Estimating the early death toll of COVID-19 in the United States

Abstract

Background Efforts to track the severity and public health impact of the novel coronavirus, COVID-19, in the US have been hampered by testing issues, reporting lags, and inconsistency between states. Evaluating unexplained increases in deaths attributed to broad outcomes, such as pneumonia and influenza (P&I) or all causes, can provide a more complete and consistent picture of the burden caused by COVID-19. Methods We evaluated increases in the occurrence of deaths due to P&I above a seasonal baseline (adjusted for influenza activity) or due to any cause across the United States in February and March 2020. These estimates are compared with reported deaths due to COVID-19 and with testing data. Results There were notable increases in the rate of death due to P&I in February and March 2020. In a number of states, these deaths pre-dated increases in COVID-19 testing rates and were not counted in official records as related to COVID-19. There was substantial variability between states in the discrepancy between reported rates of death due to COVID-19 and the estimated burden of excess deaths due to P&I. The increase in all-cause deaths in New York and New Jersey is 1.5-3 times higher than the official tally of COVID-19 confirmed deaths or the estimated excess death due to P&I. Conclusions Excess P&I deaths provide a conservative estimate of COVID-19 burden and indicate that COVID-19-related deaths are missed in locations with inadequate testing or intense pandemic activity.

Excess deaths from COVID-19 correlate with age and socio-economic status. A database study in the Stockholm region

“…An additional finding was that nursing home residents dying from COVID-19 were more often admitted to hospitals than residents dying from other causes. Our data are in good agreement with similar data from other countries who also report excess deaths, not only related to a COVID-19 diagnosis but also to other causes (9,10,(17)(18)(19). Such unexplained deaths were also seen in the Stockholm region in April, the most affected month.…”

“…Moreover, due to a shortage of tests, only severe hospital cases were initially tested, implying that patients with less obvious symptoms in nursing homes might have been overlooked. A general way to partially overcome this problem is to study excess deaths (all causes of death), which is what has been done to track influenza mortality for more than a century (9,10).…”

Understanding COVID-19 nonlinear multi-scale dynamic spreading in Italy

“…Recall that the problem of employing confirmed cases to fit models is highly uncertain and is furthermore complicated by the fact that the fraction of cases that are confirmed is spatially heterogeneous and nonlinearly time-varying [47,48].…”

Understanding COVID-19 nonlinear multi-scale dynamic spreading in Italy

“…Recall that the problem of employing confirmed cases to fit models is highly uncertain, and is furthermore complicated by the fact that the fraction of cases that are confirmed is spatially heterogeneous and nonlinearly time-varying [43,44].…”