Coronavirus death toll in the US is higher than reported, experts say. Here’s why

Since the onset of the coronavirus pandemic, there has been much speculation as to the accuracy of countries’ death tolls.

Some have pointed fingers at China, claiming the country intentionally concealed the extent of its outbreak and death toll, while one study found that factors such as the number of home deaths in Italy have skewed the country’s numbers.

During an April 7 news conference, Dr. Deborah Birx, coordinator of the White House’s coronavirus task force, said pre-existing conditions have caused some countries’ numbers to be off.

“There are other countries that if you had a pre-existing condition and let’s say the virus caused you to go to the ICU and then have a heart or kidney problem -- some countries are recording that as a heart issue or a kidney issue and not a COVID-19 death,” she said, according to a transcript of the news conference. “Right now ... if someone dies with COVID-19 we are counting that as a COVID-19 death.”

But in the U.S., many experts agree that the country’s death toll. has likely been under-reported. Here’s why.

How is the U.S. death toll calculated?

The Centers for Disease Control and Prevention tabulates the country’s coronavirus death toll based on death certificates received and coded by the National Center for Health Statistics, according to the agency.

It can take several weeks for death records to be submitted to the NCHS then processed and counted, meaning the CDC’s numbers likely don’t include all deaths in a given time period, especially more recent time periods, the agency said.

The CDC says death counts from earlier months are consistently revised, but that data lags an estimated one to two weeks.

On Tuesday, the CDC announced it would also start including probable deaths and cases in its tabulations, which are deaths and cases that meet critical criteria but have not been confirmed with lab testing, CNN reported.

A case or death can also be considered probable if there are death certificates or other vital records that list coronavirus as a cause, according to the outlet.

Lack of testing

Epidemiologists say a lack of testing capacity and asymptomatic people could cause the nation’s death toll to be underestimated, NBC reported.

Difficulty in getting a coronavirus test has been well-documented in news stories and on social media, with some testing sites requiring a symptomatic person to have been in contact with a confirmed case of COVID-19 to get tested.

Julie Murillo tried to get her husband tested in California after he developed “fever, cough and body aches” after returning home from a work trip, the New York Times reported. Her husband, Julio Ramirez, 43, also lost his sense of smell and taste.

“I kept trying to get him tested from the beginning,” she told the newspaper. “They told me no.”

Murillo took her husband to an urgent care clinic where he got a chest X-ray and was prescribed antibiotics and cough syrup, but just a week after returning from his trip, Murillo found her husband dead in bed, according to the Times.

She ultimately hired a private company to perform an autopsy, the owner of which pleaded with local and federal officials to do a post-mortem coronavirus test. Nineteen days after his death, the results came back positive, the Times reported.

Misclassification of illness

The CDC says some COVID-19 deaths may have been misclassified..

“Deaths due to COVID-19 may be misclassified as pneumonia deaths in the absence of positive test results, and pneumonia may appear on death certificates as a comorbid condition,” the agency said on its website. “Thus, increases in pneumonia deaths may be an indicator of excess COVID-19-related mortality.”

Deaths related to pneumonia had reached an alarming high by mid-March, NBC reported. While a decline in flu deaths typically coincides with a decline in pneumonia deaths, states including Florida, New York and Washington were seeing pneumonia deaths increase while flu deaths decreased.

“In the United States, testing started very slowly which allowed the virus to spread silently through the population,” Gerardo Chowell, professor of epidemiology and biostatistics at the Georgia State University School of Public Health in Atlanta, told NBC.

“And then obviously when people start to die, they are classified as a death from a respiratory disease or flu-like symptoms who may also have hypertension or diabetes. Those deaths will likely not get counted when in reality it was the virus that triggered their death.”

Differing standards state to state

Health officials state to state disagree on the appropriate way to determine whether a death was due to coronavirus.

In Colorado, officials include in its death toll some probable cases of COVID-19 — based on exposure and symptoms — that were not confirmed in a test, the Washington Post reported.

Ohio, Connecticut and Delaware also report deaths of presumed-positive cases of COVID-19, according to the newspaper.

Alabama, however, has ruled that about 10% of people die with COVID-19, but not of it, the Post reported. This guideline means that one person who died with a partially collapsed lung and fluid buildup and another who died with aspiration pneumonia in one lung were not included in numbers reported to the federal government, according to the newspaper.

Karen Landers, a spokesperson for the state’s public health agency, said people who died with no respiratory symptoms could be excluded along with those who suffered a stroke or heart attack or other acute events, the Post reported.

“Simply because persons have other medical diagnoses, they are not automatically excluded,” she told the newspaper. “Rather, other factors in the course of illness are taken into consideration on medical record review.