In recent weeks, residents outside Boston have died at home much more often than usual. In Detroit, authorities are responding to nearly four times the number of reports of dead bodies. And in New York, city officials are recording more than 200 home deaths per day — a nearly sixfold increase from recent years.
As of Tuesday afternoon, the United States had logged more than 592,000 cases of COVID-19 and more than 24,000 deaths, the most in the world, according to the Center for Systems Science and Engineering at Johns Hopkins University. But the official COVID-19 death count may, at least for now, be missing fatalities that are occurring outside of hospitals, data and interviews show. Cities are increasingly showing signs of Americans succumbing to the coronavirus in their own beds.
ProPublica requested death data from several major metropolitan areas. Its review provides an early look at the pandemic’s hidden toll.
Experts say it’s possible that some of the jump in at-home death stems from people infected by the virus who either didn’t seek treatment or did but were instructed to shelter in place, and that the undercount is exacerbated by lack of comprehensive testing. It’s also possible that the increase in at-home deaths reflects people dying from other ailments like heart attacks because they couldn’t get to a hospital or refused to go, fearful they’d contract COVID-19.
Mark Hayward, a sociology professor at the University of Texas-Austin who’s an expert on mortality statistics, said all of those deaths are part of the “overall burden of the pandemic.” He said an uptick in deaths, specifically in ProPublica’s findings for Massachusetts and Detroit, indicates an undercount is occurring.
You should think about the official coronavirus death counts, he said, “as just the tip of the iceberg.” The quality of the deaths data will improve as testing expands and fewer people die without getting tested, he added.
The reason having accurate death statistics is important is because they help signal the location of hot spots and prompt officials to deploy resources. Knowing someone died of COVID-19 also enables health officials to alert their contacts so they can quarantine themselves.
New York City was among the first to provide data on at-home deaths. Officials said last week that roughly 200 residents were dying each day outside of hospitals and nursing homes. That’s compared with about 35 per day on average between 2013 and 2017, according to city records.
ProPublica found similar patterns beyond America’s largest and most hard-hit city. Our review examined parts of states like Massachusetts, Michigan and Washington state, drawing upon information from vital-records departments, health agencies, 911 call centers and police departments. ProPublica then compared those findings with historical deaths provided by the federal Centers for Disease Control and Prevention.
In Middlesex, Massachusetts’s most populous county and home to Cambridge, Somerville and Lowell, officials reported 317 at-home deaths in March. That’s about a 20% increase from the same time period for the past three years, in which deaths ranged from 249 to 265. In late February, a Cambridge-based biotech firm hosted a conference in nearby Boston that was later reportedly linked to more than 100 infections; it’s unclear if anyone died.
Older people are particularly vulnerable to dying from COVID-19. In all of Massachusetts, deaths for people 65 and older increased by 3.6% in March from the same month, on average, during the previous three years. The comparison to 2019 was particularly dramatic, an additional 250 deaths across Massachusetts. At the same time, the data shows that increase can’t be accounted for by the official coronavirus tally alone: only 89 deaths statewide were attributed to the virus in March, according to state Health Department data.
The rise in deaths of the elderly is “a pretty dramatic change,” Hayward said, that’s “very consistent with COVID-related deaths.” (As of Monday, Massachusetts’ official COVID-related death count was more than 840.) The Massachusetts Health Department said that the data is preliminary and that there are year-to-year fluctuations.
In Detroit, authorities responded to more than 150 “dead person observed” calls in the first 10 days of April. It was around 40 during the same period for the past three years, according to city 911 call data. Almost all of the incidents in this year’s period occurred in areas where the median household income was less than $45,000, census data shows. Lower-income areas have been particularly hard hit by the coronavirus.
While specifics of each death weren’t available, a review of Detroit radio transmissions revealed instances of individuals found “dead on scene,” such as a March 31 call to a low-income apartment complex northwest of downtown. “Use your precautions here,” said the dispatcher after broadcasting a medical code but few other details. Detroit-area officials couldn’t immediately provide totals on at-home deaths.
In other parts of the U.S., 911 calls for medical assistance have dropped. In Seattle, an early epicenter of the pandemic, data shows that EMT and paramedic calls dropped by more than 25% in the first 10 days of April compared with the same time frame last year. It’s unclear how much, if any, of that drop is due to people being fearful of interacting with the health care system.
Guidance from the CDC says that coroners and medical professionals can list “probable” or “presumed” COVID-19 on death certificates in cases where the symptoms match, even if the person wasn’t tested. For the most part, official death tallies from the disease haven’t included people who died before they were confirmed positive.
Bureaucratic delays and restrictive laws are also contributing to an incomplete picture. Some state officials told ProPublica it would take weeks to provide complete death numbers because of thin staffing or antiquated computer systems. In California, a Health Department spokesman said a request for detailed figures on statewide deaths would take a month to process and would cost $325. (ProPublica plans to pay for it.) Hawaii has suspended the processing of public records.
