July 17, 2020

The number of deaths from COVID-19 reported in the news during March and April may be underestimating the pandemic’s actual death toll, according to research by the Center on Society and Health at VCU and Yale published in the Journal of the American Medical Association.

From March 1st to April 25, 2020, the United States saw 87,001 excess deaths, but only 65% of the excess deaths were attributed to COVID-19. The other one-third (35%) was linked to other causes such as heart disease, diabetes, cerebrovascular disease, and Alzheimer’s disease. Simply put, for every two deaths attributed to COVID-19, there was another death attributed to other causes.

This means that the pandemic is costing more lives than the COVID-19 death count would suggest. In 14 states, including the nation’s most populous like California and Texas, COVID-19 explained less than half of the excess deaths. 

The undercount could have multiple explanations as the number of publicly reported COVID-19 deaths is taken from provisional data that are often incomplete and may omit COVID-19 deaths that were misattributed to another cause. Deaths attributed to other causes like heart disease, stroke, and diabetes could also reflect undocumented complications from COVID-19 such as clotting disorders or inflammation caused by the virus. 

Additionally, some of the excess deaths may have less to do with the virus itself than the restrictions imposed by the pandemic, such as stay-at-home orders, reduced access to health care, fears of calling 911 for acute emergencies, or psychological stresses that lead to death. 

Learn more about the JAMA study in this video from the Center’s director emeritus, Dr. Steven Woolf.