That’s the conclusion of a new IHME study, that compares actual mortality in nations all around the world over the last 15 months with the projected all-cause mortality in those nations over that time if not for COVID. Strikingly, severe undercounting has been almost as much of a problem in the USA as it has in third world countries with far less sophisticated public health systems:
It makes sense that countries with less robust health care systems and fewer resources would struggle to keep track of how many people are dying of Covid-19. But the US, a wealthy country that has a national Covid-19 death reporting system, also missed almost 40 percent of Covid-19 deaths, according to the IHME model.
That’s because while death can seem like a pretty obvious health indicator, the causes of death can be mercurial.
The problems start with the death certificate. Ivor Douglas, chief of the Pulmonary Sciences and Critical Medicine division at the Denver Health Medical Center, explained that death certificates emphasize the primary cause of death, which is the most immediate condition leading to the fatality. Death certificates also have space for secondary and indirect causes.
So a Covid-19 death certificate could list something like a blood clot in the lungs as the primary cause of death, with Covid-19 as a secondary or indirect cause. Whether that specific death is then coded as a Covid-19 fatality could differ depending on the state. That local-level reporting has sometimes become politicized and led to discrepancies in death tolls.
And when Covid-19 first arrived in the US, many health workers didn’t realize what they were dealing with and thus didn’t include it in their paperwork. “I think the preponderance of missed cases were early on in the pandemic,” Douglas said. “Often, certainly early in the pandemic, there was the primary diagnosis without Covid-19 attribution.”
The missing Covid-19 deaths are also another manifestation of the inequities in US society. “If you’re poor, don’t have access [to health care], and die at home, you’re much less likely to have an attribution of Covid pneumonia as a cause of your death than ‘oh, you’re a sad old person with diabetes’ and that was the cause of death,” Douglas said.
(Interestingly, among developed nations Japan seems to have the most severe undercounting problem, with the number of estimated COVID-related deaths being nearly ten times the official COVID death total there so far).
Note that this analysis is designed to also capture deaths caused indirectly by the pandemic, from overwhelmed health care systems, people not seeking or being unable to seek treatment for other health problems, physical and mental health issues exacerbated by extreme isolation, etc.
The bottom line is that since early last year, per this analysis, the US has seen 905,000 excess deaths, even though the official death toll from COVID is “only” 574,000. By my back of the enveloping, this means that approximately one out of every five deaths in the US over the past 15 months is a death that wouldn’t have happened if not for the COVID epidemic. Given that prior to the epidemic nearly three million Americans were dying from “normal” all-cause mortality, this is a staggering death toll, that is apparently about to reach seven figures.
We haven’t really even begun to wrap our minds around what has happened, and is still happening.