When a city’s health care system is overwhelmed, the true scope of deaths due to the pandemic is easily missed “in the fog of war,” said Lorna Thorpe, director of the epidemiology division at New York University’s Langone Medical Center. The official numbers provided by health departments are imperfect, she said, and mostly used for “situational awareness” to show which areas are hardest hit.
“One of the reasons we count deaths is to allocate resources to where they need to go,” said Robert Anderson, the chief of the CDC’s mortality statistics branch. “It becomes a little more time sensitive when you’re dealing with something like a pandemic.”
He said it’s particularly important to catch potential hotspots before they explode. If officials can direct adequate resources to places early, “maybe we can keep things from going crazy.”
Given that the U.S. doesn’t have enough tests in the first place, the majority of the screenings are “probably marked for people who are alive,” and the shortage is particularly acute in rural areas with few confirmed cases, said Hayward, the University of Texas professor.
The CDC is logging COVID deaths by collecting death certificates from every state, territory and the District of Columbia, a meticulous process that involves time lags and is vulnerable to errors. Hayward, who is part of a CDC advisory council on vital statistics, said the quality and speed of the data coming in varies so much that it can feel like wrangling reports from more than 50 countries.
Even for routine illnesses like the flu, the national count based on death certificates is always an underestimate. The CDC uses a model that adjusts for the real toll of flu deaths every year, Anderson said, and his staff will create a new model for the coronavirus by comparing the total deaths recorded in the past few months against historic death rates.
At the beginning of the pandemic, “the undercount is going to be really high,” Hayward said. “I couldn’t give you a number. There is no good news on that front.”
–Jack Gillum, Lisa Song and Jeff Kao, ProPublica
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WhackAMole says
Of course deaths are higher. Cases are higher too. No one can say they have peaked or flattened anything without a substantial percentage of the population tested. Any statistician that creates a model using less than 1% of a total value is using guesswork at best. Yes, statistics is primarily an assessment of randomized data used to formulate a model used for comparison. However, in this case, it’s a deadly assumption and presumption that FL is anywhere near a peak or plateau. We need at least 10% of the state tested. We need antibody tests for the remaining 80%. We need safe work environments with 6 feet in diameter from the next person. We need social distancing to continue. I 100% refuse a forced return to the office where I can be exposed and then pass it on to my elderly family members, killing them just because my employer needed to see me in the office as opposed to working from home.
On another note, the fact that nursing homes and long-term care living facilities are still NOT part of the reporting on cases or deaths is disgusting. It’s almost like they are conceding the fact they can’t do anything to protect the most vulnerable. Their infections matter. Their deaths matter. I’m tired of hearing about this 20-something or 30-something dying from this, as though their loss is more impactful than losing someone in their 90s. We need to go about this the proper way and STOP saying it is like the flu. You have NO idea what it’s like until you’ve had it. If you’re one of the lucky ones who had it mild or nothing at all, consider yourself blessed and remember, you may not be as lucky next time.
Jimbo99 says
Sounds like the experts are over reaching because we’ve had 2 deaths in Flagler. Did you know, in 2018, there were 21 Flu-Pneumonia deaths in Flagler county ? We’re 3.5 months into 2020, 2 deaths annualized over 1/4-1/3 of the year is weak justification that the economy should be shut down ? Ask the Healthcare industry how many traditional flu-Pneumonia-ARDS deaths there have been in 2020, I’ll bet those experts can’t tell you that number without eliminating COVID-19 attributed ARDS deaths.
I do agree there is a potential for negligible under reporting, I think there is more potential for over reporting, because any Pneumonia ARDS death is going to be linked, positive or false positive test results considered.
Healthcare’s solution to this or even the traditional flu, wash your hands, stay away from infected & contagious. With the Flu, they have a vaccine, for previous strains. I think COVID-19 has been around us longer than they knew it was. They’d have to discover it first, they’d have to have experienced it before. There are no experts, even with the current “pandemic” all there are is observations of those they’ve classified, which at 500 for the state of FL, is far less than the 2018 Traditional Flu & Pneumonia deaths. I find it disingenuous when folks transmit the flu that resulted in 21 total deaths in 2018, again we stand at 2 in Flagler county for 3.5 months. I doubt the healthcare industry in Flagler county can tell you the current 2020 death toll for traditional flu & Pneumonia.
Me says
Very well said, WhackAMole.
capt says
Well said WhackAMole.
Richard says
So tell me exactly how these brilliant people who collect statistics on the people who are dying at home have died from Covid-19 versus the flu versus old age versus some other disease, etc? Fact is I bet you can’t! Waste of time and space.
Sherry says
WhackAMole you have such a great handle for these times. You are “right on” with your reasoned logic. The trouble is that so many in our community will not benefit from your words as they live in a world of “alternative facts” along with Kellyanne and trump.
