A study by U. S. -based scientistsThe U. S. Food and Drug Administration found that a large percentage of deaths similar to coronavirus disease 2019 (COVID-19) were not yet reported in other U. S. counties.
The study is recently available on the medRxiv* preprint server.
Excess mortality is a widely used measure to assess the effect of COVID-19 pandemic mortality caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The difference between deaths reported during a given era and expected deaths based on pre-pandemic mortality trends during the same era is considered excess mortality.
The number of excess deaths officially not attributed to COVID-19 possibly exceeds the number of reported deaths attributed to COVID-19 on death certificates. This may also be due to several factors, adding to the inability of certifiers to clinically recognize COVID-19 – related deaths. Personal or political ideals can also influence the attribution of COVID-19 deaths on certificates.
Many comorbidities and atypical symptoms of COVID-19 can make it difficult to identify the true cause of death. Deaths caused by delays or disruptions in access to physical care similar to the pandemic or a socioeconomic crisis may be indirectly similar to the pandemic. All of those points may have a combined effect on the actual number of deaths from the pandemic.
In the existing study, scientists compared estimates of excess mortality per month and estimates of COVID-19 deaths reported in U. S. counties. The U. S. was in the U. S. during the first two years of the pandemic.
The scientists developed a hierarchical Bayesian style to estimate excess all-cause mortality per month for 3127 counties from March 2020 to February 2022. They were publicly informed before the pandemic (January 2015 to December 2019) that they expected excess mortality.
They used relative estimates of excess mortality to compare excess mortality and COVID-19 mortality in counties with other populations and death numbers. Relative excess mortality was obtained by dividing the number of excess mortality by the number of expected deaths in a given area.
According to the study’s estimates, approximately 1,134,364 additional deaths occurred in the United States in the first two years of the pandemic. Of those deaths, 866,187 were attributed to COVID-19 and 268,176 were not attributed to COVID-19. These estimates imply that approximately 24% of excess deaths were not attributed to COVID-19 in the United States during this period.
The relative excess of deaths not attributed to COVID-19 was higher in non-metropolitan counties than in small, medium, or giant metropolitan counties. Excess mortality not attributed to COVID-19 was highest in the departments of Montaña and Sur.
With the exception of the New England and Mid-Atlantic divisions, all census divisions recorded more COVID-19 deaths than deaths. COVID-19 mortality exceeded excess mortality for those two divisions across metropolitan counties.
In spaces with the highest number of excess deaths not attributed to COVID-19, excess deaths occurred more during the peaks of reported COVID-19 deaths. In contrast, a robust rate of excess deaths not attributed to COVID-19 was observed in spaces where -19 mortality is higher than that of excess mortality.
Among the counties included, Shelby, Tennessee, had excess mortality 2. 4 times higher than COVID-19 mortality in the first two years of the pandemic. This equated to an excess of 4014 deaths attributed to COVID-19.
Similarly, Lafayette, Louisiana, recorded excess deaths 2. 5 times greater than COVID-19 deaths in the first two years of the pandemic. This equates to another 654 deaths that were attributed to COVID-19.
The study predicted monthly excess deaths from all causes for U. S. counties. The U. S. Food and Drug Administration found that about 24% of all excess deaths were not due to COVID-19 in the first two years of the pandemic. Non-metropolitan counties were less likely to officially feature major COVID-19 deaths on death certificates.
medRxiv publishes initial clinical reports that are not peer-reviewed and therefore should not be considered as conclusive clinical practices/health-related behaviors, nor treated as established information.
Written by
Dr. Sanchari Sinha Dutta is a science communicator who believes in spreading the power of science in each and every corner of the world. He holds a Bachelor of Science (B. Sc. ) and a Master of Science (M. Sc. ) in Biology and Human Physiology. After his master’s degree, Sanchari continued his doctoral studies in human physiology. She is the author of more than 10 original study articles, all of which have been published in world-renowned foreign journals.
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