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May 21, 2020

Estimates of excess deaths during pandemic show underreporting of Covid-19 fatalities

By GlobalData Healthcare

In the US, there are over 1.5 million cases and over 91,000 deaths from coronavirus disease 2019 (COVID-19). However, these statistics may not capture all COVID-19 deaths due to testing limitations. In order to understand the true impact of the disease, excess deaths data had been used as a measure of impact and severity. GlobalData epidemiologists analyzed data on predicted excess deaths during the pandemic and found that COVID-19 deaths are most likely underreported in the US.

Excess deaths measure the difference between observed number of deaths and expected number of deaths. The US Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) have provided provisional estimates of excess deaths since February 2, 2020, that may be associated with COVID-19. The CDC compared death counts from the most recent weeks with historical trends to determine if there were excess deaths. The excess deaths reported are based on observed number of deaths relative to two different thresholds. The lower value of excess deaths was generated by comparing observed counts to the upper bound of a 95% confidence interval (a model was used to generate a set of expected values for each jurisdiction in the US). The higher value of estimated excess deaths was generated by comparing observed counts to the average expected number of deaths.

Figure 1 shows the number of estimated excess deaths from ‘all causes’ and ‘all causes, excluding COVID-19’ in the US. For ‘all causes’ of excess deaths, the estimated number of excess deaths ranged from 68,774 to 92,742 cases and for ‘all causes, excluding COVID-19,’ the estimated number of excess deaths ranged from 21,462 to 40,097 cases. The difference between the lower estimated values from ‘all causes’ and ‘all causes, excluding COVID-19’ was 47,312. The difference between the higher estimated values from ‘all causes’ and ‘all causes, excluding COVID-19’ was 52,645. If estimates were to be taken from either the lower or higher estimates of excess deaths, all causes of deaths that may include additional COVID-19 cases ranges from approximately 47,000 to 52,000 excess deaths.

Although the data are not completely accurate due to a number of limitations such as delay and accuracy in data collection and reporting, the preliminary numbers and estimates of deaths highlights the impact of the COVID-19 pandemic. Due to limitations in early testing for the disease, there is a high possibility that COVID-19 deaths may have been undercounted, which has resulted in underreporting of COVID-19 deaths. It is also possible that the excess deaths can be indirectly related to other problems during the pandemic, such as overburden on the healthcare system and lack of access to care. Accurate reporting of excess COVID-19 deaths needs to be done and that includes additional testing. The consequence of underreporting cases and deaths can have an effect on public policy and the outcome of the pandemic.

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