Dan Weinberger,1 Jenny Chen,7 Ted Cohen,1 Forrest W. Crawford,2 Farzad Mostashari,3 Don Olson,4 Virginia E Pitzer,1 Nicholas G Reich,5 Marcus Russi,1 Lone Simonsen,6 Annie Watkins,1 Cecile Viboud7

1Department of Epidemiology of Microbial Diseases and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT 2Department of Biostatistics and the Public Health Modeling Unit, Yale School of Public Health, New Haven, CT; Yale Departments of Ecology and Evolutionary Biology, Statistics & Data Science, Yale School of Management 3Aledade, Inc 4Department of Health and Mental Hygiene, New York City, NY 5Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 6Department of Science and Environment, Roskilde University, Denmark 7Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD

Mortality data on deaths due to all causes and pneumonia & influenza through the week ending 2020-09-26

IMPORTRANT NOTE: The model used in the original JAMA Internal Medicine paper was designed for short-term evaluations. The model is fit to data through the end of January 2020 and then extrapolated forward. The further we get from that point, the less accurate the results might become. A manuscript covering the full methods was published in JAMA Internal Medicine and can be found here. The full analysis code can be found here.

Overview

Background Efforts to track the severity and public health impact of the novel coronavirus, COVID-19, in the US have been hampered by testing issues, reporting lags, and inconsistency between states. Evaluating unexplained increases in deaths attributed to broad outcomes, such as pneumonia and influenza or due to all causes, can provide a more complete and consistent picture of the burden caused by COVID-19.

Methods We evaluated increases in the occurrence of deaths due to any cause above a seasonal baseline (adjusted for influenza activity) or deaths due to coronaivirus/P&I (P&I&C) for March-early-May across the United States. These estimates are compared with reported deaths due to COVID-19 and with testing data. Detailed methods can be found here

Conclusions Excess deaths provide an estimate of full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus.

Estimate for national excess deaths:

National all-cause excess

Excess deaths for the United States from March 1, 2020 through Sep 26, 2020. The observed number of deaths is indicated by the black solid line, and the expected number of deaths, adjusting for seasonality, influenza epidemics, and reporting delays, is indicated by the black dashed line. The area between these two lines represents the total number of excess deaths. The blue area represents deaths recorded as due to COVID-19, the red shaded area presents additional pneumonia and influenza excess deaths not coded as due to COVID-19, and the green shaded area represents deaths that were not attributed to COVID-19 or pneumonia or influenza.

Alternative plot

Excess deaths in New York City and the rest of New York

Excess deaths for New York state (excluding New York City) and for New York City from March 1, 2020 through Sep 26, 2020. The observed number of deaths is indicated by the black solid line, and the expected number of deaths, adjusting for seasonality, influenza epidemics, and reporting delays, is indicated by the black dashed line. The area between these two lines represents the total number of excess deaths. The blue area represents deaths recorded as due to COVID-19, the red shaded area presents additional pneumonia and influenza excess deaths not coded as due to COVID-19, and the green shaded area represents deaths that were not attributed to COVID-19 or pneumonia or influenza.

Excess deaths in four high-incidence states

Excess deaths for four states that had large numbers of reported COVID-19 deaths from March 1, 2020 through Sep 26, 2020. The observed number of deaths is indicated by the black solid line, and the expected number of deaths, adjusting for seasonality, influenza epidemics, and reporting delays, is indicated by the black dashed line. Area between these two lines represents the total number of excess deaths. The blue area represents deaths recorded as due to COVID-19, the red shaded area presents additional pneumonia and influenza excess deaths not coded as due to COVID-19, and the green shaded area represents deaths that were not attributed to COVID-19 or pneumonia or influenza.