Review of COVID death stats finds likely undercount in official numbers

A doctor works with a COVID-19 patient.
Doctor Jacob Lyons works with a COVID-19 patient at the St. Cloud Hospital’s intensive care unit.
Paul Middlestaedt for MPR News | 2021

COVID-19 deaths in the United States were likely undercounted in official statistics during the first 30 months of the pandemic, according to a new scientific paper from a national team that includes a University of Minnesota researcher.

Working with colleagues from Boston University, the University of Pennsylvania, and other institutions, University of Minnesota sociologist and demographer Elizabeth Wrigley-Field compared official fatality figures from March 2020 to August 2022 with the estimated number of deaths from natural causes that exceeded historical trends.

The team’s peer-reviewed findings are published in the Proceedings of the National Academy of Sciences.

In a phone interview with MPR News, Wrigley-Field said that most of the 1.2 million excess deaths recorded during that period were attributed to COVID. About 163,000 were not, and most of those appear to be pandemic-related because they correlate with virus surges.

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“This shows us how we underestimated surges as they were beginning,” she said. “And so people were already dying in pretty large numbers often before there was a social and institutional recognition that COVID is surging. That matters because a lot of us adjusted our behavior based on what we thought was happening.”

Wrigley-Field said that many deaths that occurred at the start of a surge may not have been attributed to the virus because those responsible for determining cause of death were likely unaware that a surge was taking place and did not test for COVID.

“Most of the excess deaths happen at home, so it’s not like a hospital where you’d be routinely tested for COVID,” Wrigley-Field said. “It’s people dying at home in a context where their families don’t know there’s a COVID surge, the coroner doesn’t know there’s a COVID surge. It hasn’t been recognized yet.”

Wrigley-Field said her team found evidence of the largest undercounts in the southern and western United States and counties outside of metropolitan areas, but they did not try to find reasons for the statistical disparities.

“The U.S. has this really patchwork and decentralized death reporting system where who is responsible for deciding the causes of death is really different in different places,” she said. “Sometimes it’s a medical examiner who has training. Sometimes it’s potentially someone with no training and no medical background.”

Conversely, the researchers also determined that COVID fatalities reported in the northeastern United States surpassed estimates of naturally caused excess deaths.

Wrigley-Field said it’s possible that some non-COVID deaths in that region may have been misattributed to the virus and that social distancing and other precautions prevented people from dying of influenza and other respiratory diseases.

And that Minnesota’s COVID fatalities tracked closely with the estimate of excess deaths. She said saving lives during a pandemic depends on gathering accurate data.

“People talk about pandemic preparedness and disaster preparedness, but a part we don’t talk about enough is getting our cause of death reporting to be better in the United States so that we have more accurate information in real time about what people are dying of.”