Since COVID-19’s spread to the United States earlier this year, death rates in the U.S. have risen strongly.
But in a new study, researchers found that deaths attributed to COVID-19 only account for about two-thirds of the increase in March and April.
The research was conducted by a team at Virginia Commonwealth University and Yale University.
In the study, the team found that from March 1 to April 25, the U.S. saw 87,001 excess deaths—or deaths above the number that would be expected based on averages from the previous five years.
But only 65% of the excess deaths that occurred in March and April were attributed to COVID-19, meaning more than one-third were linked to other causes.
In 14 states, including two of the most populated—California and Texas—more than half of the excess deaths were tied to an underlying cause other than COVID-19.
This data suggests the COVID-19 death counts reported to the public underestimate the true death toll of the pandemic in the U.S.
The team says there are several potential reasons for this under-count.
Some of it may reflect under-reporting; it takes a while for some of these data to come in. Some cases might involve patients with COVID-19 who died from related complications, such as heart disease, and those complications may have been listed as the cause of death rather than COVID-19.
But a third possibility is indirect mortality—deaths caused by the response to the pandemic.
People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship, or emotional distress.
The team found that deaths from causes other than COVID-19 rose sharply in the states that had the most COVID-19 deaths in March and April.
Those states were Massachusetts, Michigan, New Jersey, New York—particularly New York City—and Pennsylvania.
At COVID-19’s peak for March and April (the week ending April 11), diabetes deaths in those five states rose 96% above the expected number of deaths when compared to the weekly averages in January and February of 2020.
Deaths from heart disease (89%), Alzheimer’s disease (64%) and stroke (35%) in those states also spiked.
The team found New York City’s death rates alone rose a staggering 398% from heart disease and 356% from diabetes.
They suspect that some of these were indirect deaths from the pandemic that occurred among people with acute emergencies, such as a heart attack or stroke, who may have been afraid to go to a hospital for fear of getting the virus.
Those who did seek emergency care, particularly in the areas hardest hit by the virus, may not have been able to get the treatment they needed, such as ventilator support if the hospital was overwhelmed by the surge.
Others may have died from a chronic health condition, such as diabetes or cancer, that was exacerbated by the effects of the pandemic.
Still, others may have struggled to deal with the consequences of job loss or social isolation.
In addition, a number of people struggling with depression, addiction, and very difficult economic conditions caused by lockdowns may have become increasingly desperate, and some may have died by suicide.
People addicted to opioids and other drugs may have overdosed.
The team says the findings showed a death count well beyond what researchers would normally expect for this time of year, and it’s only partially explained by COVID-19.
One author of the study is Steven Woolf, M.D., the director emeritus of VCU’s Center on Society and Health.
The study is published in JAMA.
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