Counting the missing deaths: Tracking the true toll of the coronavirus outbreak

The official counting of deaths is just a fraction of the real toll of COVID-19 in about every country affected by the pandemic. The New York Times, doing important work, found at that least 60,000 more people have died during the coronavirus pandemic than the official Covid-19 death counts report, a review of mortality data in 15 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis. Over the last two months, far more people have died in most of these countries than in previous years.

These numbers undermine the notion that many people who have died from the virus may soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than in the peak of a bad flu season. In New York City, the number has spiked to six times the normal figure. The city has become the epicenter of the outbreak in the United States. More than 30,700 people have died since mid-March — 23,000 more than normal, and 4,300 more than have been captured by official death statistics.

They estimated the excess mortality for each country by comparing the number of people who died from all causes this year with the historical average during the same period. It is unusual for mortality data to be released so quickly, demographers say, but many countries are working to provide more comprehensive and timely information because of the urgency of the coronavirus outbreak. The data is limited and, if anything, excess deaths are underestimated because not all deaths have been reported. The data reflects that most acute side of the situation, primarily through the hospital-based system.

Despite the early data, many European countries have reported clear deviations from normal patterns of deaths, according to data released by the European Mortality Monitoring Project, a research group that collects weekly mortality data from 24 European countries. In Italy, almost 50 percent more people died in March than the average for that month in the last five years, about 25,000 deaths more than normal in a single month. In some countries, like Belgium and France, authorities are working to include Covid-19 deaths outside of hospitals in their daily reports, or adjusting the overall Covid-19 death totals once a death is confirmed in a place like a nursing or retirement home. Others, like Britain’s Office for National Statistics, have started to release mortality data after death certificates have been processed, confirming those that mention Covid-19. This provides a more accurate, if delayed, account of mortality than the hospital figures released each day by Public Health England.

In a handful of countries, including Norway and Denmark, there has been no clear sign of increased mortality this year. Demographers say this is due in part to a less severe flu season this winter — and because these countries implemented early, severe restrictions to slow the spread of the virus when their outbreaks were smaller and easier to contain. Denmark announced a nationwide lockdown on March 11, before it had registered a single confirmed death. Norway announced a lockdown the next day, with just one confirmed death. In comparison to neighboring Sweden, which never implemented a national lockdown, Norway and Denmark have each recorded fewer than 500 Covid-19 deaths. Sweden has tallied over 2,500.

The totals include deaths from Covid-19 as well as those from other causes, likely including people who could not be treated as hospitals became overwhelmed. The article profiles the death of a cancer patient who could not obtain proper attention, describing the situation in the United States. Beds, blood, doctors, nurses and ventilators are in short supply; operating rooms are being turned into intensive care units; and surgeons have been redeployed to treat people who cannot breathe. Even if there is room for other patients, medical centers hesitate to bring them in unless it is absolutely necessary, for fear of infecting them — or of health workers being infected by them. Patients themselves are afraid to set foot in the hospital even if they are really sick. Early on, as the epidemic loomed, many hospitals took the common-sense step of halting elective surgery. Knee replacements, face lifts and most hernias could wait. So could checkups and routine mammograms.

But some conditions fall into a gray zone of medical risk. While they may not be emergencies, many of these illnesses could become life threatening, or if not quickly treated, leave the patient with permanent disability. Doctors and patients alike are confronted with a worrisome future: How long is too long to postpone medical care or treatment?

RNAO’s view: Although the New York Times does not include Canada among the countries studied, the issues and concerns hold as well for our country. Canada doesn’t provide up-to-date death data, so this kind of study may have to wait, but it’s importance does not diminish. It is essential to know the real death toll, including those who are not counted in official statistics. As the pandemic moves to a “new normal,” we need to place focus on the non-COVID patients, the delayed surgeries, and those falling through the cracks of a healthcare system entirely captured by COVID.