A new study led by the Boston University School of Public Health (BUSPH) challenges prevailing narratives about the causes of excess mortality during the COVID-19 pandemic.

The research has produced compelling evidence that many deaths previously attributed to natural causes were, in fact, uncounted fatalities from COVID-19.
Study significance

“Official COVID-19 mortality statistics have not fully captured deaths attributable to SARS-CoV-2 infection in the United States,” wrote the researchers.

“While some excess deaths were likely related to pandemic health care interruptions and socioeconomic disruptions, temporal correlations between reported COVID-19 deaths and excess deaths reported to non-COVID-19 natural causes suggest that many of those excess deaths were unrecognized COVID-19 deaths.”
Understanding the true toll

The investigation represents a significant stride in understanding the true toll of the pandemic.

Kristin Urquiza co-founded Marked By COVID, a justice and remembrance movement, after losing her father to COVID. “This study documents the deadliness of COVID-19 and the effectiveness of public health interventions,” said Urquiza. “The least we can do to honor those who died is to accurately account for what happened.”
Excess mortality

The official count of COVID-19 deaths in the United States stands at nearly 1.17 million, according to federal data. However, this figure is believed to be an underestimation, as suggested by multiple excess mortality studies.

Excess mortality refers to the number of deaths during a given time period that surpasses the number expected under normal circumstances.

Until now, the challenge has been to determine whether these additional deaths were directly due to COVID-19 or resulted from indirect consequences of the pandemic, such as healthcare disruptions or socioeconomic factors.
Unrecognized COVID-19 fatalities

In collaboration with researchers at the University of Pennsylvania, the BUSPH team provides the first definitive evidence linking a significant portion of excess deaths during the pandemic directly to COVID-19, rather than to non-COVID natural causes like chronic illnesses.

By analyzing monthly data on natural-cause deaths and reported COVID-19 fatalities across 3,127 U.S. counties from March 2020 to August 2022, the team discovered that spikes in non-COVID natural cause deaths coincided with or preceded surges in COVID-19 deaths in most regions. This pattern suggests that many deaths were misclassified and should have been attributed to COVID-19.
Many deaths went uncounted

“Our findings show that many COVID-19 deaths went uncounted during the pandemic. Surprisingly, these undercounts persisted well beyond the initial phase of the pandemic,” said study co-author Dr. Andrew Stokes, who has led numerous studies analyzing excess mortality patterns and drivers during the pandemic.

According to Dr. Stokes, the temporal correlation between reported COVID-19 deaths and excess deaths reported to non-COVID-19 natural causes offers insight into the causes of these deaths.

“We observed peaks in non-COVID-19 excess deaths in the same or prior month as COVID-19 deaths, a pattern consistent with these being unrecognized COVID-19 deaths that were missed due to low community awareness and a lack of COVID-19 testing.”
Broader implications

Study lead author Eugenio Paglino, a PhD student at UPenn, noted that if the primary explanation for these deaths were healthcare interruptions and delays in care, the non-COVID excess deaths would likely occur after a peak in reported COVID-19 deaths and subsequent interruptions in care. “However, this pattern was not observed nationally or in any of the geographic subregions we assessed,” said Paglino.

The study also disproves any claims that mortality during the pandemic can be attributed to COVID-19 vaccinations or shelter-in-place policies.

Dr. Nahid Bhadelia, founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research, said that the research is important because our ability to detect and correctly assign deaths during an epidemic goes to the heart of our understanding of the disease and how we organize our response.

The study is published in the journal Proceedings of the National Academy of Sciences.

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