Why the early U.S. COVID-19 death toll may be 155,000 higher
By Mike Stobbe
Edited by Andrew Zinin
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The COVID-19 pandemic's early death toll was much higher than the official U.S. count, according to a new study that spotlights dramatic disparities in the uncounted deaths.
About 840,000 COVID-19 deaths were reported on death
certificates in 2020 and 2021. But a group of researchers—using a form of
artificial intelligence—estimate that as many as 155,000 unrecognized
additional deaths likely occurred in that time outside of hospitals. That would
mean about 16% of COVID-19 deaths went uncounted in those years.
The overall findings, published
Wednesday by the journal Science Advances, were close to
estimates from other studies of pandemic deaths during that time. But the
authors of the new study tried to determine exactly which deaths were more
likely to be missing from the official tallies.
The answer: The undiagnosed dead were more likely to
be Hispanic
people and other people of color, who had died in the first few months
of the pandemic, and who had been in certain states in the South and
Southwest—including Alabama, Oklahoma and South Carolina.
Six years after the coronavirus swept through the U.S., barriers remain for many of the same people, said Steven Woolf, a Virginia Commonwealth University researcher not involved in the study.
"People on the margins continue to die at
disproportionate rates because they can't access care," he said in an
email.
Access to care wasn't the only challenge
While hospital patients were routinely tested for COVID-19,
many who grew sick and died outside of hospitals were not tested—often because
at-home testing was not readily available early in the pandemic, said one of
the study's authors, the University of Minnesota's Elizabeth Wrigley-Field.
In some parts of the country, death investigations are
handled by elected coroners who don't necessarily have the specialized training
that medical examiners do. Some research has suggested partisan opinions could affect whether a sick person
or their family members sought COVID-19 testing, and whether coroners pursued
postmortem coronavirus testing. Indeed, some coroners said families had pressed
them not to list COVID-19 as a cause of death.
"Our antiquated
death investigation system is one key reason why we fell short of
accurate counts, particularly outside of big metropolitan areas," said
Andrew Stokes of Boston University, the senior author on the paper.
Death counts were swept up in COVID politics
The Centers for Disease Control and Prevention data
count more than 1.2 million COVID-19 deaths since the
pandemic erupted in early 2020. More than two-thirds of those reported deaths
occurred in 2020 and 2021.
The count has long been debated, as false claims on social
media said the number of COVID-19 deaths was inflated. Adding to the rancor was
President Donald Trump, who in August 2020 retweeted a post claiming only 6% of
reported deaths were actually from COVID-19—a post Twitter later removed.
To be sure, there were other kinds of pandemic deaths. For
example, uninfected
people died from other medical conditions because they could not get
care at hospitals overloaded with COVID-19 patients. People with drug
addictions died of overdoses as a result of social isolation and losing access
to treatment. Other studies that have estimated the actual number of pandemic
deaths have taken those deaths into account.
But Stokes and his collaborators wanted to focus on the
deaths of people infected by the coronavirus. They used machine
learning to sift through the death certificates of infected patients
who died in hospitals and then used patterns observed in those records to
evaluate death certificates of people who died outside hospitals and whose
deaths were attributed to things like pneumonia or diabetes.
Scientists' understanding of the strengths and weaknesses of
machine learning-reliant research is still evolving, but Woolf called this
team's use of it "intriguing."
Publication details
Mathew Kiang et al, Applying Machine Learning to Identify
Unrecognized COVID-19 Deaths Recorded as Other Causes of Death in the United
States, Science Advances (2026). DOI:
10.1126/sciadv.aef5697. www.science.org/doi/10.1126/sciadv.aef5697
Journal information: Science Advances