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  • USA: Excess death data compared to confirmed COVID-19 fatalities


    U.S. Coronavirus Death Toll Is Far Higher Than Reported, C.D.C. Data Suggests


    By Josh Katz, Denise Lu and Margot Sanger-Katz

    April 28, 2020


    snip

    Total deaths in seven states that have been hard hit by the coronavirus pandemic are nearly 50 percent higher than normal for the five weeks from March 8 through April 11, according to new death statistics from the Centers for Disease Control and Prevention. That is 9,000 more deaths than were reported as of April 11 in official counts of deaths from the coronavirus.

    https://www.nytimes.com/interactive/...oll-total.html
    Last edited by Ronan Kelly; July 31, 2020, 08:48 AM.

  • #2
    CDC data currently showing 54,080 excess deaths in the 4 week period ending on April 18. Our toll on that date was 38,705 https://flutrackers.com/forum/forum/...848#post850848 - Ro


    Excess Deaths Associated with COVID-19


    Estimates of excess deaths can provide information about the burden of mortality potentially related to COVID-19, beyond the number of deaths that are directly attributed to COVID-19. Excess deaths are typically defined as the difference between observed numbers of deaths and expected numbers. This visualization provides weekly data on excess deaths by jurisdiction of occurrence. Counts of deaths in more recent weeks are compared with historical trends to determine whether the number of deaths is significantly higher than expected.

    Estimates of excess deaths can be calculated in a variety of ways, and will vary depending on the methodology and assumptions about how many deaths are expected to occur. Estimates of excess deaths presented in this webpage were calculated using Farrington surveillance algorithms (1). For each jurisdiction, a model is used to generate a set of expected counts, and the upper bound of the 95% Confidence Intervals (95% CI) of these expected counts is used as a threshold to estimate excess deaths. Observed counts are compared to these upper bound estimates to determine whether a significant increase in deaths has occurred. Provisional counts are weighted to account for potential underreporting in the most recent weeks. However, data for the most recent week(s) are still likely to be incomplete. Only about 60% of deaths are reported within 10 days of the date of death, and there is considerable variation by jurisdiction. More detail about the methods, weighting, data, and limitations can be found in the Technical Notes.

    This visualization includes several different estimates:
    • Number of excess deaths: The number of excess deaths was calculated as the difference between the observed count and the threshold, by week and jurisdiction. Negative values, where the observed count fell below the threshold, were set to zero.
    • Percent excess: The percent excess was defined as the number of excess deaths divided by the threshold.
    • Total number of excess deaths: The total number of excess deaths in each jurisdiction was calculated by summing the excess deaths in each week, from January 1, 2020 to present. Similarly, the total number of excess deaths for the US overall was computed as a sum of jurisdiction-specific numbers of excess deaths (with negative values set to zero), and not directly estimated using the Farrington surveillance algorithms.

    Weekly counts of deaths from all causes were examined, including deaths due to COVID-19. As many deaths due to COVID-19 may be assigned to other causes of deaths (for example, if COVID-19 was not mentioned on the death certificate as a suspected cause of death), tracking all-cause mortality can provide information about whether an excess number of deaths is observed, even when COVID-19 mortality may be undercounted. Additionally, deaths from all causes excluding COVID-19 were also estimated. Comparing these two sets of estimates — excess deaths with and without COVID-19 — can provide insight about how many excess deaths are identified as due to COVID-19, and how many excess deaths are reported as due to other causes of death. These deaths could represent misclassified COVID-19 deaths, or potentially could be indirectly related to COVID-19 (e.g., deaths from other causes occurring in the context of health care shortages or overburdened health care systems).

    Estimates presented here will be updated periodically, and additional information by cause of death will be added in future releases.

