Coronavirus numbers miss some deaths, experts warn. Here’s why

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Cardiologist worried non-coronavirus patients could die by waiting too long for help
Calgary cardiologist and internal medicine specialist Dr. Jeff Shaw is urging anyone experiencing serious medical conditions unrelated to COVID-19 to seek immediate medical attention – Apr 16, 2020

Directly and indirectly, the novel coronavirus is killing more people than are showing up in official statistics, epidemiologists warn.

Part of the problem is related to how deaths are accounted for, they say.

Some deaths, like a healthy person who dies in a traffic accident, are simple to classify, and others, like someone with serious health issues who dies with the coronavirus, are not.

“When somebody dies, it should be straightforward in terms of assigning the cause of their death,” says University of Toronto epidemiologist Ashleigh Tuite. “But it actually can be kind of complicated.”

“You can have somebody with an underlying condition who dies, and they have a COVID infection, the question is: did they die of COVID, or did they die of their underlying condition? That attribution can be a little bit less objective than you might expect it to be.”

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A similar problem complicates trying to count deaths from influenza, the University of Toronto’s Colin Furness says.

“Influenza kills a lot of people every year, but it tends to pick off people who are already really sick,” he explains.

“You’ve got chronic obstructive pulmonary disease. You get the flu and then you die. On your death certificate, it’s going to say that you died of COPD. It doesn’t record what pushed you over the cliff, it records that you were tottering on the edge of the cliff and then you fell.”

As well, health officials are reluctant to use scarce tests on people who are already dead, something Furness laments.

“There’s a huge case why you should,” he says. “If you don’t have an understanding of what you’re dealing with, that’s crazy. At the very least you should be swabbing every corpse and freezing them, so that when you do have enough tests you can figure out what happened.”

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Harder-hit countries, like the U.K., appear to have far more deaths from COVID-19 than are officially linked to it, something epidemiologists refer to as ‘excess mortality.’ A report Wednesday pointed out that while about 17,000 deaths in the U.K. had been formally attributed to coronavirus, the country as a whole had 40,000 more deaths than would be normal at this time of year.

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In New York City, coronavirus deaths are officially totalled at 13,240, but the city has seen 17,200 more deaths than normal, leaving roughly 4,000 deaths left over. Spain, France, Turkey and the Netherlands all have over 1,000 deaths over the usual total that aren’t accounted for by official coronavirus death tolls.

Experts Global News talked to said that in the worst-hit countries, the formal process of classifying and accounting for deaths may simply be overwhelmed, another part of a complex problem.

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Deaths in March in British Columbia, which publishes mortality data promptly by Canadian standards, were not out of line with totals for March for previous years.

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Coronavirus also kills in indirect ways, as people who belong in hospital avoid it — or as overwhelmed hospitals can’t give patients the resources they would normally get.

Canadian doctors Global News has talked to say it makes them uneasy that they have seen fewer patients with heart attacks since the coronavirus started spreading. Since there’s no reason to believe that fewer people are having heart attacks, the reason can only be that fewer people suffering heart attacks are seeking medical attention. (Doctors say that people who need emergency care shouldn’t avoid hospitals.)

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Ambulance crews in Britain are being called to far more deaths at home from heart attacks than is normal.

People don’t want to go near hospital,” a study by London hospitals said. “As a result salvageable conditions are not being treated.”

Other people with unrelated health conditions have found that appointments have been cancelled or changed into phone-based meetings with their doctors, since the coronavirus forced hospitals to adapt.

“That’s why people are starting to look at the excess mortality, because that captures those sorts of events as well, which in the bigger picture are COVID-attributable,” Tuite says.

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“That person didn’t die of COVID, but had COVID not been circulating in their community, there’s the potential that they would have gone to the hospital and received treatment and not died.”

On a smaller scale, homicide linked to domestic violence has more than doubled in Britain since the lockdown there began.

“Two years from now, we’ll really know what happened,” Furness says.

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