Death toll in Missouri from COVID-19 may be undercounted, according to CDC data
The impact of the coronavirus in Missouri is likely bleaker than what has been officially recorded in the COVID-19 death toll, according to experts and data from the Centers for Disease Control and Prevention.
By April 18, the state had recorded 291 “excess deaths” — that is, an increase in deaths that wouldn’t be expected based on past years of death certificate data collected by the CDC.
That there have been more deaths than usual isn’t surprising given that a pandemic has swept across the globe, infecting more than 4.1 million people, according to Johns Hopkins University, including 1.3 million in the U.S. As of Monday, 9,918 people in Missouri had contracted the virus and 488 had died.
Of the 291 excess deaths reported in Missouri by mid-April, 162 were caused by the coronavirus.
But it’s likely that the remaining 129 deaths were also related to the pandemic. That’s happening in one of two ways.
“I think these are cases where it was just not known that the person had COVID-19,” said Bob Anderson, chief of mortality statistics with the National Center for Health Statistics, which is a branch of the CDC. “Somebody dies at home and there’s nobody there who can say ‘This is what the person’s symptoms were like’ and there’s no postmortem testing.”
Rex Archer, director of the Kansas City Health Department, said he suspects that has happened in the Kansas City area.
“We’ve got some people I think that are dying at home, we have some people that are dying in institutions that aren’t being tested,” Archer said. “Our death rate is much higher than what these numbers are showing. We should be testing every unexplained death right now to determine whether it’s COVID.”
Another portion of the deaths were an indirect result of the health crisis.
“This might be somebody who is having heart problems, but can’t get into the ER or is afraid to go to the ER,” Anderson said.
That’s something Karen Joynt Maddox, a physician at Barnes-Jewish Hospital in St. Louis and policy expert with Washington University in St. Louis, said she has observed.
“I just finished a couple weeks rounding at the hospital and people with many, many different types of conditions seem to be coming into the hospital later than they otherwise would,” she said. “Many of the patients that I spoke with in the hospital over the last two weeks said that they waited as long as they could before they came to the hospital ... your heart just breaks for somebody who was sitting at home enduring whatever that was, being terrified, scared of what’s happening to them and and what they’re feeling, be that heart attack symptoms or stroke symptoms or abdominal pain or whatever, and then also being scared of going to get help.”
Some patients, Joynt Maddox said, arrived in such critical condition that they died.
Anderson cautioned that the CDC’s data is incomplete because it can take up to eight weeks to receive death certificate records from each state’s vital statistics agency.
“It’s possible as more data come in, that the number of excess deaths will increase,” he said.
At some point, the CDC will try to separate out the unreported and indirect COVID-19 deaths, but Anderson said they need more information before proceeding with that step. He also said something besides the pandemic could account for some of the excess deaths, but the main difference between the current numbers and previous time periods is the coronavirus.
“Some of it we will never know,” Joynt Maddox added.
