New analysis finds many excess deaths attributed to natural causes are actually uncounted deaths from COVID-19

A new study provides the most compelling data to date suggesting that excess mortality rates from chronic diseases and other natural causes were actually driven by COVID-19 infections, refuting high-profile claims that attributed these deaths are due to other factors such as COVID vaccinations and housing. -policies in place.

Nearly 1,170,000 people have died from COVID-19 in the United States, according to official federal tallies, but several studies of excess mortality suggest those totals are vastly underestimated. Although excess mortality provides an estimate of deaths that would likely not have occurred under normal, non-pandemic conditions, there is still little evidence on whether the SARS-CoV-2 virus contributed to these additional deaths or whether these deaths were caused by other causes. factors such as healthcare disruptions or socio-economic challenges.

Now, a new study led by the Boston University School of Public Health (BUSPH) and the University of Pennsylvania (UPenn) provides the first concrete data showing that many of these excess deaths were indeed uncounted deaths due to COVID-19.

Published in the journal PNASThe study compared reported deaths from COVID-19 to excess deaths from non-COVID-related natural causes, such as illness and chronic disease, and found that increases in excess non-COVID deaths occurred at the same time or in the month preceding increases in the number of deaths. have reported deaths from COVID-19 in most U.S. counties.

Focusing on excess deaths from natural causes rather than estimates of excess deaths from all causes provides a better understanding of the true number of deaths attributable to COVID-19, because it eliminates external causes of mortality, such as intentional injury or not, for which COVID-19 -19 would not be a contributing factor.

“Our results show that many COVID-19 deaths went uncounted during the pandemic. Surprisingly, these undercounts persisted well beyond the initial phase of the pandemic,” explains Dr. Andrew Stokes, Corresponding author of the study, associate professor of global health at BUSPH, who has led numerous studies analyzing patterns and drivers of excess mortality during the pandemic.

The temporal correlation between reported COVID-19 deaths and excess deaths reported from natural causes unrelated to COVID-19 offers insight into the causes of these deaths, he says. “We observed spikes in excess non-COVID-19 deaths in the same or previous month as COVID-19 deaths, a trend consistent with these being COVID deaths -19 unrecognized that were missed due to low community awareness and lack of COVID-19 awareness.

If the primary explanation for these deaths was healthcare interruptions and delays in care, excess non-COVID mortality would likely occur after a peak in reported COVID-19 deaths and subsequent interruptions in care, explains the The study’s lead author, Eugenio Paglino, a Ph.D. D. student studying demography and sociology at UPenn. “However, this trend was not observed nationally or in any of the geographic subregions we evaluated,” says Paglino.

Importantly, these findings also refute political claims or public beliefs that attribute mortality during the pandemic to COVID-19 vaccinations or lockdown policies.

“This work is important because our ability to detect and correctly attribute deaths during an epidemic is central to our understanding of the disease and how we organize our response,” says Dr Nahid Bhadelia, founding director from the Boston University Center for Emerging. Infectious disease policy and research.

For the study, Dr. Stokes, Dr. Paglino and their colleagues used new statistical methods to analyze monthly natural cause death data and reported COVID-19 deaths in 3,127 counties over the past 30 first months of the pandemic, from March 2020 to August. 2022. They estimated that 1.2 million excess deaths from natural causes occurred in U.S. counties during this period, and found that about 163,000 of these deaths had no mention of COVID at all -19 on death certificates.

By analyzing the temporal and geographic patterns of these deaths, researchers found that the gap between these excess non-COVID deaths and reported COVID-19 deaths was widest in non-metropolitan counties, in the West and the South – and that the second year of the pandemic saw almost as many excess non-COVID deaths in the second year of the pandemic as in the first year, contrary to previous research. Meanwhile, metropolitan areas in New England and the Mid-Atlantic states were the only areas reporting more COVID-19 deaths than excess non-COVID deaths.

Many of these geographic differences in mortality patterns are likely explained by differences in national policies, COVID-related death protocols, or the political biases of local officials who have influenced COVID-related policies. In rural areas, for example, COVID-19 testing was more limited, and political bias or stigma around COVID may have influenced the mention of COVID-19 on a death certificate.

Conversely, reported COVID-19 deaths may have exceeded excess non-COVID deaths due to the success of mitigation policies that encouraged physical distancing and mask wearing, and which likely reduced cases of other respiratory diseases. Some state protocols, like Massachusetts’, have also allowed death investigators to list COVID-19 as the official cause of death within 60 days of diagnosis (through March 2022), rather than the limit of 30 days effective in other states.

“Geographic variation in the quality of reporting of causes of death has not only negatively impacted the pandemic response in areas where COVID-19 deaths were underreported, but it has also reduced the accuracy of our national monitoring data and modeling,” says Katherine Hempstead, co-author of the study. senior policy advisor at the Robert Wood Johnson Foundation. “Standardizing and improving death investigation and certification should be a public health priority.”

Researchers hope this new data will encourage future analyzes using hospitalizations and other local data to continue analyzing countless COVID-19 deaths from excess natural causes as well as external deaths.

“This study documents the deadly nature of COVID-19 and the effectiveness of public health interventions,” said Kristin Urquiza, co-founder of Marked By COVID, the justice and memory movement led by COVID mourners, after losing her father to COVID. “The least we can do to honor those who died is to accurately report what happened.”

The study was also co-authored by researchers from BUSPH, UPenn, University of Washington School of Public Health, University of Minnesota, RTI International and the University of California, San Francisco.