The covid-19 pandemic was perhaps the greatest natural disaster to befall America and the world in modern times. Research out today, however, indicates that we’re still underselling just how deadly it truly was.
Researchers at Boston University and others examined national death certificate data collected in the first two years of the pandemic. They estimated that the official tally missed nearly 20% of covid-related fatalities between 2020 and 2021, amounting to 155,536 uncounted deaths. These missing cases were more common among minority and disadvantaged communities, likely reflecting longstanding disparities in how deaths are investigated in the country, the researchers say.
“These findings suggest that the U.S. death investigation system undercounted COVID-19 deaths unevenly, hiding the true extent of inequities,” they wrote in their paper, published Tuesday in Science Advances.
Scientists have long known the pandemic’s official death counts were an underestimate, both in the U.S. and worldwide. Available testing for the coronavirus was scarce at first, making it difficult to officially tie a person’s death to the infection. And even as these tests became widely available, health care systems may have still struggled to identify people who contracted and died from the disease.
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Historically, researchers have tried to look for these hidden fatalities by measuring a country’s excess deaths—deaths above the typical baseline of mortality seen in recent years. These studies have provided a decent estimate of the pandemic’s true death toll, but they have their limitations, according to the researchers. For one, it’s difficult to figure out how many of these excess deaths were attributable to the coronavirus directly, as opposed to the indirect effects the pandemic had on the world. It’s also harder to study how undercounting might have occurred among specific groups of people.
The researchers instead used a different approach for their study.
Compared to the outside world, hospitals in the U.S. were much quicker to implement widespread covid-19 testing. And studies have found that recorded hospital covid-19 deaths closely aligned with excess death data, indicating that hospitals were reliably detecting these deaths early on into the pandemic. So the researchers trained a predictive machine learning model on data from covid-19 deaths in U.S. hospitals. They then asked the model to look for similar deaths that occurred outside hospitals but weren’t recorded as covid-related.
Between March 2020 and December 2021, the official death toll of covid-19 in the U.S. had reached 840,251. The team’s model, however, estimated that 995,787 covid-19 deaths had actually happened by then—a 19% difference. As of today, the official death toll from covid-19 is now around 1.24 million.
The researchers found that this undercounting didn’t occur equally.
Unrecognized covid-19 deaths were most common in the southern U.S., with a 31% gap between the estimated and official death toll. The single largest peak of missing deaths was in January 2021, when some 35,000 deaths went untallied. And though the likelihood of unrecognized deaths did decline over time, undercounting was still happening as late as the Omicron winter of 2021.
The researchers also found that undercounting was more likely to happen among Hispanic, American Indian, Alaska Native, Asian, and Black Americans. And it happened more often among people with less education, low incomes, or poorer baseline health.
While this study can’t tell us directly the reasons for these disparities, these same groups tend to face disproportionate burdens in accessing health care. Other research has shown that covid-19 cases and deaths in general were more likely to happen among many minority and poorer communities.
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At the very least, the researchers say, there should be more study of why these gaps seemingly also extend to properly counting the dead. “The communities affected by the undercounting of covid-19 deaths could be interpreted as a pattern of structural racism, classism, and ableism in the death investigation system that warrants further research and policy attention,” they wrote.
While covid-19 is far from gone, it’s thankfully become much less of a public health threat over time. As this study illustrates, though, the pandemic widened many of the cracks already present in our world. Trying to repair those cracks won’t be easy, especially in our current times, but it’s still a worthwhile goal.
Source: Gizmodo