    Select a dashboard from the drop-down menu, then click on “Update Dashboard” to navigate through different graphics.
    • The first dashboard shows the weekly predicted counts of deaths from all causes, and the threshold for the expected number of deaths. Select a jurisdiction from the drop-down menu to show data for that jurisdiction.
    • The second dashboard shows the weekly predicted counts of deaths from all causes and the weekly count of deaths from all causes excluding COVID-19. Select a jurisdiction from the drop-down menu to show data for that jurisdiction.
    • The third dashboard shows the weekly counts of deaths from all causes. Predicted counts (weighted) are shown, along with reported (unweighted) counts, to illustrate the impact of underreporting. Select a jurisdiction from the drop-down menu to show data for that jurisdiction.
    • The fourth dashboard shows the total number of excess deaths in 2020. Jurisdictions with one or more excess deaths are shown. Use the radio button to select all-cause mortality, or all-cause excluding COVID-19. Use the drop-down menu to select certain jurisdictions.
    • The fifth dashboard shows the percent by which the observed counts exceed the threshold (i.e. percent excess) by week and jurisdiction. Use the radio button to select all-cause mortality, or all-cause excluding COVID-19. Use the drop-down menu to select certain jurisdictions.

    Download datasets in CSV format by clicking on the link for the desired dataset under “CSV Format” link. Additional file formats are available for download for each dataset at Data.CDC.Gov.
    ...
    https://www.cdc.gov/nchs/nvss/vsrr/c...ess_deaths.htm
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      CDC now showing an estimated 65,410 excess deaths between March 21 and April 25. (68,774 since Feb 1)
      https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard

      By comparison FluTrackers confirmed death toll on April 25 was 53,465.
      https://flutrackers.com/forum/forum/...752#post853752
      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        Daily Updates of Totals by Week and State


        Provisional Death Counts for Coronavirus Disease (COVID-19)

        minus icon
        Contents
        Updated: May 15, 2020

        alert icon

        Note: Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics as of May 15, 2020. Death counts are delayed and may differ from other published sources (see Technical Notes). Counts will be updated periodically. Additional information will be added to this site as available.

        The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks.

        The provisional data presented on this page include the weekly provisional count of deaths in the United States due to COVID-19, deaths from all causes and percent of expected deaths (i.e., number of deaths received over number of deaths expected based on data from previous years), pneumonia deaths (excluding pneumonia deaths involving influenza), pneumonia deaths involving COVID-19, influenza deaths, and deaths involving pneumonia, influenza, or COVID-19; (a) by week ending date and (b) by specific jurisdictions.
        Table 1 has counts of death involving COVID-19 and select causes of death by the week ending date in which the death occurred. For COVID-19 deaths by week ending date at the state level, Click here to download.Table 1. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by week ending date, United States. Week ending 2/1/2020 to 5/9/2020.*

        Updated May 15, 2020
        Total Deaths 60,299 857,948 101 81,318 26,516 6,158 120,370
        2/1/2020 0 57,535 97 3,705 0 472 4,177
        2/8/2020 1 58,140 97 3,703 0 506 4,210
        2/15/2020 0 57,480 98 3,734 0 535 4,269
        2/22/2020 2 57,510 99 3,602 0 553 4,157
        2/29/2020 7 57,784 100 3,714 5 625 4,341
        3/7/2020 32 57,373 99 3,796 16 608 4,419
        3/14/2020 51 55,856 98 3,781 26 598 4,403
        3/21/2020 517 55,965 99 4,291 237 518 5,083
        3/28/2020 2,897 59,074 106 5,804 1,314 420 7,758
        4/4/2020 8,893 66,978 120 9,208 4,260 445 14,066
        4/11/2020 14,287 72,459 131 10,983 6,372 450 19,018
        4/18/2020 14,077 68,029 126 9,893 6,082 246 17,954
        4/25/2020 10,760 60,216 112 7,851 4,607 128 14,045
        5/2/2020 6,464 47,070 87 5,057 2,660 43 8,889
        5/9/2020 2,311 26,479 50 2,196 937 11 3,581
        NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period. The United States population, based on 2018 postcensal estimates from the U.S. Census Bureau, is 327,167,434.

        *Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

        1Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1

        2Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019. Previous analyses of 2015–2016 provisional data completeness have found that completeness is lower in the first few weeks following the date of death (<25%), and then increases over time such that data are generally at least 75% complete within 8 weeks of when the death occurred (8).

        3Pneumonia death counts exclude pneumonia deaths involving influenza.

