Far more Americans have died as a result of the Covid-19 pandemic than have been counted and reported, according to new research published Monday in the Journal of the American Medical Association.
"For every two Americans that we know of who are dying of Covid-19, another American is dying," said Dr. Steven Woolf, author of the new research and director emeritus of the Center on Society and Health at Virginia Commonwealth University.
Woolf's study looked at death statistics from the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention, as well as the Census Bureau.
The study found that from March through July, there were 225,530 "excess" deaths — a 20 percent increase over the average number of deaths expected for those months. (Excess deaths refer to the number of fatalities above what would be expected in a typical time period.)
Deaths directly linked to Covid-19 account for 67 percent of those excess deaths, the study found, leaving the remaining 33 percent without a clear explanation.
One explanation for the gap may be underreporting or misreporting of Covid-19-related deaths — in other words, not counting Covid-19 deaths.
"The second explanation for the gap is people who did not have Covid-19, but died because of disruptions caused by the pandemic," Woolf said. "That would include someone who has chest pain, who is scared to call 911, because they're afraid of getting the virus, and then dies of a heart attack."
Woolf's study also took into account increased mortality related to increases in substance abuse and decreases in access to medical care, particularly among those who lost health care coverage during the economic downturn caused by the pandemic.
A second study, also published Monday in JAMA, used death rates to compare the U.S. response to the pandemic to that of other high-income countries.
"What we show pretty consistently, is that the United States did worse in terms of deaths compared to every other of the 18 countries," said Dr. Ezekiel Emanuel, author and vice provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.
As of Sept. 19, the study showed, the U.S. reported an overall Covid-19 mortality rate of 60.3 per 100,000 people. Canada's rate was 24.6 per 100,000 and Australia's rate was 3.3 deaths per 100,000. The overall mortality rates include deaths from the start of the pandemic through mid-September.
If the U.S. had the same death rate as that of Canada, there would have been 117,000 fewer Covid-19 deaths; with Australia's death rate, the U.S. would've seen 188,000 fewer deaths, the authors wrote.
"That's tens of thousands of Americans who have unnecessarily died," Emanuel said.
Even hard-hit Italy had an overall Covid-19 mortality rate that was better that the U.S., at 59.1 per 100,000.
"It's not like Italy had some vaccine or therapeutic or special anything compared to the United States," Emanuel said. "What it had was much better adherence to public health measures," such as masks, physical distancing and business lockdowns.
Indeed, Italy's mortality rate dropped down to 10.3 deaths per 100,000 after June 7, while the rate in the U.S. remained at 27.2 per 100,000, the study reported. (The only three countries to report higher overall mortality rates than the U.S. were Belgium, Spain and the United Kingdom, but their rates dropped below 10 per 100,000 after June 7.)
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Woolf anticipates Covid-19-related deaths will continue for years after the raging spread of infection is controlled.
"Imagine cancer patients whose chemotherapy has been disrupted, or women who put off their mammograms," Woolf said. "The consequences of those impacts are going to be felt several years down the road."
"This could be a health ramification that lasts an entire generation."