Unrecognized Deaths During the COVID-19 Pandemic: A Study Reveals Significant Undercounting

A recent study published in the journal *Science Advances* reveals that the official COVID-19 death toll in the United States during the pandemic's early years was significantly underestimated. While approximately 840,000 deaths were reported on death certificates from March 2020 to December 2021, researchers estimate that an additional 155,000 deaths—about 16% of the total—went unrecognized. This undercounting disproportionately affected minority communities and those with lower socioeconomic status, particularly in southern states such as Alabama, Oklahoma, and South Carolina.

Gizmodo

The research team, including experts from Boston University and the University of Minnesota, employed artificial intelligence to analyze 5.7 million death records of adults aged 25 and older. They trained a machine learning model on hospital death data to identify patterns and then applied this model to assess deaths outside hospital settings. The study found that for every five officially counted COVID-19 deaths, approximately one went unreported. The researchers highlighted that the death investigation system in the U.S. systematically undercounted COVID-19 fatalities, revealing significant inequities in how deaths were recorded.

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The study indicates that unrecognized deaths were more prevalent among Hispanic, American Indian, Alaska Native, Asian, and Black Americans. Factors contributing to this undercounting include barriers to healthcare access, lack of testing, and the role of coroners, who may lack specialized training compared to medical examiners. The researchers noted that some families even pressured coroners not to list COVID-19 as a cause of death. This situation reflects broader issues of structural racism, classism, and ableism within the death investigation system.

Gizmodo

Andrew Stokes, a senior author of the study, emphasized the need for reform in the death investigation system, stating, “Our antiquated death investigation system is one key reason why we fell short of accurate counts, particularly outside of big metropolitan areas.” Steven Woolf, a researcher not involved in the study, described the use of AI in this context as “intriguing,” acknowledging the evolving understanding of machine learning's strengths and weaknesses in public health research.

The Guardian

Despite the study's findings, some skepticism remains regarding the accuracy of the death toll. Critics have pointed to misinformation campaigns, including claims made by former President Donald Trump, which suggested that the number of COVID-19 deaths was inflated. However, the researchers focused specifically on deaths attributed to the virus, excluding other pandemic-related fatalities, such as those from untreated medical conditions or drug overdoses.

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The implications of this study extend beyond COVID-19, as the AI techniques developed could be applied to other public health issues where death counts may be underreported, such as drug overdoses and deaths in police custody. The researchers advocate for further investigation into the systemic issues that led to these disparities in death reporting, emphasizing the need for comprehensive reforms in the death investigation system.

Philly Voice

• “These findings suggest that the U.S. death investigation system undercounted COVID-19 deaths unevenly, hiding the true extent of inequities,” — Andrew Stokes, Senior Author

Gizmodo

• “the communities affected by the undercounting of COVID-19 deaths could be interpreted as a pattern of structural racism, classism, and ableism in the death investigation system that warrants further research and policy attention.” — Research Team Statement

Philly Voice

• “Our antiquated death investigation system is one key reason why we fell short of accurate counts, particularly outside of big metropolitan areas,” — Andrew Stokes, Senior Author

The Guardian

• “This study indicates that the US death investigation system reported COVID-19 deaths in a systematically inequitable way that hid the true extent of pandemic mortality and inequities,” — Research Team Statement

Philly Voice