U.S Medical News: University Of Pennsylvania And Boston University Study Shows Under-Reporting Of COVID-19 Deaths In Various Counties Across United States!

U.S Medical News: A new detailed study by American researchers has found extensive under-reporting of COVID-19 deaths in various counties across the United States.


 
The study team comprised of researchers from the University of Pennsylvania, Philadelphia, Boston University School of Public Health, University of Washington School of Public Health, RTI International-North Carolina and Robert Wood Johnson Foundation-New Jersey.
 
Accurate and timely tracking of COVID-19 deaths is essential to any well-functioning public health surveillance system.
 
The extent to which official COVID-19 death tallies have captured the true toll of the pandemic in the United States is unknown.
 
The study team develop a Bayesian hierarchical model to estimate monthly excess mortality in each county over the first two years of the pandemic and compare these estimates to the number of deaths officially attributed to COVID-19 on death certificates.
 
The study team estimated that 268,176 excess deaths were not reported as COVID-19 deaths during the first two years of the COVID-19 pandemic, which represented 23.7% of all excess deaths that occurred.
 
Differences between excess deaths and reported COVID-19 deaths were substantial in both the first and second year of the pandemic.
 
It was found that excess deaths were less likely to be reported as COVID-19 deaths in the Mountain division, in the South, and in non-metro counties. The number of excess deaths exceeded COVID-19 deaths in all Census divisions except for the New England and Middle Atlantic divisions where there were more COVID-19 deaths than excess deaths in large metro areas and medium or small metro areas.
 
Increases in excess deaths not assigned to COVID-19 followed similar patterns over time to increases in reported COVID-19 deaths and typically preceded or occurred concurrently with increases in reported COVID-19 deaths.
 
Estimates from this study can be used to inform targeting of resources to areas in which the true toll of the COVID-19 pandemic has been underestimated.
 
The study findings were published on a preprint server and are currently being peer reviewed.
https://www.medrxiv.org/content/10.1101/2023.01.16.23284633v1
 
In the last 12 weeks, COVID-19 deaths and excess deaths were also increasing at a high rate in the United States but the actual details were being concealed and there was no mention in any U.S. Medical News coverages!
 
This is the first study to highlight that a considerable percentage of coronavirus disease 2019 (COVID-19)-related deaths remained unreported in different counties across the United States.
 
Excess mortality is a widely used measure to assess the mortality impact of the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The difference between the reported deaths in a given period and the expected deaths based on pre-pandemic mortality trends in the same period is regarded as excess mortalit y.
 
It is already suspected that the number of excess deaths officially not assigned to COVID-19 can exceed the reported number of deaths assigned to COVID-19 on death certificates. This could be due to several factors, including the failure of certifiers to recognize COVID-19-related deaths clinically. Personal or political beliefs could also influence assigning deaths to COVID-19 on certificates.
 
Numerous comorbidities and atypical symptoms of COVID-19 can make it difficult to identify the real cause of death. Deaths caused by pandemic-related delays or interruptions in healthcare access or socioeconomic crisis could be indirectly related to the pandemic. All these factors could collectively impact the actual death toll of the pandemic.
The study team compared the estimates of monthly excess mortality and the estimates of reported COVID-19 deaths in counties across the United States during the first two years of the pandemic.
 
The researchers developed a Bayesian hierarchical model to estimate the monthly all-cause excess mortality for 3,127 counties from March 2020 to February 2022. They used publicly available pre-pandemic data (January 2015 - December 2019) to predict excess mortality.
 
The study team used relative estimates of excess mortality to compare excess mortality and COVID-19 mortality across counties with different populations and numbers of deaths. Relative excess mortality was derived by dividing the number of excess deaths by the number of expected deaths in a given area.
 
From the study estimations, about 1,134,364 excess deaths occurred in the United States during the first two years of the pandemic. Of these deaths, 866,187 were assigned to COVID-19, and 268,176 were not assigned to COVID-19. These estimates indicate that about 24% of excess deaths were not assigned to COVID-19 in the United States during this period.
 
Interestingly, the relative excess deaths not assigned to COVID-19 were higher in non-metro counties than in small, medium, or large metro counties. The excess mortality not assigned to COVID-19 was highest in the Mountain division and the South. 
 
With the exception of New England and Middle Atlantic divisions, all Census divisions had more excess deaths than COVID-19 deaths. COVID-19 mortality exceeded excess mortality for these two divisions in all metro counties.
 
It was found that in areas with the highest number of excess deaths not assigned to COVID-19, excess deaths occurred more frequently during the peaks of reported COVID-19 deaths.
 
However, in contrast, a stable rate of excess deaths not assigned to COVID-19 was observed in areas with higher COVID-19 mortality than in excess mortality.

Among included counties, Shelby, Tennessee, had 2.4 times higher excess mortality than COVID-19 mortality during the first two years of the pandemic. This was equivalent to 4,014 excess deaths that were not assigned to COVID-19.
 
In the same light, Lafayette, Louisiana, had 2.5 times higher excess deaths than COVID-19 deaths during the first two years of the pandemic. This was equivalent to 654 excess deaths that were not assigned to COVID-19.
 
The research findings predicted the monthly excess all-cause deaths for US counties and identified that about 24% of all excess deaths were not assigned to COVID-19 during the first two years of the pandemic. Non-metro counties were less likely to attribute excess deaths to COVID-19 on death certificates officially.
 
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