        4Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.
        5Deaths with confirmed or presumed COVID-19, pneumonia, or influenza, coded to ICD–10 codes U07.1 or J09–J18.9.Table 2. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by jurisdiction of occurrence, United States. Week ending 2/1/2020 to 5/9/2020.*

        Updated May 15, 2020
        United States6 60,299 857,948 101 81,318 26,516 6,158 120,370
        Alabama 342 14,849 95 955 94 87 1,289
        Alaska - 1,034 83 49 - - 58
        Arizona 401 18,648 103 1,350 191 108 1,668
        Arkansas 57 9,075 96 629 17 71 740
        California 1,904 80,587 99 7,113 1,113 557 8,461
        Colorado 878 12,853 109 1,219 486 92 1,698
        Connecticut 525 3,503 37 315 118 47 768
        Delaware 162 2,549 93 193 62 15 308
        District of Columbia 161 1,823 101 286 161 - 293
        Florida 1,477 63,846 102 4,824 777 295 5,814
        Georgia 935 23,893 95 1,744 432 100 2,347
        Hawaii 15 3,318 96 221 - 19 250
        Idaho 66 4,170 99 224 21 24 293
        Illinois 2,245 34,358 109 3,466 1,200 173 4,681
        Indiana 1,088 20,130 102 1,983 509 125 2,685
        Iowa 188 8,666 96 618 39 82 849
        Kansas 132 7,715 97 540 59 86 699
        Kentucky 207 12,684 88 1,155 109 91 1,344
        Louisiana 1,497 13,862 103 1,272 670 68 2,162
        Maine 61 4,397 101 353 15 31 430
        Maryland 1,320 16,383 110 1,594 493 118 2,524
        Massachusetts 4,108 22,373 125 3,033 1,492 155 5,797
        Michigan 3,361 32,764 113 3,674 1,682 231 5,580
        Minnesota 469 13,466 103 1,009 136 116 1,457
        Mississippi 334 9,518 102 886 152 51 1,119
        Missouri 380 17,936 93 1,167 130 170 1,587
        Montana 15 2,707 88 157 - 33 203
        Nebraska 42 4,520 89 350 10 27 409
        Nevada 237 7,573 98 684 182 38 777
        New Hampshire 117 3,753 102 271 32 30 385
        New Jersey 7,237 31,292 141 5,545 3,592 112 9,292
        New Mexico 148 5,161 93 388 68 27 495
        New York7 7,267 38,394 129 6,528 3,675 199 10,303
        New York City 15,440 37,759 236 8,079 5,871 928 17,779
        North Carolina 145 15,431 54 971 57 177 1,236
        North Dakota 17 1,743 83 160 - 19 190
        Ohio 797 33,082 90 2,104 348 241 2,794
        Oklahoma 193 10,149 85 930 76 99 1,143
        Oregon 119 10,093 93 541 47 61 674
        Pennsylvania 2,819 35,445 87 2,984 1,065 182 4,917
        Rhode Island 205 2,784 88 215 72 24 372
        South Carolina 220 14,778 102 911 79 94 1,146
        South Dakota 21 2,203 90 172 - 21 205
        Tennessee 204 21,581 98 1,612 93 122 1,845
        Texas 745 57,248 96 4,295 319 321 5,040
        Utah 57 5,628 101 321 21 40 397
        Vermont 47 1,753 102 116 11 14 166
        Virginia 744 21,243 104 1,292 259 109 1,884
        Washington 747 16,242 95 1,403 398 102 1,850
        West Virginia 36 5,513 81 407 - 57 493
        Wisconsin 355 16,160 103 908 47 147 1,361
        Wyoming - 1,313 98 102 - - 113
        Puerto Rico 98 6,298 74 897 50 36 981
        NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

        *Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

        1Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

        2Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

        3Pneumonia death counts exclude pneumonia deaths involving influenza.

        4Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

        5Deaths with confirmed or presumed COVID-19, pneumonia, or influenza, coded to ICD–10 codes U07.1 or J09-18.9.

