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by Photocreo | Covidian States of America

Peer-Review Politics

Here’s How You Know We’re Underestimating COVID-19 Deaths, Even Without Hospital Death-Cause Data

The number of dead Americans is so dramatic that you don’t need the hospital cause of death data to see we’re under-counting deaths.

Claims that hospitals receive more money for COVID-19 deaths are true, but it doesn't show we overestimated cases. Both assertions are plausible, so let’s walk through the relevant facts.

Then you decide if the deaths are over- or underestimated. As a thoroughly stubborn albeit endearing medical doctor informed me, “garbage in equals garbage out,” so we’ll also discuss the source and quality of the data.

Let’s look at all-cause death totals. Figure 1 shows excess deaths, deaths above what we would expect in a normal year, attributed to COVID-19, influenza-pneumonia deaths, or deaths from neither.

You can see the excess deaths in the US represented between the black solid and dashed lines.

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Figure 1. Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, Mar to May 2020 | BLUE GREY (bottom): deaths recorded as related to COVID-19 | ORANGE (narrow middle section): deaths from pneumonia and influenza not recorded as related to COVID-19 | BEIGE (top): deaths not recorded as related to COVID-19, pneumonia, or influenza.

If not caused by COVID-19, these deaths warrant immediate investigation because many more people have died than expected. If these are influenza cases and deaths as some assert, we still have a pandemic of something.

The lower numbers of influenza are true, but that’s actually more evidence these are COVID-19 deaths. SEASONAL flu usually peaks between December and February.

Experts were cautious about death causes in February and March. In fact, Americans that had not traveled to China or who did not come in contact with a proven case could not get testing before March 4–9.

They had no choice but to guess, and the numbers say they erred on the side of caution. People wanting to avoid over-counting COVID-19 cases could partly explain the increase in all-cause deaths.

Delaying care can only explain so much, and doesn’t explain the Alzheimer's Disease deaths, the largest share of these deaths above the norm, from causes other than Covid. Not all citizens believed — they still don’t — much of a risk exists, so we would need more evidence to show these were care-delay deaths.

In the time between February 1 to June 26, 2020, according to the CDC website, 1,276,875 people died in the US. Over the same period, the CDC says 112,226 people died from COVID-19.

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CDC | Excess Deaths from other causes in the US since Feb 1

That’s roughly 10% of all deaths counted as caused by COVID-19. This doesn’t support the notion we have marked all or most deaths as COVID-19 deaths.

The 16,000 extra deaths from Alzheimer’s Disease, over the normal number of deaths we expect from the disease, warrants an earnest effort to find out what truly happened so it never happens again.

We need to know if those who died of COVID-19 without symptoms, who also had Alzheimer’s could have been mislabeled as an Alzheimer’s death. We cannot guess. We need to find evidence and abide by whatever we find.

The increased deaths from diabetes and hypertensive diseases also raise a red flag, as we know both as risk factors for death with COVID-19.

The impact on the brain from this disease may include stroke, a dementia-like syndrome, and brain inflammation called encephalitis. The significant uptick in Alzheimer’s deaths says we should explore whether it has affected the brain more than we thought.

July 1, 2020, the Washington Times reported:

Researchers from Johns Hopkins University using “mini-brains” made from human stem cells have discovered that brain cells could be infected by the coronavirus, an indication that COVID-19 could cause serious neurological problems.

The true impact of this disease has only just started appearing.

Only time will tell if we see a long-term consequence like measles encephalitis, which kills you years after a measles infection; shingles, which can affect people long after a chickenpox infection; or the many cancers that can follow a viral infection, like HPV and cervical cancer.

What are the key takeaways here?

1 More people than expected, regardless of the cause, died between March and May 2020. In the US, excess deaths not attributed to COVID-19 make-up an enormous chunk of deaths that we should not be seeing.

Notice COVID-19 deaths compared to those from other causes. The trends resemble one another.

2 If we’re saying these deaths aren’t from COVID-19, then we need to look and ask what has killed 20,000 to 50,000 Americans besides the Covid deaths.

That’s 2 to 4x the number of deaths as in the 2009 H1N1 pandemic that some are saying aren’t caused by COVID-19. This is another way of saying, “I don’t know why 20,000–50,000 Americans suddenly died from a variety of causes, but it wasn’t Covid.”