Jimbo99 says
They have to be counting those, because nobody is going to be keeping a corpse around their house for very long. The Coroner has to prepare a death certificate and that involves an autopsy of sorts. How many were hospice patients that the healthcare system already knew about ? If Pneumonia or ARDS (Acute Respiratory Distress Syndrome), how many of those do they link to COVID-19 by a reporting code with a test kit that determine 5 out of 6 positives are false positives ? I think this discussion by “the experts” is over-reaching for a casualty count & death stats on this. I mean really, how many funeral people have shown up in anyone’s neighborhood ? I’ll start, we had one in 2019 that I witnessed and that was Spring 2019, so it was a year ago, dude collapsed in the bathroom, died of old age, not COVID-19. Well, I say it wasn’t COVID-19, they really haven’t had any testing kits until recently ? And we all are aware of how inaccurate those are anyway.
Sherry says
REPUBLICAN VOTERS. . . are you ready to lay down your lives?
Money more important than human life. . . says the young REPUBLICAN Congressman from a sparsely populated state:
On Tuesday, that take was summed up by Indiana congressman Trey Hollingsworth, who told a radio-show host that it’s Congress’s job to sit Americans down and explain to them that dying in a pandemic isn’t as bad as the havoc said pandemic is wreaking on the economy. “We are going to have to look Americans in the eye and say, ‘We are making the best decisions for the most Americans possible,’” Hollingsworth told WIBC. “And the answer to that is unequivocally to get Americans back to work, to get Americans back to their businesses.”
Asked by host Tony Katz how he will respond to the critics who will inevitably say he’s anti-science and is going to get people killed, Hollingsworth—who strangely did not mention which of his family members he’d be willing to let the virus knock off for the greater good—replied: “It is policymakers’ decision to put on our big boy and big girl pants and say, ‘This is the lesser of these two evils. And it is not zero evil, but it is the lesser of these evils, and we intend to move forward in that direction.’ That is our responsibility, and to abdicate that is to insult the Americans that voted us into office.” Sure, some might argue that the bigger insult is to suggest that people should be willing to die to save the economy—which won’t be in a great place if infections and deaths start surging again as a result of relaxed restrictions—but potato, potahto.
Hollingsworth—whose parents must have had a sixth sense that he’d give this interview one day when they named him Trey—is of course far from the only member of the Grand Old Party making such proclamations. In March, White House National Economic Council chairman Larry Kudlow said in an interview that “The cure can’t be worse than the disease, and we’re gonna have to make some difficult trade-offs” because the “economic cost to individuals is just too great.”
And, from Texas this Jewel:
Later in the month, Texas Lieutenant Governor REPUBLICAN Dan Patrick claimed on live television that “lots of grandparents” are willing to “take a chance” on their survival for the good of the economy, saying “Those of us who are 70-plus, we’ll take care of ourselves. But don’t sacrifice the country, don’t do that, don’t ruin this great America.” After all, it’s like the founding fathers said: “We hold these truths to be self-evident, that all men are created equal, and sorry if you’re over 70 or have asthma but I refuse to spend another Saturday not strolling the aisles of Bob’s Big Lots followed by a dine-in experience at the Cheesecake Factory, you selfish pricks.”
Racy says
WhackAMole, I categorically concur!
Racy says
WhackAMole, Categorically concur!
Jane gentile-youd says
Pierre..your on top of everything 24/7 and give us far more detail than any tv media. They touch on issues but you take a shovel and dig before you report to us. Thank you .. some issues you try to cover the various differences in what readers are more I retested and you balance the sensational crimes and the real news at the same time. Amazing
palmcoaster says
I am glad to see that all our residents above concur with Pierre’s editorial as the code of silence is broken by whistle blowers risking it all to uncover the reality and just proven next: https://www.nbcnewyork.com/news/local/17-bodies-found-in-new-jersey-nursing-home-after-anonymous-tip/2376259/
Also no fake news or fear mongering in the next two tragically concerning editorials so lets prepare: //www.npr.org/sections/coronavirus-live-updates/2020/04/13/832981899/emergency-declared-in-japanese-prefecture-hit-by-2nd-wave-of-coronavirus-infecti?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR2cKzeBzFllgPQhoaMIJdGUM5WSSQX7V23Dcj4k4zZLm7Cf-946guV__J0
Also coming back around in China: https://www.nbcsandiego.com/news/coronavirus/china-reports-spike-in-coronavirus-cases-signaling-possible-second-wave/2305493/?fbclid=IwAR1aFDV8t_q-awRAraiaznNBn6i4b8VYndlNlcVt4OkV6XLj-6RbuvKy5Eo
Then we maybe also endure food shortage due to idiocy at the helm: https://www.cbsnews.com/news/coronavirus-us-farmers-foreign-labor-crops-unharvested/