The COVID-19 pandemic is ‘almost certainly’ killing a number of Americans who are not included in the country’s climbing fatalities, according to government officials and public health experts involved in the count.
Officials at the US Center for Disease Control and Prevention describe the death toll an ‘underestimation.’
As the United States battles the ongoing coronavirus pandemic – which has infected 312,601 and killed 9,144 – an early lag in available testing meant people with respiratory illnesses died without being counted, said epidemiologists.
Even now, The Washington Post reports, some Americans who die in their homes or at overwhelmed nursing homes are not being tested.
Government officials and public health experts said more Americans are ‘almost certainly’ dying of COVID-19 than numbers show, according to The Washington Post. Pictured: Healthcare workers wheel the bodies of deceased people from the Wyckoff Heights Medical Center in New York City
‘We know that it is an underestimation,’ agency spokeswoman Kristen Nordlund said.
Postmortem testing by medical examiners can be tricky, as procedures vary widely across the United States and some officials argue testing the deceased is a misuse of valuable resources.
The process can also be difficult as examiners, coroners and health care providers are told to ‘use their judgement’ to decide when testing is appropriate.
Additionally, experts said some people who have contracted coronavirus test negative. It’s unclear how common false negatives are.
In New York City, officials have erected makeshift morgues outside of Bellevue Hospital to handle the expected surge in coronavirus victims
Pictured: Bodies are wrapped in protective plastic in a holding facility at Daniel J. Schaefer Funeral Home in Brooklyn, New York, as employees are swamped with an influx in cases
Officials with the Center for Disease Control and Prevention said the reported number for coronavirus death toll in is an ‘underestimation’
Consequentially, public health officials and leaders are missing the full picture of the outbreak’s true death toll as they rush to contain the spread.
It’s too early to estimate how many coronavirus-related deaths have evaded official count, according to scientist who analyze mortality statistics from influenza and respiratory illnesses.
For a disease with common symptoms like coronavirus, scientists said that deaths with positive results most likely represent just a fraction of total deaths by the disease.
Marc-Alain Widdowson, a former epidemiologist at the CDC and current director of the Institute of Tropical Medicine Antwerp in Belgium, doubled down on these claims.
‘You can’t rely on just the laboratory-confirmed cases,’ he said.
‘You’re never going to apply the test on everybody who is ill and everybody who dies. So without doubt — it’s a truism — the number of deaths are underestimated globally because you don’t apply the test.’
Clay Marsh, known as West Virginia’s ‘coronavirus czar’, admitted that the state’s official count is in all likelihood incomplete.
‘Based on the best recent information about limited testing and sizable false negative rates of testing, we are likely underestimating the number of deaths,’ said Marsh, vice president and executive dean for health sciences at West Virginia University.
West Virginia’s count is also low because of the state’s rural, small population and the early closure of schools and nonessential businesses.
The CDC is currently collecting national data on hospitalizations, illnesses and deaths to estimate the impact of COVID-19. The agency also publishes weekly estimates for flu, where confirmed numbers similarly represents a fraction of national cases.
Studies of influenza show that fatality counts are often deceiving during a pandemic.
Nordlund said: ‘We’re probably getting more information on covid-19 because there’s a greater awareness in the community of what it is.
The CDC’s official fatality count, which is created from reports submitted by state and tops at 7,616 as of Sunday, are noticeably lower than those revealed by media organizations and university researchers. This is in part due to in lapse in official reporting.
The lag also happened because the code for recording COVID-19 as an official cause of death was not announced until March 24.
The US government’s death toll is broadcasted globally each day as a sign of how quickly COVID-19 can spread and how it can debilitate a country.
The White House previously estimated that between 100,000 and 240,000 Americans could be killed during the pandemic.
Some scientists did not understand how the administration came to those numbers, and the White House has declined to specify.
Despite the uncertainty surrounding the US’s COVID-19 death toll, supporters of Trump’s coronavirus response said the official number is inflated because it includes deceased people who were diagnosed with the disease, even if they died from another cause.
Marc Lipsitch, a professor of epidemiology at Harvard University, explained that some people may be dying with COVID-19 and not of it.
The muddled distinction is a problem for any cause of death, but it’s a minor point that is ‘swamped by the opposite problem: deaths that are caused by covid but never attributed, so the death count is underestimated.’
Around the world, officials are wondering if the number of COVID-19 deaths is unwittingly low.
The death toll in France shot up by more than 2,000 last week after officials began including unreported deaths in nursing homes.
China, where the disease surfaced last December, has been accused of downplaying their infection cases and deaths.
The Post reported that the number of cremation urns ordered to Wuhan indicate far more people died of COVD-19 than the official death toll of around 2,500.
Chinese officials have denied the allegations, but President Trump doubled down during a briefing that China’s ‘numbers seem to be a little bit on the light side, and I’m being nice when I say that.’
In addition to the previously laboratory-confirmed deaths, the CDC said Friday that death certificates showed 1,150 people have died.
Excess deaths – or ‘the number of deaths over and above the average number during a particular period’ – are what scientists often look at to estimate total fatalities from a disease.
The most comprehensive estimates need national statistics that can take up to three years to gather, said Cécile Viboud, a National Institutes of Health scientist who co-authored the study estimating the U.S. undercount during the H1N1 flu.
Pictured: A man administers his COVID-19 test at a testing location near Dodger Stadium during the outbreak of the coronavirus disease in Los Angeles
Critics said the United States’ death toll was inflated because it includes deceased people who were diagnosed with the disease, even if they died from another cause
The initial number of uncounted flu deaths usually includes people with pneumonia and other respiratory symptoms who never tested for influenza.
People who contract the flu, but are more susceptible to die from other conditions are also added. Although people may not be reported as dying of influenza, it still contributed to their deaths.
Jeffery F. Wakefield Sr., a funeral director in Georgia, said: ‘We’ll never really have true, true numbers. We’ll get almost close, but we’ll never have the true numbers of who died from this. ‘
Even with efforts to expand testing, places like prisons and nursing homes – where the disease is quickly spreading – are still behind.
In New York, Suffolk County Medical Examiner Michael Caplan told funeral directors that nursing homes and hospitals are in charge if collecting postmortem samples.
It’s a move that Michael A. L. Balboni, executive director of the Greater New York Health Care Facilities Association, said is impractical.
‘The last thing that a nursing home is going to do is try to determine if someone who has passed away is covid or no covid,’ he said.
‘They have their hands full trying to dispose of their remains appropriately. . . . Why waste the swabs on decedents?’
An operator at a Suffolk County nursing home, who wished to remain anonymous, said almost no one is being tested for COVID-19, dead or alive. Residents taken to the hospital are the exception.
‘We’re assuming that everyone is positive,’ said the operator.
‘To utilize a test on the deceased, it’s not going to be very helpful. Because at the end of the day, there’s a shortage of tests to begin with. We don’t have tests. We don’t have swabs.’
A FBI prison is Louisiana stopped testing for COVID-19 amid a dozen positive results and at least one death.
A spokesperson said the decision to test for the disease posthumously is decided by health officials on a case-to-case basis.
Sally Aiken, the president of the National Association of Medical Examiners wrote in a press release that the US does not have a ‘uniform death investigation system’ to count fatalities.
‘The public, in general, does not understand that there is not a uniform death investigation system in the United States. . . . So, a uniform response to COVID-19 by Medical Examiners will not occur,’ she wrote.
Amy Schaefer, an investigator supervisor for the Summit County medical examiner’s office in Ohio, agreed.
She said: ‘You certainly are going to have numbers that aren’t being counted because deceased people aren’t being tested.”