The number of coronavirus deaths in the United States in the first weeks of the pandemic has exceeded the official number

0
62


Excess

death

less

covid-19

Covid-19

death

reported

at the time

Excessive deaths are dead

above what is historically

planned for this period.

Sources: Aggregate death data is from the National Center for Health Statistics, covid-19 death figures are from state health services and are compiled by the Washington Post, and estimates of expected deaths are from l modeling unit of the Yale School of Public Health.

Excess

death

less

covid-19

Covid-19

death

reported

at the time

Excessive deaths are dead

above what is historically

planned for this period.

Sources: Sources: overall death data is from the National Center for Health Statistics, covid-19 death figures are from state health services and are compiled by the Washington Post, and estimates of expected deaths are from from the Yale School of Public Health modeling unit.

Excessive deaths

other than

reported

covid-19

Covid-19

death

reported

at the time

Excessive deaths are dead

above what is historically

planned for this period.

Sources: Aggregate death data is from the National Center for Health Statistics, covid-19 death figures are from state health services and are compiled by the Washington Post, and estimates of expected deaths are from l modeling unit of the Yale School of Public Health.

Excessive deaths

other than

reported

covid-19

Covid-19

death

reported

at the time

Excessive deaths are dead

above what is historically

planned for this period.

Sources: Aggregate death data is from the National Center for Health Statistics, covid-19 death figures are from state health services and are compiled by the Washington Post, and estimates of expected deaths are from l modeling unit of the Yale School of Public Health.

In the first weeks of the coronavirus epidemic, the United States recorded approximately 15,400 excess deaths, almost twice as many as publicly attributed to Covid-19 at the time, according to a federal data analysis conducted for the Washington Post by a research team led by the Yale School of Public Health.

The excess deaths – the number beyond what would normally be expected for this time of the year – occurred in March and until April 4, a period when 8,128 deaths from coronavirus were reported.

The excess deaths are not necessarily directly attributable to Covid-19, the disease caused by the coronavirus. These may include people who died from the epidemic, but not from the disease, such as those who were afraid to seek medical treatment for unrelated illnesses, as well as a number of deaths that are part of the ordinary change in the mortality rate. The count is also affected by increases or decreases in other categories of deaths, such as suicides, homicides and motor vehicle accidents.

But in any pandemic, higher than normal mortality is a starting point for scientists looking to understand the full impact of the disease.

Yale’s analysis for the first time estimates excessive deaths, both nationally and in each state, during those five weeks. Drawing on data released Friday by the National Center for Health Statistics (NCHS), the analysis paints an unusually high mortality picture that will become clearer as more data become available.

The analysis calculates excess deaths using a model to estimate the number of people who would likely have died in the absence of the pandemic, then subtracting this number from all deaths reported by the NCHS.

Analysis suggests that the deaths announced in the weeks leading up to April 4, based on reports from the state’s public health departments, have failed to fully capture the impact of the pandemic. These incomplete figures were widely cited at a time when many states were making critical decisions regarding business closings and other measures to stem the spread of the virus.

The analysis also suggests that the death toll from the pandemic is significantly higher than has been reported, said Daniel Weinberger, professor of epidemiology at Yale and head of the research team. More than 54,000 people were killed by the new coronavirus on Sunday, according to figures released by state health officials and compiled by The Post.

“It is really important to get the right numbers to inform policy makers so that they can understand how the epidemic is evolving and how serious it is in different places,” said Weinberger.

The national count also shapes public perception of the severity of the disease and, therefore, the need to maintain social distance despite economic disruption. The figure has political implications for President Trump, who initially downplayed the threat of the virus and whose administration failed to speed up rapid testing of Covid-19, allowing the virus to spread undetected for years. weeks.

Some of Trump’s advocates have said that Covid-19’s death numbers were inflated because they could include people who died of the disease but not of it.

“The death toll is maintained by everyone, really, as a fairly straightforward measure to assess the competence of the federal response,” said Jeremy Konyndyk, a former USAID official who helped lead the American response to the Ebola epidemic and other international disasters. during the Obama administration.

The problem of undercoverage of coronavirus deaths is not unique to this pandemic or to the United States. In many countries, insufficient testing is a major obstacle to understanding the magnitude of the pandemic.

Public health experts in the United States say reporting delays, as well as the fact that almost all states initially only counted cases in which the coronavirus was confirmed by a test, contributed to an incomplete picture deaths in those first weeks.

The NCHS has recently started to maintain its own covid-19 death count, separate from the counts based on state reports to the Centers for Disease Control and Prevention.

The NCHS count, based on death certificates, attempts to correct reporting delays and includes cases where there was no laboratory confirmation of the coronavirus. But even the total of NCHS covid-19 deaths in those first weeks – 10,505 as of Sunday – only represents two-thirds of excess deaths in Yale’s estimate.

