> The official covid death count is likely an undercount of deaths caused by covid, because a number of people died from covid related complications and got recorded as pneumonia, Alzheimer’s, or heart disease/attack/stroke related deaths.
That's a theory. Meanwhile, we know that many places are classifying anyone who dies within N days of a positive test (N is typically 30) as a "covid death", regardless of actual cause.
I can guarantee that not all of those people died from Covid-19. Point being: there's likely to be overcount and undercount, for different reasons.
> Serious question, how many of those people would have died in the past 12 months if they didn't get COVID? The number is most likely not 500,000, but it also probably isn't 0.
This can be answered using “excess mortality” data.
Studies have shown during that time period, about 600,000 more people died than would have been expected compared to deaths in the previous year.
The official covid death count is likely an undercount of deaths caused by covid, because a number of people died from covid related complications and got recorded as pneumonia, Alzheimer’s, or heart disease/attack/stroke related deaths.
> I also saw a medical worker saying that if someone dies before testing, that will be counted as a COVID death[1]
But this is what happens for flu too. You want to count them using the same methodology. You either use confirmed cases (Covid-19 kills more people than a bad flu year, and yes we do test for flu); or you use confirmed and suspected cases (again, covid-19 kills more than a bad flu year); or you use excess mortality (and this year we have huge increase in excess mortality).
There's no way to look at the data and come up with anything other than "covid-19 kills a lot of people".
> and then subtly shifting between deaths from Covid and deaths during a flu wave (so not caused by the flu?).
Newsflash, genius. They are counting every person that died with COVID (or even "presumed" positive) as a death from COVID-19. The actual number of people that were killed directly by COVID is not known, just like we don't measure, test, or track every single person that dies of flu each year. It's an estimate that's arrived at long after the fact by reviewing data.
> The death counts record the number of people who died after testing positive for this coronavirus
Probably important to point out the large regional variation.
In the UK the doctor has to be able to say to the best of their knowledge and belief that covid-19 was the cause of death before putting it on the death certificate.
We're not testing everyone, not even the ones in hospital for severe respiratory illness. We don't test dead people. So this feels like it's going to under-count, not over-count the deaths.
If this was just people who were going to die anyway we wouldn't have the huge rates of excess mortality. We know we have excess mortality because (again in the UK) we're having to build temporary morgues to hold all the dead bodies, and we're having to change the process to register deaths.
>There is also a good chance that COVID mortality in the US is being significantly overcounted.
It seems experts (CDC among other) suggest the mortality is quite a bit undercounted, since there are many deaths for which the person is not tested, since we lacked the testing capabilities.
One interesting place to see it is expected death rates versus actual death rates while COVID is here, and note there is no other known thing that spiked at the same time to account for the excess deaths.
What science groups or medical groups are claiming it's overcounted?
Unless you have an alternative explanation, it's a fairly reasonable assumption. In fact it's arguably more reliable in aggregate than trying to positively identify the cause of death for each victim, given the magnitude of the number. That wouldn't work for smaller effects though.
> for now we assume that total COVID-19 deaths equal excess mortality.
This seems reasonable, although I'd suggest it's an underestimate of COVID-19 deaths.
Excess deaths counts have been consistently showing negative in countries during periods of time where they have coronavirus under control.
Other significant causes of death (including suicide, influenza, road traffic accidents) appear to be down.
As such, I'd assume that COVID-19 deaths are likely somewhat higher than excess mortality figures. I'm prepared to accept the assumption that they're approximately the same.
[Edited to note: the linked article discusses this with further detail and evidence]
>> Due to varying protocols and challenges in the attribution of the cause of death, the number of confirmed deaths may not
accurately represent the true number of deaths caused by COVID-19.
How can this then be "confirmed deaths" if they themselves state it's not possible to accurately determine them.
> Ascribing all excess deaths to coronavirus is a mistake.
I worded my statement intentionally.
> It's also most likely still an undercount
Some of the excess deaths will be other things. It will take more careful analysis to come up with reasonable breakdowns, and what percentage is likely covid-19 deaths.
> “I think people need to be aware that the data they’re seeing on deaths is very incomplete,” said Dan Weinberger, a Yale professor of epidemiology who led the analysis for The Post.
> Those excess deaths — the number beyond what would normally be expected for that time of year — are not necessarily attributable directly to covid-19, the disease caused by the coronavirus. They could include people with unrelated maladies who avoided hospitals for fear of being exposed or who couldn’t get the care they needed from overwhelmed health systems, as well as some number of deaths that are part of the ordinary variation in the death rate. The number is affected by increases or decreases in other categories of deaths, such as traffic fatalities and homicides.
> But excess deaths are a starting point for scientists to assess the overall impact of the pandemic.
>but it's also a methodology that should be likely to give a high side estimate
It's the same methodology they use for all diseases. If it's too high an estimate, they'd pretty quickly find it since it would overcount enough reasons fro death that totals would not match measured death totals.
In my original post I linked evidence and the expert reasons why counting is likely low.
>Outside of New York/New Jersey and Massachusetts, I don't find a high disparity in the excess death ratio that supports the idea that there is significant under reporting of deaths.
The CDC link had many states with many thousands of excess deaths. And remember CDC death count lags actual death counts by a few weeks, so the 118k-154k (95%-ile) they list is to be compared to COVID as of a few weeks ago, which was under 110K two weeks ago. So taking the median gives around 136K actual deaths (prob not all COVID, but majority so) vs 110K reported - approx 20% undercounted.
