By Christopher Cheney
U.S. coronavirus deaths are likely understated, and the United States has relatively high COVID-19 mortality compared to 18 similar countries, a pair of recent studies published by the Journal of the American Medical Association shows.
The United States has led the world in reported coronavirus deaths. As of Oct. 15, more than 221,000 Americans had died of COVID-19, according to worldometer. The country with the next highest death count was Brazil at more than 150,000.
“Few people will forget the Great Pandemic of 2020, where and how they lived, how it substantially changed their lives, and for many, the profound human toll it has taken,” an editorial accompanying the JAMA studies says.
Accounting for coronavirus deaths
One of the JAMA studies focuses on U.S. excess deaths—the difference between observed and expected deaths—from March to July 2020. The study includes several key data points.
- From March 1 to Aug. 1, there was a 20% increase over expected deaths, with 1,336,561 deaths reported and 1,111,031 deaths expected.
- Of the 225,530 excess deaths, only 67% were attributed to COVID-19.
- The Top 10 states for highest per capita excess death rates were New York, New Jersey, Massachusetts, Louisiana, Arizona, Mississippi, Maryland, Delaware, Rhode Island, and Michigan.
- There were statistically significant increases in two other causes of death—heart disease and Alzheimer disease/dementia. The increase in heart disease deaths coincided with the spring surge of coronavirus deaths. The increase in Alzheimer disease/dementia deaths coincided with the spring and summer surges of coronavirus deaths.
The number of excess deaths attributed to the coronavirus is likely understated, the study’s co-authors wrote. “Although total U.S. death counts are remarkably consistent from year to year, U.S. deaths increased by 20% during March-July 2020. COVID-19 was a documented cause of only 67% of these excess deaths.”
Two factors may account for the understated number of excess deaths tied to the coronavirus, they wrote.
“U.S. deaths attributed to some noninfectious causes increased during COVID-19 surges. Excess deaths attributed to causes other than COVID-19 could reflect deaths from unrecognized or undocumented infection with severe acute respiratory syndrome coronavirus 2 or deaths among uninfected patients resulting from disruptions produced by the pandemic.”
In terms of COVID-19 deaths, the United States fares poorly in a comparison with 18 other Organisation for Economic Co-operation and Development countries, the other JAMA study found.
The study compares U.S. coronavirus mortality to 18 other OECD countries with a population of at least 5 million and a per capita gross domestic product of at least $25,000. The countries were categorized by COVID-19 per capita mortality as low, moderate, or high.
The research includes several key data points.
- On Sept. 19, 2020, the United States reported COVID-19 per capita mortality at 60.3 per 100,000 of population, which was higher than countries with low or moderate coronavirus mortality but comparable to other high-mortality countries.
- Australia was categorized as a low-mortality country, with 3.3 COVID-19 deaths per 100,000. If the United States had been able to match Australia’s per capita mortality, 94% of American deaths could have been avoided.
- Canada was categorized as a moderate-mortality country, with 24.6 COVID-19 deaths per 100,000. If the United States had been able to match Canada’s per capita mortality, 59% of American deaths could have been avoided.
- The United States had a lower coronavirus mortality rate than high-mortality countries during the early spring, but the U.S. coronavirus mortality rate has been higher than all other high-mortality countries since May 10.
The U.S. per capita coronavirus mortality rate has been relatively high compared to OECD peers, the study’s coauthors wrote. “After the first peak in early spring, U.S. death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent U.S. response to the pandemic.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.