Uncovering COVID-19’s Hidden Deaths in the United States

According to Stokes, a BU School of Public Health assistant professor of global health, the true number of COVID deaths in the United States is likely much higher than records indicate. He recently led a team of researchers from BU, the University of Pennsylvania, and the Robert Wood Johnson Foundation to analyze mortality data in more than 3,000 US counties. They examined excess deaths—the number of deaths beyond what would have been expected in a normal year—and how many were tied to COVID.

The researchers found substantial variation in the percentage of excess deaths assigned to COVID across the country, with counties in the South and West especially likely to underreport pandemic deaths. COVID deaths were also more likely to be missed in counties with fewer primary care physicians, less access to health insurance, and more people dying at home; communities of color were disproportionately impacted. Some undercounts, says Stokes, may even be politically motivated.

“Accurate and timely mortality surveillance is critical to pandemic preparedness and response efforts,” he says. “Without accurate mortality data, it becomes very challenging to devise effective policy responses or to develop fair and equitable responses targeting the most heavily affected communities.”

Using Stokes’ data and modeling, journalists with Documenting COVID-19—an online repository of local, state, and federal public records obtained through open-records requests—are guiding on-the-ground reporting in counties across the United States. The searchable repository is hosted by Columbia University’s Brown Institute for Media Innovation.

The first two articles of the USA Today series, published on December 9 and December 22, examine the national data, and social and racial inequities, tied to excess mortality, with a particular focus on undercounting in rural counties in Louisiana, Missouri, and Mississippi.