The statement leaves something to be desired.

H1N1, appearing in southern California in April 2009, killed 12,400 Americans and infected 60 million, so whatever the cause, we have a problem larger than the last pandemic. Probable cases were used in 2009, too.

Pandemic deaths used to be impossible to estimate. Then, a man from Johns Hopkins University devised a method. Wade Hampton Frost, a physician, “excelled in mathematics, field biology, and laboratory analysis.

The CDC still uses Frost’s method today, which recognized 57% higher mortality than official reports during the 1918 pandemic. We use the method because we know not estimating excess deaths is the poorer estimate because it will dramatically under-count the deaths.

Unless one wanted to reduce the recognized impact, opposition makes little sense. The method works. We have used it for over 100 years.

Many US locations have experienced spikes in both heart attacks and diabetes-related deaths, both conditions that notably increase the risk of death from COVID-19.

Some likely related to delayed treatment and COVID-19 has increasingly shown its ability to cause heart attacks and worsen or cause diabetes in people predisposed.

Whether you think COVID-19 caused them doesn’t matter because we’re only talking about death, not the cause. The CDC supplied the all-cause mortality statistic. Many more people died — alarmingly so — than expected.

That is fact.

The excess deaths from COVID-19 bear a striking resemblance to the proportions seen in 1918, follow what anyone who has studied pandemics could have told you to expect, and offer the most accurate estimate.

3 State-level break downs of deaths from any cause can shed more light. Unless hospital death certificates cause death, we need to find this unknown death-accelerant and fast.

We cannot simply blame the deaths on the myriad of diseases because it’s the number that is the problem, not only cause.

If not COVID-19, something is killing a lot of Americans.

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Fig. 2 Excess Mortality Due to All Causes or Reported Deaths because of COVID-19 From March 1 to May 30 | Solid Black Lines: excess deaths from all causes, with shadow showing the range for the line | Dotted black lines: reported COVID-19 deaths. These are deaths positive in testing or met the definition from a probable case. | Dotted blue lines: tests per 1000 people in a week

Massachusetts ramped up testing and began the nation’s most expansive contact-tracing efforts. Incomplete contact-tracing could have controlled our outbreak in three months, something we knew in February. Little action happened.

Americans remain wary of an outbreak control method, but we’ve used it since the 1980s for sexually transmitted infections. The fact that you probably didn’t know about that contact-tracing says it probably isn’t as troublesome as people imagine.

Some fear the government will use it to track them. Don’t be silly; they already have your iPhone and the house bugging device, beloved around the world, that you call Alexa for that.

If you have either device, the objection has as many legs to stand on as that guy from Monty Python.

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Image for post infographic | Contact-tracing works pretty much the same as it has since the 1980s

OK, let’s look at New York City to show what we can learn from the city-level numbers. In the month leading up to April 4th, 5,330 more people died than should have — these are excess deaths.

If you expect 10 people at holiday dinner because that’s how many people have repeatedly come on this day and time each year but 13 people show, you have 3 excess guests.

I assume you’d want to know why.

Out of the 5,330 excess deaths, 3,350 of these were attributed to COVID-19. That leaves around 2,000 people dead in New York City who should not have died.

The only time death rose to a number even close to that was around 9/11. New York City saw 2730 unexpected deaths following the terrorist attacks.

Over 27,000 New Yorkers died between March 11 and mid-April. That’s 20,900 more than the expected number and thousands more than recorded COVID-19 deaths. The number is astonishing, especially looking at the 9/11 numbers.

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Analysis of data provided by the NYC Department of Health

Let’s look at the national all-cause deaths, shall we? These are deaths attributed to Alzheimer’s, diabetes, and other diseases, not COVID-19, that we should not be seeing.

From March 15 to May 2, about 4,700 people died from Alzheimer’s Disease over the number that would have in a normal year. At least, that’s what their death records show, but the evidence strongly suggests these as possible COVID-19 deaths.

No, they weren’t counted as COVID-19 deaths.

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NYT | Deaths from other causes

Other conditions have definitely been recorded as killing people above the norm. The data shows that death from other causes closely follow death suggest from COVID-19 outbreaks.