No jurisdiction has been as aggressive as New York City, the US epicenter of the epidemic, revising its death figures for the first few weeks. As of Saturday, the city had added 2,542 covid-19 deaths to these numbers, bringing the total for this period to 5,085. The newly added deaths were divided almost evenly between cases confirmed by laboratory tests and cases that were judged “probable” by the death of covid-19 based solely on symptoms and exposure.

At least 6,300 additional deaths

March to April 4

At least 6,300 additional deaths

March to April 4

At least 6,300 additional deaths

March to April 4

At least 6,300 additional deaths

March to April 4

At least 6,300 additional deaths

March to April 4

Covid-19

death

in% of

excess

death

* Deaths reported by Covid-19 exceed excessive estimates

All figures range from March to April 4. New York City and Washington State have since updated their figures for this period.

Covid-19 kills

as a% of the surplus

death

Reported by Covid-19

deaths exceed

excess estimates

All figures range from March to April 4. New York City and Washington State have since updated their figures for this period.

Covid-19 deaths in%

excessive deaths

Deaths reported by Covid-19 exceed excessive estimates

All figures range from March to April 4. New York City and Washington State have since updated their figures for this period.

Covid-19 deaths in%

excessive deaths

Deaths reported by Covid-19 exceed excessive estimates

All figures range from March to April 4. New York City and Washington State have since updated their figures for this period.

The revisions approximated the New York City covid-19 total to Yale’s analysis estimate of an additional 6,300 deaths during this period.

A handful of states have also started reporting probable deaths in recent days, usually adding them to current counts rather than publicly reviewing the figures for the past few weeks. Most states have not added probable deaths. For example, New York State, unlike New York, has not done so.

Yale’s analysis estimates that excluding New York City, approximately 1,700 more New York residents than expected would have died on April 4 – far more than the 1,022 reported as 19 deaths .

Governor Andrew M. Cuomo (D) admitted at a press conference last week that his count “is not an exact total number of deaths, in my opinion.”

“This number will increase,” he said. “These deaths are only hospital and nursing deaths. This is not what we call home deaths. “

Long Island resident’s family, Adrian Sokoloff, says they believe he is one of the countless. A retired pet business owner, he had just celebrated his 99th birthday when he started showing symptoms of covid-19 on March 19, said his daughter Karen Sokoloff. His family said his pulmonologist diagnosed him with covid-19 because of fevers and coughs – and because two of his caregivers came down with chills and lost their sense of taste, a telltale sign of the virus.

Sokoloff’s children had decided not to take him to the hospital for fear that he would die there alone. They couldn’t have it tested for Covid-19 at home.

On March 29, he died at his home in Sands Point, New York. Her death certificate says “congestive heart failure,” according to her daughter.

She says her father’s death should be reflected in Covid-19’s balance sheet and is concerned that an artificially low number may give some states the right to reopen their economies prematurely. “You have to have the data to make a smart decision, and if you don’t count the number of people who died, then you don’t make a smart decision,” she said.

In New Jersey, another hard-hit state, 9,854 people died in the period covered by the analysis – about 2,200 more than you would expect, according to Yale’s estimates. Of these, however, only 846 were counted as covid-19 deaths.

Marco Navarro, an EMT who works in three cities in northern New Jersey, said that before the pandemic, he could spend two to three weeks without seeing a cardiac arrest or a call requiring his team to perform CPR. Now, this happens two or three times a day.

No one knows why. Does the virus attack the heart? Do blood clots cause heart problems? Are people terrified of contracting the virus in a hospital by ignoring their symptoms and staying at home until it is too late, as many doctors have concluded?

“I don’t really have an answer,” said Navarro, who works in Union City and sometimes in Jersey City and North Bergen.

Interviews and data on 911 calls from other cities also suggest an increase in the number of people who died at home, a circumstance that makes them less likely to be tested for coronavirus or included in the official death toll . For example, the updates New York City made to its Covid-19 death statistics include hundreds of these deaths at home.

In mid-April, paramedics in the Chicago fire department saw about four times more calls than usual in which the patient was beyond resuscitation and pronounced dead at the scene, said sman Larry Langford. Normally there are about four such cases; now on some days there are more than 20. In Detroit, as reported by ProPublica, 911 call data shows that the number of coded “deceased observed” calls has increased in the first 10 April days.

But in dozens of states, Yale’s analysis shows that the total number of reported deaths is either unchanged or even slightly down from historical trends.

In some states, the epidemic started later and spread less rapidly, killing few people in early April. A relatively small number of covid-19 deaths may have been offset by a reduction in fatal automobile accidents or other less likely traumatic events when people are confined to their homes.

Delays in reporting overall deaths could also play a role, said Weinberger. Although the federal government’s provisional death toll until April 4 is more complete than that of the past few weeks, it remains incomplete and the number of deaths is expected to continue to increase in the coming months, with states reporting additional deaths during of these weeks. The number of deaths across the country and in each state will not be known with confidence for at least a year, said Weinberger.

