According to a new analysis by the University of Washington’s Institute for Health Metrics and Evaluation, the coronavirus pandemic may have already killed 905,000 people in the U.S. as of May 3. That is 61 percent higher than the Centers for Disease Control and Prevention’s official estimated count of deaths attributed to COVID-19 up to about that date, which is nearly 561,600. The IHME’s estimate for the total number of global deaths, meanwhile, is more than double the official count: 6.93 million people, rather than 3.24 million — and it predicts that 2.5 million more will die of COVID-19 around the world by September, including an additional 44,000 in the U.S.
The IHME numbers, which are based on an analysis of excess mortality and other data in 56 countries and 198 subnational locations like states and cities, far exceed most other estimates of COVID deaths thus far, and that’s because the organization’s researchers took a different approach, as NPR explains:
The group reached its estimates by calculating excess mortality based on a variety of sources, including official death statistics from various countries, as well as academic studies of other locations. Then, it examined other mortality factors influenced by the pandemic. For example, some of the extra deaths were caused by increased opioid overdoses or deferred health care. On the other hand, the dramatic reduction in flu cases last winter and a modest drop in deaths caused by injury resulted in lower mortality in those categories than usual.
Researchers at UW ultimately concluded that the extra deaths not directly caused by COVID-19 were effectively offset by the other reductions in death rates, leaving them to attribute all of the net excess deaths to the coronavirus.
If the IHME estimates are accurate, that would mean COVID-19 has already killed more people in the U.S. than the so-called Spanish flu did. From 1918 to 1920, the Spanish flu is estimated to have killed some 675,000 people in the U.S. The global death toll of that earlier pandemic is estimated to be anywhere from 17.4 million to 100 million dead. Per Stat News, IHME director Christopher Murray fears, based on their new analysis, that COVID-19 could ultimately “rival” that:
We’re probably not yet at the global toll of Spanish flu and certainly not at the death rate from Spanish flu. But given what’s unfolding in India right now, given our expectation of continued deaths, COVID is going to rival Spanish flu at the global level in terms of the count, likely, before we see the end of this epidemic.
India’s official death toll is about a third of what the IHME analysis indicates. Most experts agree that India’s officially reported numbers of COVID deaths and cases are severe undercounts, though the estimated degrees vary. The IHME analysis also estimated that of the other world leaders in coronavirus deaths, Mexico and Russia, provided COVID death counts that were low by hundreds of thousands. And it estimated that in some countries, like Egypt and Japan, reported COVID death numbers were about a tenth of the real picture.
Indeed, there appears to be universal agreement among scientists studying the pandemic that the official number of COVID deaths and cases, both nationally and globally, is definitely an undercount — and in the case of many foreign countries, a significant one. For a variety of factors, it remains very difficult to calculate the cost of the pandemic in human lives, including in the U.S., as Vox’s Umair Irfan noted Friday:
The problems start with the death certificate. Ivor Douglas, chief of the Pulmonary Sciences and Critical Medicine division at the Denver Health Medical Center, explained that death certificates emphasize the primary cause of death, which is the most immediate condition leading to the fatality. Death certificates also have space for secondary and indirect causes.
As the COVID-19 pandemic has revealed, the disease can manifest in myriad ways and leave lasting damage, even in people who had a mild illness. So a COVID-19 death certificate could list something like a blood clot in the lungs as the primary cause of death, with COVID-19 as a secondary or indirect cause. Whether that specific death is then coded as a COVID-19 fatality could differ depending on the state.
The IHME says its new report is in part meant to highlight the challenge of accurately counting COVID deaths, and to encourage more thoroughness and transparency on the part of governments.
At the same time, some researchers have expressed skepticism about the analysis, as NPR points out:
“I think that the overall message of this (that deaths have been substantially undercounted and in some places more than others) is likely sound, but the absolute numbers are less so for a lot of reasons,” said William Hanage, an epidemiologist at Harvard University, in an email to NPR.
Last month, a group of researchers at Virginia Commonwealth University published a study in the medical journal JAMA that examined excess mortality rates in the U.S. through December. While that team similarly found the number of excess deaths far exceeded the official COVID-19 death toll, it disagreed that the gap could be blamed entirely on COVID-19 and not other causes.
“Their estimate of excess deaths is enormous and inconsistent with our research and others,” said Dr. Steven Woolf, who led the Virginia Commonwealth team. “There are a lot of assumptions and educated guesses built into their model.”
Other researchers applauded the UW study, calling the researchers’ effort to produce a global model important, especially in identifying countries with small reported outbreaks but larger estimates of a true death toll, which could indicate the virus is spreading more widely than previously thought.
IHME’s modeling early in the pandemic, which severely underestimated what was to come in the U.S. and was utilized by the Trump White House to downplay the pandemic, was widely criticized. Murray, the IHME director, has insisted that their team has improved its modeling.
In the end, the unfortunate reality is that it may never be fully clear how many people have died from COVID-19, either in individual countries or overall globally. What is clear is that the death toll will be more, and always has been more, than the official numbers indicate almost everywhere.