        6United States death count includes the 50 states, plus the District of Columbia and New York City.
        7Excludes New York City.
        Understanding the Numbers: Provisional Death Counts and COVID-19


        Provisional death counts deliver our most complete and accurate picture of lives lost to COVID-19. They are based on death certificates, which are the most reliable source of data and contain information not available anywhere else, including comorbid conditions, race and ethnicity, and place of death.
        How it works


        The National Center for Health Statistics (NCHS) uses incoming data from death certificates to produce provisional COVID-19 death counts. These include deaths occurring within the 50 states and the District of Columbia.

        NCHS also provides summaries that examine deaths in specific categories and in greater geographic detail, such as deaths by county, by race and Hispanic origin.

        COVID-19 deaths are identified using a new ICD–10 code. When COVID-19 is reported as a cause of death – or when it is listed as a “probable” or “presumed” cause — the death is coded as U07.1. This can include cases with or without laboratory confirmation.
        Why these numbers are different


        Provisional death counts may not match counts from other sources, such as media reports or numbers from county health departments. Our counts often track 1–2 weeks behind other data.
        • Death certificates take time to be completed. There are many steps to filling out and submitting a death certificate. Waiting for test results can create additional delays.
        • States report at different rates. Currently, 63% of all U.S. deaths are reported within 10 days of the date of death, but there is significant variation between states.
        • It takes extra time to code COVID-19 deaths. While 80% of deaths are electronically processed and coded by NCHS within minutes, most deaths from COVID-19 must be coded by a person, which takes an average of 7 days.
        • Other reporting systems use different definitions or methods for counting deaths.
        Things to know about the data


        Provisional counts are not final and are subject to change. Counts from previous weeks are continually revised as more records are received and processed.

        Provisional data are not yet complete. Counts will not include all deaths that occurred during a given time period, especially for more recent periods. However, we can estimate how complete our numbers are by looking at the average number of deaths reported in previous years.

        Death counts should not be compared across states. Some states report deaths on a daily basis, while other states report deaths weekly or monthly. State vital record reporting may also be affected or delayed by COVID-19 related response activities.

        For more detailed technical information, visit the Provisional Death Counts for Coronavirus Disease (COVID-19) Technical Notes page.
        Page last reviewed: May 15, 2020
        Content source: National Center for Health StatisticshomeNational Vital Statistics SystemRelated Siteshttps://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm
        Twitter: @RonanKelly13
        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

        Comment


        • #5
          CDC now showing an estimated 82,197 excess deaths between March 21 and May 9. (Range between 84,891 and 113,139 since Feb 1)
          https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard

          By comparison FluTrackers confirmed death toll on May 9 was 78,708.
          https://flutrackers.com/forum/forum/...881#post858881


          Daily Updates of Totals by Week and State



          Provisional Death Counts for Coronavirus Disease (COVID-19)

          minus icon
          Contents
          Updated: May 22, 2020

          alert icon

          Note: Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics as of May 22, 2020. Death counts are delayed and may differ from other published sources (see Technical Notes). Counts will be updated periodically. Additional information will be added to this site as available.



          The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks.

          The provisional data presented on this page include the weekly provisional count of deaths in the United States due to COVID-19, deaths from all causes and percent of expected deaths (i.e., number of deaths received over number of deaths expected based on data from previous years), pneumonia deaths (excluding pneumonia deaths involving influenza), pneumonia deaths involving COVID-19, influenza deaths, and deaths involving pneumonia, influenza, or COVID-19; (a) by week ending date and (b) by specific jurisdictions.
          Table 1 has counts of death involving COVID-19 and select causes of death by the week ending date in which the death occurred. For COVID-19 deaths by week ending date at the state level, Click here to download.Table 1. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by week ending date, United States. Week ending 2/1/2020 to 5/16/2020.*