In Washington, the first state to fight a large-scale epidemic, 310 people were believed to have originally died from the virus on April 4. The state has since released data showing that in fact nearly 600 people died of seizures. 19 on that date. Due to the state’s relatively robust contact testing and research infrastructure, experts say the death toll in Covid-19 is likely more accurate than in other states.

According to Yale’s analysis, the total number of deaths in Washington during these weeks has only increased by about 100 from the number expected. This could be due in part to the fact that fewer people died on the roads. Statewide, there have been 34 fatal collisions in March and April to date – about half the usual number for this time of year, according to data from 2018 and 2019.

There are signs that road accidents are decreasing more widely. Data collected by ESO, a company that provides software for about a third of EMS services nationwide, shows a sharp drop in calls for motor vehicle crashes as orders for stay at home have taken hold.

Patterns of crime are also changing in some places. Miami has not reported a single homicide for seven weeks and six days, from mid-February to mid-April, police said. The last time the city was homicide-free during this period was in 1957.

Governor Ron DeSantis (R) has pushed to lift restrictions in Florida as soon as possible to reopen the economy. Yale estimated that the state had only a small number of excess deaths until early April, around 200, and that number is almost equal to the official Covid-19 count.

“We expect some undercoverage,” said Natalie Dean, professor of biostatistics at the University of Florida. “It is clear that we are missing the dead. “

In Louisiana, Yale’s analysis seems to go against what you would expect based on the headlines.

The state is experiencing one of the worst coronavirus outbreaks in the country after more than a million people gathered for Mardi Gras celebrations in New Orleans in February. The analysis estimates, however, that although 408 people would have died of Covid-19 as of April 4, Louisiana had registered a slightly lower than normal death toll in the previous five weeks. According to estimates from Yale’s team, Louisiana was recently among the slowest states to report deaths.

Joe Kanter, an assistant public health officer with the Louisiana Department of Health, confirmed that as of the end of March, the state had yet to see an overall increase in deaths from previous years . He said he believed Louisiana’s covid-19 number was as accurate as possible, noting that last week the state began reporting probable deaths in addition to those confirmed by laboratory tests.

Part of this may be due to the fact that the number of trauma victims in the city has dropped, said Kanter, who also works in the trauma center at University Medical Center New Orleans.

But even here, some officials say the death toll from coronavirus will end up being higher than what is currently known, according to emails obtained by the Brown Institute for Media Innovation at Columbia University which were shared with The Post.

In an email dated April 4, New Orleans director of health Jennifer Avegno noted a spike in paramedic reports of fatalities and cardiac arrest requiring advanced respiratory assistance, including CPR. The number of these reports in March was 24% higher than in March 2019.

“So, I would probably add about 15% of the known death toll,” she wrote to two city officials. “However – no city or state will take this into account or report it, so I don’t think we should either. We just have to assume that the deaths are about 15% more than we can count, but not include them in the official modeling, as we will never really know. “

In a telephone interview Thursday, Avegno said she was concerned about the reopening of cities and elected states across the country based on what she believes to be an undercoverage of Covid cases and deaths. 19.

“I fear the numbers will give them a false sense of security that they could communicate to the public,” she said. “They may think the number of cases is more limited, but they don’t test enough to know.”

Lenny Bernstein, Lenny Bronner, Jacqueline Dupree, Aaron Steckelberg and Reis Thebault contributed to this report.

Methodology

A research team led by the Yale School of Public Health used historical data on all deaths between 2015 and early 2020, published by the National Center for Health Statistics (NCHS), to model the number of deaths normally expected each week at from March. April 1-4. The estimate takes into account seasonal variations, the intensity of influenza epidemics, as well as the expected increase in deaths due to overall population growth.

Details on the team’s statistical approach to estimating seasonal reference deaths can be found in an article published online on the medRxiv preprint server. The method used for this analysis differs in that the researchers did not attempt to correct the delays in reporting, as they did in their previous article. Instead, The Post’s analysis was based only on reported deaths, a more conservative approach to estimating excessive deaths.

The total number of deaths in the United States and for each state was obtained from preliminary death data published weekly by the NCHS, which is part of the Centers for Disease Control and Prevention. The figures for Connecticut, North Carolina and the district were not up to date, and these jurisdictions are not included in this analysis.

These data are collected from state health services, which report deaths at different rates. It usually takes about three weeks for the death data to stabilize, but even then it is still not complete. As a result, the total number of deaths as of April 4 is expected to continue to increase as states continue to report additional data to the NCHS.

The number of excess deaths was calculated by subtracting the expected seasonal reference from the number of all deaths. Since the seasonal benchmark is an estimate, there is some uncertainty associated with the figure for excessive deaths of 15,400. Based on the only deaths reported to date, there is a 90% chance that the actual number of deaths excess is greater than 12,000 and 70% chance that it is greater than 14,000 (there is 2.5% chance that the actual number of excess deaths is less than 10,000, and an equal chance that it more than 20,000.)

The death toll from Covid-19 as of April 4 comes from figures released by state public health and compiled by The Post.

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