Estimating the early death toll of COVID-19 in the United States

  1. Daniel M. Weinberger
  2. Ted Cohen
  3. Forrest W. Crawford
  4. Farzad Mostashari
  5. Don Olson
  6. Virginia E Pitzer
  7. Nicholas G Reich
  8. Marcus Russi
  9. Lone Simonsen
  10. Anne Watkins
  11. Cecile Viboud

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Abstract

Background

Efforts to track the severity and public health impact of the novel coronavirus, COVID-19, in the US have been hampered by testing issues, reporting lags, and inconsistency between states.

Evaluating unexplained increases in deaths attributed to broad outcomes, such as pneumonia and influenza (P&I) or all causes, can provide a more complete and consistent picture of the burden caused by COVID-19.

Methods

We evaluated increases in the occurrence of deaths due to P&I above a seasonal baseline (adjusted for influenza activity) or due to any cause across the United States in February and March 2020. These estimates are compared with reported deaths due to COVID-19 and with testing data.

Results

There were notable increases in the rate of death due to P&I in February and March 2020. In a number of states, these deaths pre-dated increases in COVID-19 testing rates and were not counted in official records as related to COVID-19. There was substantial variability between states in the discrepancy between reported rates of death due to COVID-19 and the estimated burden of excess deaths due to P&I. The increase in all-cause deaths in New York and New Jersey is 1.5-3 times higher than the official tally of COVID-19 confirmed deaths or the estimated excess death due to P&I.

Conclusions

Excess P&I deaths provide a conservative estimate of COVID-19 burden and indicate that COVID-19-related deaths are missed in locations with inadequate testing or intense pandemic activity.

RESEARCH IN CONTEXT

Evidence before this study

Deaths due to the novel coronavirus, COVID-19, have been increasing sharply in the United States since mid-March. However, efforts to track the severity and public health impact of COIVD-19 in the US have been hampered by testing issues, reporting lags, and inconsistency between states. As a result, the reported number of deaths likely represents an underestimate of the true burden.

Added Value of this study

We evaluate increases in deaths due to pneumonia across the United States and relate these increases to the number of reported deaths due to COVID-19 in different states and evaluate the trajectories of these increases in relation to the volume of testing and to indicators of COVID-19 morbidity. This provides a more complete picture of mortality due to COVID-19 in the US and demonstrates how delays in testing led to many coronavirus deaths not being counted in certain states.

Implications of all the available evidence

The number of deaths reported to be due to COVID-19 represents just a fraction of the deaths linked to the pandemic. Monitoring trends in deaths due to pneumonia and all-causes provides a more complete picture of the tool of the disease.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.15.20066431: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Influenza-like illness (ILI) is a longstanding indicator of morbidity from acute respiratory pathogens, including SARS-CoV-2.
    SARS-CoV-2
    suggested: (Active Motif Cat# 91351, RRID:AB_2847848)

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.15.20066431v2 on medRxiv
  3. Version published to 10.1101/2020.04.15.20066431v1 on medRxiv