          Updated May 22, 2020
          Total Deaths 73,639 922,510 103 89,555 32,320 6,253 136,219
          2/1/2020 0 57,584 97 3,713 0 475 4,188
          2/8/2020 1 58,245 97 3,715 0 507 4,223
          2/15/2020 0 57,585 98 3,747 0 541 4,288
          2/22/2020 2 57,640 99 3,610 0 553 4,165
          2/29/2020 5 57,956 101 3,727 3 629 4,358
          3/7/2020 32 57,716 100 3,816 16 610 4,441
          3/14/2020 51 56,421 98 3,818 26 600 4,442
          3/21/2020 532 56,801 99 4,351 242 528 5,163
          3/28/2020 2,964 60,375 106 5,902 1,343 429 7,903
          4/4/2020 9,215 68,401 120 9,352 4,431 451 14,365
          4/11/2020 15,031 73,869 133 11,235 6,749 456 19,640
          4/18/2020 15,311 70,194 130 10,335 6,584 252 19,132
          4/25/2020 12,457 64,426 122 8,760 5,400 136 15,863
          5/2/2020 9,359 56,606 108 6,839 3,986 50 12,244
          5/9/2020 6,764 46,487 94 4,924 2,795 30 8,917
          5/16/2020 1,915 22,204 53 1,711 745 6 2,887
          NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period. The United States population, based on 2018 postcensal estimates from the U.S. Census Bureau, is 327,167,434.

          *Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

          1Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1

          2Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019. Previous analyses of 2015–2016 provisional data completeness have found that completeness is lower in the first few weeks following the date of death (<25%), and then increases over time such that data are generally at least 75% complete within 8 weeks of when the death occurred (8).

          3Pneumonia death counts exclude pneumonia deaths involving influenza.

          4Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.
          5Deaths with confirmed or presumed COVID-19, pneumonia, or influenza, coded to ICD–10 codes U07.1 or J09–J18.9.Table 2. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by jurisdiction of occurrence, United States. Week ending 2/1/2020 to 5/16/2020.*

          Updated May 22, 2020
          United States6 73,639 922,510 103 89,555 32,320 6,253 136,219
          Alabama 423 15,836 95 1,023 120 88 1,413
          Alaska - 1,125 85 54 - - 64
          Arizona 518 19,997 105 1,483 254 109 1,856
          Arkansas 82 9,842 98 673 22 74 807
          California 2,485 86,030 100 7,718 1,414 562 9,350
          Colorado 1,088 13,815 111 1,361 588 93 1,949
          Connecticut 918 4,875 48 438 195 56 1,216
          Delaware 217 2,758 96 220 85 15 367
          District of Columbia 216 1,962 103 344 216 - 351
          Florida 1,698 67,473 102 5,135 889 300 6,237
          Georgia 1,139 25,493 97 1,895 530 102 2,606
          Hawaii 15 3,538 97 236 - 19 265
          Idaho 70 4,362 98 227 23 24 298
          Illinois 3,016 37,267 112 3,986 1,601 174 5,572
          Indiana 1,396 21,367 102 2,149 629 126 3,039
          Iowa 264 9,244 97 662 62 83 947
          Kansas 163 8,126 97 574 73 87 751
          Kentucky 274 13,570 90 1,243 141 93 1,468
          Louisiana 1,754 14,889 105 1,411 778 70 2,452
          Maine 70 4,643 101 364 16 31 449
          Maryland 1,752 17,873 113 1,810 648 121 3,020
          Massachusetts 5,066 24,287 128 3,431 1,836 159 6,812
          Michigan 3,904 33,752 111 3,936 1,973 231 6,094
          Minnesota 618 14,431 104 1,097 182 117 1,649
          Mississippi 391 9,902 101 939 176 51 1,205
          Missouri 496 19,301 95 1,262 173 171 1,756
          Montana 16 2,965 90 166 - 34 213
          Nebraska 88 5,093 95 396 28 28 484
          Nevada 292 8,081 100 744 220 38 854
          New Hampshire 156 4,010 103 301 49 30 437
          New Jersey 9,253 35,069 149 6,487 4,582 115 11,261
          New Mexico 190 5,446 93 414 84 27 547
          New York7 8,256 40,874 130 7,035 4,135 200 11,339
          New York City 17,002 40,229 236 8,742 6,560 937 19,316
          North Carolina 222 18,651 63 1,208 87 196 1,539
          North Dakota 24 1,839 83 167 10 19 200
          Ohio 1,101 35,529 90 2,327 469 246 3,204
          Oklahoma 214 10,642 85 983 87 99 1,206
          Oregon 137 10,748 95 578 52 61 724
          Pennsylvania 4,439 39,622 92 3,735 1,699 183 6,655
          Rhode Island 304 3,045 93 261 110 24 479
          South Carolina 339 16,102 106 1,023 131 95 1,325
          South Dakota 34 2,354 93 182 13 21 224
          Tennessee 246 22,827 100 1,704 105 124 1,969
          Texas 962 61,339 99 4,620 405 325 5,500
          Utah 70 5,990 102 334 26 40 418
          Vermont 51 1,866 104 123 12 14 176
          Virginia 962 22,339 105 1,394 329 110 2,135
          Washington 766 17,726 100 1,460 409 103 1,916
          West Virginia 50 5,864 84 438 12 58 534
          Wisconsin 419 17,109 105 958 67 148 1,456
          Wyoming - 1,393 103 104 - - 115
          Puerto Rico 110 7,274 86 1,026 58 47 1,124
          NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