Why? The evidence suggests that these deaths may have been unrecognized COVID-19 cases. The coronavirus may have worsened someone’s existing chronic illness, which killed them. No, that does not mean anyone counted these as COVID-19 related deaths.

It does, however, mean that COVID-19 may well have led people with these conditions to worsen.

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NYT | Alzheimer deaths over time
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NYT | Respiratory deaths over time

HIV, for example, doesn’t directly kill people. It weakens the immune system such that infection can thrive. Without medical intervention, eventually, the immune system becomes so weak that a normally minor infection can cause death.

The coronavirus is causing blood clots capable of causing strokes, heart attacks, and other conditions.

Counting someone as a COVID-19 death after a heart attack, makes as much sense as it does to label a death from pneumonia that followed HIV infection as an HIV death. Clarifying: it makes a lot of sense.

To simply say pneumonia killed a person is misleading — bordering on ethically questionable if the HIV-pneumonia connection was known — which is what it is to label a death a heart attack caused by a clot that happened because the coronavirus infected someone.

4 The world is not the US, and our performance here has not left others envious. Massive amounts of research happen internationally and require teamwork with people who have different governments, political parties, religions, and cultures.

A team member will not remain silent on the bias because their name goes on the research and that could ruin their career.

Fact-checking each other is science’s favorite pastime, kind of like politics, except they root the criticism in evidence. Science critics merely want the truth. They don’t worry about pleasing voters who can demote them.

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The Economist | Excess mortality since region/country’s first 50 covid deaths

The relatively uniform findings globally, that excess deaths from all causes follow a COVID-19 outbreak serves as compelling separate evidence that affirms the conclusion we’re under-counting.

New York City had so much excess death, it ranks among the highest excess death counts even when regarded as its own country.

5 No other explanation exists that includes and reflects all facts with evidence for all claims. If someone has one, please speak up and tell others, but don’t be surprised if someone zeros in with the critical precision of a white-gloved mother-in-law judging your dusting in the 1950s.

We should always question, but to make an assertion, someone must answer — with credible evidence — what has driven up the total number of deaths to such extremes.

If it’s true these all-cause death increases are not related to COVID-19, then officials must answer for delaying the search for this unknown agent driving up the number of dead Americans, closely trailing COVID-19 outbreaks.

If they find nothing, instead, they must answer for the time wasted, they can answer for the doubt sown among the American people and devastating negative impact it has had on controlling the outbreak.

Three possibilities remain, considering all evidence.

1 There is a second driver of all-cause deaths that we must quickly find and strategize against since we are even further behind it than we were COVID-19. Internal bipartisan reviews similar to that which followed 9/11 should launch following the investigation of the delayed COVID-19 response.

2 Some of the all-cause deaths are actually deaths from a COVID-19 infection that worsened a chronic condition or a number of other scenarios that lead to mislabeling a death, but some wish to conceal and sow doubt about the impact of this virus.

3 Officials cannot intelligibly discern data nor do they recognize when they should defer to those who know more, showing exceptional and alarming unsuitability for office.

If you see another option, please e-mail me or leave a comment with an address of how all relevant, credible evidence fits into the theory.

If I am incorrect, I want to know. Valid alternatives will be added to this list and the author, credited.

What do I think? Some say the unidentified agent speeding up the all-cause deaths is COVID-19, given

  • the unfamiliarity with this virus,
  • the excessive number of deaths from other causes that follow outbreaks, both in and outside of the USA,
  • testing biases and shortages, and
  • the current direction of our insufficient-yet-growing body of knowledge on how the virus spreads and behaves in the human body,
  • the absence of other explanations that include all facts and no evidence suggesting other culprits,
  • the absence of official inquiry into what triggered the spike in all-cause deaths, and
  • most of all, years of experience study on pandemics,

We call these people infectious disease epidemiologist.

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Please always consider media outlet bias and verify information, ideally multiple sources holding opposing perspectives if no neutral commentary is unavailable. This chart receives regular updating as bias fluctuates over time. All outlet scoring data is publicly available.

Please do not copy or redistribute the chart below, which does not belong to me, is licensed, and takes considerable effort to continually update.

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June 2020 | Licensed Copy from Ad Fontes Media | All scoring data is publicly available.

Public health biologist studying at Johns Hopkins | Science writer & artist | Views reflect me alone | Subscribe @

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