New research suggests that in the United States, around 35% of excess deaths during the early phase of the pandemic were not directly caused by COVID-19.

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A recent study asks if experts may have underestimated the COVID-19 death toll.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

A new study has found that in the U.S., up to 35% of excess deaths during the early phase of the pandemic may not have been directly due to COVID-19.

The research, which now appears in the journal JAMA, suggests that experts may have underestimated the pandemic’s death toll in publicly reported deaths.

In severe cases, COVID-19 can cause pneumonia: The body’s inflammatory response overcompensates for the presence of the virus in the lungs, reducing the lungs’ ability to get oxygen into the blood.

This can, in turn, lead to organ failure or serious cardiovascular events and, ultimately, death.

However, as well as the direct effects of COVID-19 on a person’s body, the virus can also cause death by exacerbating underlying health issues; the body’s immune system is weakened while fighting off the illness.

Furthermore, the sudden emergence and rapid spread of the disease overwhelmed critical care units when the virus was at its peak, reducing the amount of care any individual patient could receive. This affected not only COVID-19 patients but all those who may have needed critical care.

Consequently, the effect of the pandemic on excess deaths — that is, the number of additional deaths beyond what experts expect of a country during a given time — may be greater than what experts have typically reported, particularly if those reports relied on deaths directly attributed to COVID-19.

This was the finding of a new study that explored the attribution of cause of death for the excess deaths in the U.S. during the early phase of the COVID-19 pandemic.

The study found that death toll reports attributed only 65% of the excess deaths in the U.S. to COVID-19.

Furthermore, in 14 states — including California and Texas, which have large populations — reports linked less than 50% of excess deaths directly to COVID-19.

For lead study author Prof. Steven Woolf, director emeritus of Virginia Commonwealth University’s Center on Society and Health in Richmond, this may mean that experts have underestimated the death toll of the pandemic.

According to Prof. Woolf: “There are several potential reasons for this under-count. Some of it may reflect under-reporting; it takes a while for some of these data to come in. Some cases might involve patients with COVID-19 who died from related complications, such as heart disease, and those complications may have been listed as the cause of death rather than COVID-19.”

“But a third possibility, the one we’re quite concerned about, is indirect mortality — deaths caused by the response to the pandemic. People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship, or emotional distress.”

– Prof. Steven Woolf

The study also found that excess deaths not linked to COVID-19 rose significantly in states that had the largest outbreaks of the disease during the virus’s peak in early April. These included Massachusetts, Michigan, New Jersey, New York, and Pennsylvania.

For example, in these states, there were 96% more diabetes-related deaths than experts predicted. For heart disease, the figure was 89%; for Alzheimer’s disease, it was 64%; and for stroke, it was 35%.

As well as people not being able to get the necessary treatment due to hospitals being overloaded, the study authors also speculate that people may have stayed at home due to the virus despite experiencing worsening symptoms of another condition they may have had.

They also believe that the pandemic’s effects on people’s mental health may have played a part.

As Prof. Woolf notes: “We can’t forget about mental health. A number of people struggling with depression, addiction, and very difficult economic conditions caused by lockdowns may have become increasingly desperate, and some may have died by suicide. People addicted to opioids and other drugs may have overdosed.”

“All told, what we’re seeing is a death count well beyond what we would normally expect for this time of year, and it’s only partially explained by COVID-19.”

These findings are particularly important, as new cases of the virus are beginning to surge after the relaxation of physical distancing rules in various states across the U.S.

For Prof. Woolf, “[p]ublic officials need to be thinking about behavioral healthcare and ramping up their services for those patients in need. The absence of systems to deal with these kinds of other health issues will only increase this number of excess deaths.”