One reason to think that a great majority of the excess deaths are directly caused by the virus is that in some states that seem to have meticulous reporting, such as Massachusetts, the number of excess deaths and the number of COVID-19 deaths are not so far apart.

In the early days many COVID-19 deaths were simply listed as some variant of “respiratory failure” or “multisystem organ failure.”

Signing death certificates

Dr. Alicia Skarimbas, who practices in New Jersey, said, “We signed so many death certificates, we would get behind and take turns doing them.”

Skarimbas said that she would list COVID-19 as the cause of death when that seemed obvious, but her partners might simply list “respiratory failure” unless there had been a positive test for the virus. Thus it was often random whether COVID-19 was listed as the cause of death.

The undercounting is a global problem, not just one in the United States. Dr. Christopher Murray of the Institute for Health Metrics and Evaluation at the University of Washington estimates that globally, excess deaths are about double the official COVID-19 death counts.

Excess deaths are often used to gauge mortality from an event or an epidemic. When Hurricane Maria struck Puerto Rico in 2017, the official death toll stood for a year at 64.

But scholars used a variety of techniques to calculate that excess deaths in the aftermath exceeded 1,000, perhaps by a wide margin. As a result of the statistical work, the official death toll is now 2,975.

COVID-19 will inevitably continue to kill people in the weeks ahead. Those who die over the next week or two have already been infected, perhaps several weeks ago.

Dr. Tom Frieden, a former director of the CDC, notes that even if one could end all new infections, thousands would still die from infections already contracted.

Given the uncertainty and the lags in data, why go through this exercise of estimating deaths? Because flawed numbers based on an undercount are a central part of the discussion, informing policy decisions, and Trump has made them so.

Nicholas Kristof is an American journalist, author and a winner of two Pulitzer Prizes.