>So are more people having heart attacks? Is Covid causing heart attacks?
Both of those are likely true [1]. Research since then is looking like COVID is killing asymptomatic people via attacking the heart.
>I don't feel comfortable pushing the idea that we are under-reporting deaths or over-reporting deaths because I think that we don't actually know
I've found significant decent groups and projects claiming undercounting, many with decent empirical evidence. I've not found the opposite, despite looking. I posted a few to get you started - discount as you wish.
It's shocking to see such a statement so far into the pandemic. This is solved and known already, and while complicated, we've figured it out for some time. We can easily see the massive amount of deaths when we look at excess death numbers. Covid deaths are, if anything, undercounted. To believe anything else at this point is to bury your head in the sand and avoid all scientific evidence and medical consensus.
> "As for the accuracy of the death toll, other experts have previously told us that while it’s true that some deaths attributed to COVID-19 likely would have occurred regardless of the disease, other factors — like the deaths of undiagnosed COVID-19 victims, including those that occur at home — contribute to a more significant problem of under-counting the deaths."
The Stanford professor who I saw on a recent lex Friedman podcast confirmed what many people already suspected: the death count is exaggerated because the criteria for a Covid death is that a person is dead and also tests positive for Covid regardless of how the person really died. And also that cases were massively undercounted because of the fact that many people never have symptoms bad enough to justify any concern, testing or a hospital visit. That’s what he’s asserting and it’s true.
He said when you sample randomly and follow positive testers to their conclusion, the lethality rate is something like 0.02%. I’m sorry that it upsets you to hear something you don’t already agree with
And that's assuming the count is even accurate. We now know that in some places they categorized people as dying from COVID even if they died from completely unrelated causes just because they did a COVID test on top. So the truth is certainly less.
But they often followup by arguing that we should focus on COVID deaths, because those are (usually) too hard to hide. Potential undercounts of this sort call that conclusion into question.
Which was the point of both the OP and the buzzfeed article that I pointed.
We only count someone as a case when they get tested and are positive. However we don't test someone simply because they are really sick and it looks like COVID-19. Which means that nobody has to hide the body - it simply isn't counted in the COVID-19 numbers.
This systemic source of error seems to be common across many regions and countries. And it throws all quoted statistics into question. And not by a handful, but by a significant factor.
Of course at the moment preventing bodies is more important than counting them. But knowing that we can't trust the counts either, matters.
Perhaps paradoxically, going up another level and looking at "all deaths regardless of cause" doesn't necessarily improve the quality of the decision making. If anti-COVID measures also serve to decrease flu deaths and traffic accidents, it's possible that the total numbers might show a drop even if those same measures are inadequate for reducing COVID deaths. It's hard to get anything right!
True. But if the systemic undercounting of COVID-19 deaths is a reasonably large factor and the death rate is a significant fraction of the total death rate, it can become a more accurate estimate than the official numbers.
And yes. Accurate decision making with unreliable numbers is impossible. The best we can do is heuristics.
> One is a post-epidemic estimate by independent epidemiologists, while the other is a confirmed-positive-death count subject to contemporaneous political pressure and institutional inability to confirm every Covid death.
...as well as almost certain over-counting due to extremely liberal criteria for "Covid deaths" (e.g. deaths within 30 days of a positive test, which is the standard in many areas.)
Point being: there's uncertainty on the "confirmed-positive death count" in both directions and you're assuming that it's a strict lower bound.
Just today, the WSJ published an excess-death study that put the number at 2.8M, worldwide (or 3.5/10,000):
Higher than the JHU numbers, but still within reasonable statistical error of the 1957 pandemic estimates.
> After a couple years once experts have had time to gather and crunch the numbers, the number of Covid deaths from a comparable kind of best-guess estimate is going to double or more. Even in the USA, we are probably missing on the order of 150–200k Covid deaths so far from our confirmed death counts.
Well, now you're just making things up. Also, again: see the WSJ study above. Even if you count every excess death this year as Covid...it's about the same as the 1957 flu season.
> I also suspect that if you do the simple calculation "excess mortality minus confirmed COVID deaths", this will be an overestimate, because many COVID deaths are misclassified as something else, e.g. pneumonia.
I think it depends on the country - a lot of countries are labelling any deaths with COVID symptoms as COVID (even though the symptoms are common to other illnesses like the flu).
In these countries it will likely be an overestimate.
> In Slovakia, the total mortality this year is lower than in the comparable period during previous years.
Yes, COVID has been fairly benign in a lot of countries and a massive killer of the old in others.
We only know estimates of the number of deaths. The correct number lies somewhere between the official number of covid19 fatalities and the total number of deaths during the same period, because one hand you have excessive mortality and on the other hand you have changes to the baseline due to changes in behavioral patterns. Excessive mortality are higher than officially recognized covid19 deaths and serve as a more accurate proxy for real covid19 deaths, but at the same time the baseline mortality might vary as well.
That's a theory. Meanwhile, we know that many places are classifying anyone who dies within N days of a positive test (N is typically 30) as a "covid death", regardless of actual cause.
I can guarantee that not all of those people died from Covid-19. Point being: there's likely to be overcount and undercount, for different reasons.
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