Uncovering Covid’s Hidden Deaths in US

With the United States’ pandemic death toll climbing toward one million, a Boston University public health researcher is partnering with a team of investigative journalists to shine light on a hidden aspect of COVID-19 mortality: deaths excluded from the official totals.

While the formal tallies include anyone who had COVID listed on their death certificate, they don’t catch everyone whose life was shortened by the pandemic: the older person who died alone at home, undiagnosed; the person who took their life because of new financial stresses. Some estimates suggest the unofficial death count may be 20 percent higher than the publicly touted one. Andrew Stokes, a demographer who has studied death rates since the pandemic’s outset, is working with reporters from the open-records project Documenting COVID-19 to increase public scrutiny of the potential undercounts. Their findings are being chronicled in a series of USA Today articles.

According to Stokes, a BU School of Public Health assistant professor of global health, the true number of COVID deaths in the United States is likely much higher than records indicate. He recently led a team of researchers from BU, the University of Pennsylvania, and the Robert Wood Johnson Foundation to analyze mortality data in more than 3,000 US counties. They examined excess deaths-the number of deaths beyond what would have been expected in a normal year-and how many were tied to COVID.

The researchers found substantial variation in the percentage of excess deaths assigned to COVID across the country, with counties in the South and West especially likely to underreport pandemic deaths. COVID deaths were also more likely to be missed in counties with fewer primary care physicians, less access to health insurance, and more people dying at home; communities of color were disproportionately impacted. Some undercounts, says Stokes, may even be politically motivated.

“Accurate and timely mortality surveillance is critical to pandemic preparedness and response efforts,” he says. “Without accurate mortality data, it becomes very challenging to devise effective policy responses or to develop fair and equitable responses targeting the most heavily affected communities.”

Using Stokes’ data and modeling

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