Texas death data suggest COVID-19 undercount is possible

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AUSTIN, Texas — Eyeing reports that more Texans have died in the first three months of 2020 than the historical average, some experts question whether the death toll from the new coronavirus might be an undercount.

During January, February and March, 53,583 Texans died — 1,473 more than the average for that period in the previous six years, according to a USA Today Network analysis. Texas attributed 41 of the deaths to COVID-19 from Jan. 1 to March 31, with the first victim on March 17, according to the Texas Department of State Health Services.

Doctors told the USA Today Network that they could have missed patients who died of COVID-19 in February and early March because testing was more limited then.

“Early on, I think it’s entirely possible we were undercounting,” said Dr. Victor Test, a pulmonologist who has been treating patients with COVID-19 in an intensive care unit at the University Medical Center in Lubbock. “It’s possible that there were people who didn’t get a diagnosis with coronavirus that had it (but weren’t tested) because they didn’t have a travel or exposure history.”

Similar trends are seen nationwide.

States submit information on deaths to the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention, throughout the year. Instead of publishing data at the end of 2020, the CDC published a snapshot of the data last week and continues to update it daily.

The USA Today Network analyzed deaths since the fall of 2012 and found that mortality in the U.S. this year is higher than normal, outpacing deaths attributed to COVID-19 in states that have been hit hardest by the virus. For example, from March 22 to April 11, New York saw 14,403 more deaths than is normal. During that time, authorities there attributed 8,513 deaths, 59.1%, to COVID-19.

Experts told the USA Today Network that one way to home in on COVID-19 deaths that might have been uncounted is to look at deaths attributed to pneumonia, a serious lung condition that can be developed by someone who has contracted the flu or the coronavirus.

For most of the year, Texas reported fewer pneumonia deaths than usual. From Dec. 29 to March 14, Texas reported 3,169 pneumonia deaths — 501 fewer than is typical. But from March 15 to April 11, pneumonia was listed as the cause of death for 1,185 people — 79 more than usual.

Through March 7, doctors in Texas sent more than 54,000 tests to labs, which confirmed about 1 in 3 tested positive for influenza. Over the remainder of March, doctors sent fewer than 10,000 tests, and only 6% were positive. That downward trend in state surveillance figures suggests flu was disappearing from many Texas communities even as pneumonia deaths rose and COVID-19 testing increased.

“If COVID-19 never happened, we probably would have said, ‘Wow, this is a really bad year for the flu,’?” said Angela Clendenin, whose research at the Texas A&M University School of Public Health includes pandemic response and communication.

The higher than normal death trend could hold in April as Texas finishes reporting to the National Center for Health Statistics. So far, though, it has reported 850 fewer deaths than is typical.

As of noon Saturday, 847 Texans had died of COVID-19, according to the Department of State Health Services, and the number of known cases rose to 30,522.

Experts also say the number and manner of deaths in the first quarter of 2020 probably have fluctuated because of how the pandemic has changed Texans’ day-to-day habits.

On one hand, fewer people on the road has led to fewer traffic fatalities, local public safety data have shown. On the other, more social isolation could have led to more suicides, said Dr. David Fleeger, an Austin colorectal surgeon and president of the Texas Medical Association.

The number also might have been driven up because people delayed seeking treatment for other conditions that then became life-threatening. Fleeger said even some of his cancer patients didn’t want to come in for treatment because they feared doing so would increase their chances of catching COVID-19.

Although the Harris County Forensic Science Institute has responded to more reports of in-home deaths than it had at this time last year, spokeswoman Michele Arnold said, “it is too early to draw any conclusions” about whether it is related to COVID-19.

The institute began testing decedents for COVID-19 on March 10. So far, 20 of the 68 tested, 29.4%, were positive for the disease, she said.

Clendenin, who is in the epidemiology and biostatistics department at A&M, said any correlation between the excess deaths and the pandemic is worth studying, if not now, then when we reach the other side of the crisis.

“Looking at that number, some people may say that that’s not a lot, that the population of Texas is 29 million,” she said. “But the value of looking at that number and placing an importance on that number is letting their deaths mean something. What can we learn from it? What can we figure out from it that will help us save lives in the future?”

Clendenin said it’s worth studying because it might someday become as common to get a COVID-19 shot as it is a flu shot every year.


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