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April 28, 2020

Why America's Covid-19 death toll may be much higher than we think

Daily Briefing

    The number of reported U.S. deaths tied to the new coronavirus surpassed 50,000 as of Tuesday morning, but new data suggests that figure might be a drastic undercount.

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    As US Covid-19 cases surpass 987K and death toll tops 50K, Trump revises projected death count

    As of Tuesday morning, U.S. officials had reported 987,691 cases of Covid-19, the disease caused by the new coronavirus—up from 965,214 cases as of Monday morning.

    Officials as of Tuesday morning also had reported 50,819 U.S. deaths linked to the new coronavirus, up from 49,465 deaths reported as of Monday morning.

    President Trump during a White House press briefing on Monday said more Americans likely will die from the new coronavirus than his administration had previously projected. He said his administration now predicts that about 70,000 Americans will die from the new coronavirus.

    The White House has based its Covid-19 case and death count projections on a predictive model developed by the University of Washington's Institute for Health Metrics and Evaluation (IHME). Two weeks ago, IHME's model predicted the United States would see up to 60,000 deaths tied to the new coronavirus by August, and Trump began using that projection, saying the country likely would see between 50,000 and 60,000 deaths tied to the virus.

    However, IHME has since updated its projections. As of Monday, the model projected that the United States will see about 74,073 deaths tied to the virus by Aug. 4.

    IHME Director Christopher Murray said the country's death toll likely will increase if states reopen nonessential businesses and ease social distancing measures too quickly.

    Further, recent data has shown that Covid-19 case fatality rates are rising in certain areas of the United States, The Hill reports. For example, the case fatality rate in Connecticut has increased by three percentage points over the past two weeks, while the case fatality rate has grown by two percentage points each in Louisiana, Massachusetts, and Minnesota, according to The Hill.

    Data suggests US death toll from Covid-19 is higher than reported

    Meanwhile, new data suggests the current U.S. death toll from the new coronavirus is higher than the count that's been reported—meaning the Covid-19 epidemic's impact on the country could be even more widespread than officials and researchers currently know.

    The Yale School of Public Health conducted the new analysis on behalf of the Washington Post. To do so, the researchers looked at mortality data released Friday by CDC's National Center for Health Statistics (NCHS) and examined the number of excess deaths that occurred in the country between March 1 and April 4. The number of excess deaths is determined by subtracting the number of deaths that typically occur during a certain time period from the number of reported deaths that actually occurred during that time period.

    The researchers found that 15,400 excess deaths occurred in the United States from March 1 through April 4—which is more than the 8,128 deaths tied to the new coronavirus that U.S. officials had reported during that time. The researchers said some of those excess deaths could be either directly or indirectly attributed to the Covid-19 epidemic. For example, some of the excess deaths could have occurred among people who did not seek medical treatment for an unrelated condition because they were afraid of contracting the new coronavirus—meaning the death was indirectly caused by the epidemic. In addition, some of the deaths may have occurred among individuals who had developed Covid-19 but were never tested for the new coronavirus.

    A New York Times analysis of mortality data from New York City's Department of Health and NCHS had similar findings, with researchers estimating that the city's seen 20,900 excess deaths since March. The city has attributed about 16,700 deaths that have occurred since March to the new coronavirus.

    According to the Post, researchers typically evaluate excess death counts as "a starting point for … understand[ing] the full impact of" disease outbreaks, as lags in testing and reporting—as well as differences in how areas count deaths related to a disease—often result in undercounts.

    "It's really important to get the right numbers to inform policymakers so they can understand how the epidemic is evolving and how severe it is in different places," Daniel Weinberger, a professor of epidemiology at Yale who led the research team, said.

    White House releases 'blueprint' intended to boost coronavirus testing capacity

    Meanwhile, Trump on Monday unveiled a new "testing blueprint" aimed at increasing the number of tests for the new coronavirus conducted across the United States.

    The blueprint, which includes few details, is intended to serve as guidance to help states ramp up testing for the virus, the Post reports. The blueprint notes that states are responsible for developing their own plans for testing and rapid-response programs, and the federal government's only role is to provide "strategic direction and technical assistance," as well as to "align laboratory testing supplies and capacity with existing and anticipated laboratory needs." The blueprint states that the federal government is the "supplier of last resort" for testing.

    The White House also released a "testing overview" of how increasing testing capacity could help states to reopen nonessential businesses and ease social distancing measures.

    During Monday's White House press briefing, several private companies, including CVS Health and Walgreens, committed to helping the United States increase testing capacity to conduct millions of tests per month. So far, the United States has conducted about 5.4 million tests for the new coronavirus, but Vice President Pence said the new efforts could lead to the country having the capacity to conduct as many as two million tests per week by the end of May.

    Adm. Brett Giroir, who is overseeing the administration's coronavirus testing efforts, said the federal government would be able to provide all 50 states with enough tests to screen 2% of their residents for the virus.

    However, those estimates fall below the testing capacity many public health experts have said is needed to safely reopen businesses and loosen social distancing measures in America. According to the Wall Street Journal, experts have estimated that the country needs to test at least four million people per week, and Ashish Jha, director of the Harvard Global Health Institute, has noted that some people will need to be tested for the new coronavirus more than once (Miranda Ollstein, Politico, 4/27; Singh, Reuters, 4/28; Brown et al., Washington Post, 4/27; Katz/Sanger-Katz, "The Upshot," New York Times, 4/27; Wilson, The Hill, 4/27; DeBonis et al., Washington Post, 4/27; Facher, STAT News, 4/27; Bender/Abbott, Wall Street Journal, 4/27; Rubin/Mosk, ABC News, 4/28; Testing Overview: Opening Up American Again, accessed 4/28; Testing Blueprint: Opening Up American Again, accessed 4/28; New York Times, 4/28).

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