With the beginning of a new presidency in the US, the number of 400,000 COVID-19 deaths in the US has come up in various news reports. While this is the "official" number of confirmed COVID-19 deaths, a closer look proves that it underestimates the death toll from COVID-19 by a large margin. From the beginning of March 2020 to January 19, 2021, there were more than 560,000 excess deaths in the US - deaths that are in addition to the expected 2.5 million deaths from all causes.
The Numbers: More than half a million additional deaths
Here is a quick outline where the number of 560,000 excess deaths comes from. The starting point is a spreadsheet from the CDC called "Excess Death Associated with COVID-19" which is published every week by the CDC, and which summarizes the deaths certificates that all US states and territories have to submit to the CDC. The most recent version was updated on 1/13/2021, and includes data up to the week that ended on 1/2/2021.
Since the submission of death certificates often takes several weeks or longer, data for the most recent weeks are incomplete. The CDC tries to correct for missing data to some extended by providing a "weighted" data set with a prediction of the final counts, but the correction is limited to states and regions where a substantial fraction of the expected deaths have been reported, and therefore is always an under-estimate for the most recent 4-6 weeks. Therefore, the starting point of the analysis were the data for the weeks ending between 3/7/2020 and 12/5/2020.
The "average expected count" of deaths from all causes for this period is 2.157 million. The actual number of deaths was 2.567 million. This means there were about 410,000 more deaths than expected. However, we need to correct for a few states that are exceptionally slow in reporting. This includes North Carolina, which had not submitted any death certificates for the weeks after 9/26/2020. Here's the numbers:
- COVID-19 deaths reported for NC on 12/5/2020: 5,516
- COVID-19 deaths reported for NC on 9/27/2020: 3,441
- COVID-19 deaths between 9/27 and 12/5/2020 in NC: 2,075
- Ratio of excess deaths to reported COVID-19 deaths for NC: 1.4
- Estimated excess deaths for NC from 9/27 to 12/5/2020: 2,896
There is an additional correction to make for a couple of other states what had very incomplete data for the most recent weeks, which adds another 973 excess deaths. This gives a total estimate of 413,671 excess deaths until 12/5/2020.
To this number, we have to add the deaths that occurred between 12/6/2020 and 1/19/2021. According to Worldometers.info, there were 122,648 confirmed COVID-19 deaths during this period. However, the number of excess deaths in the US has always been substantially higher than the number of confirmed COVID-19 deaths. If we use the empirical factor of 1.38 (from the period between 3/7 and 12/5/2020), we get 169,687 additional excess deaths since 12/5/2020. This give a total of 583,358 excess deaths in the US between March 2020 and today.
It is possible that the under-reporting of COVID-19 deaths has gone down over time due to various factors, including the increased availability of testing after the first wave of deaths. If we assume that the current correction factor is only 1.2 instead of 1.38, get 147,178 additional excess deaths since 12/5/2020. This gives a total of 560,849 excess deaths in the US between March 2020 and 1/19/2021.
There is some uncertainty about the exact numbers of excess deaths due to the incomplete reporting. Over the next week, this uncertainty will be reduced, but it will take several more months before we have a reasonably complete picture. But at this point in time, is seem very likely that the total number of excess deaths linked to COVID-19 so far is between 550,000 and 600,000.
For comparison, the total number of expected deaths for the period between March 2020 and the middle of January 2021 was about 2.5 million. Instead, more than 3 million people died in the US during this time - and the deaths were very closely linked to COVID-19 infections about one month before, regardless of whether states were in lockdown or not, or if the states were controlled by Republicans or Democrats.
One final thing to note is that the actual number of deaths caused directly or indirectly by COVID-19 may be even higher than the numbers I have given above. During the past 10 months, most states were in lockdown for at least several weeks, and some cities, regions, and states have been in extended lockdowns. Both lockdowns and other COVID-19 control measures like social distancing and face masks have the effect of reducing overall deaths. This has been observed in many countries when COVID-19 infection rates were low. We can see the same effect in US states, too. Here are two examples of states that had relatively strict lockdown measures, but low COVID-19 case numbers and deaths, during the period between 3/14/2020 and 5/2/2020:
- Maine: 59 fewer deaths than the expected 2,392. This is a 2.5% reduction in mortality, even though Maine reported 56 deaths from COVID-19 during this period.
- Hawaii: 94 fewer deaths than the expected 1,894. This is a 5% reduction in mortality. Hawaii, which has a very similar population size to Maine, reported only 16 COVID-19 deaths during this period.
If the "expected" deaths numbers would take into account the mortality-reducing effect of lockdowns, the calculated death toll numbers would be even higher.
But regardless what the exact number is, the bottom line is that more than half a million people already died because of COVID-19. Since COVID-19 case numbers have remained very high, and deaths are delayed by up to a month after infection, the US will see close to 100,000 additional confirmed COVID-19 deaths over the next 30 days. At that point in time, the death toll we be equal to the entire population of cities like Boston, Washington D.C., or Seattle.