          *Data during this period are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

          1Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

          2Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

          3Pneumonia death counts exclude pneumonia deaths involving influenza.

          4Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

          5Deaths with confirmed or presumed COVID-19, pneumonia, or influenza, coded to ICD–10 codes U07.1 or J09-18.9.

          6United States death count includes the 50 states, plus the District of Columbia and New York City.
          7Excludes New York City.
          Understanding the Numbers: Provisional Death Counts and COVID-19


          Provisional death counts deliver our most complete and accurate picture of lives lost to COVID-19. They are based on death certificates, which are the most reliable source of data and contain information not available anywhere else, including comorbid conditions, race and ethnicity, and place of death.
          How it works


          The National Center for Health Statistics (NCHS) uses incoming data from death certificates to produce provisional COVID-19 death counts. These include deaths occurring within the 50 states and the District of Columbia.

          NCHS also provides summaries that examine deaths in specific categories and in greater geographic detail, such as deaths by county, by race and Hispanic origin.

          COVID-19 deaths are identified using a new ICD–10 code. When COVID-19 is reported as a cause of death – or when it is listed as a “probable” or “presumed” cause — the death is coded as U07.1. This can include cases with or without laboratory confirmation.
          Why these numbers are different


          Provisional death counts may not match counts from other sources, such as media reports or numbers from county health departments. Our counts often track 1–2 weeks behind other data.
          • Death certificates take time to be completed. There are many steps to filling out and submitting a death certificate. Waiting for test results can create additional delays.
          • States report at different rates. Currently, 63% of all U.S. deaths are reported within 10 days of the date of death, but there is significant variation between states.
          • It takes extra time to code COVID-19 deaths. While 80% of deaths are electronically processed and coded by NCHS within minutes, most deaths from COVID-19 must be coded by a person, which takes an average of 7 days.
          • Other reporting systems use different definitions or methods for counting deaths.
          Things to know about the data


          Provisional counts are not final and are subject to change. Counts from previous weeks are continually revised as more records are received and processed.

          Provisional data are not yet complete. Counts will not include all deaths that occurred during a given time period, especially for more recent periods. However, we can estimate how complete our numbers are by looking at the average number of deaths reported in previous years.

          Death counts should not be compared across states. Some states report deaths on a daily basis, while other states report deaths weekly or monthly. State vital record reporting may also be affected or delayed by COVID-19 related response activities.

          For more detailed technical information, visit the Provisional Death Counts for Coronavirus Disease (COVID-19) Technical Notes page.
          Page last reviewed: May 22, 2020
          Content source: National Center for Health StatisticshomeCOVID-19 Data from NCHSRelated Siteshttps://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

          Twitter: @RonanKelly13
          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

          Comment


          • #6
            CDC now showing an estimated 84,891 excess deaths between March 21 and May 9.
            https://www.cdc.gov/nchs/nvss/vsrr/c...ess_deaths.htm

            By comparison FluTrackers confirmed death toll on May 9 was 78,708.
            https://flutrackers.com/forum/forum/...881#post858881
            Twitter: @RonanKelly13
            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

            Comment


            • #7
              CDC now showing an estimated 91,933 to 106,953 excess deaths between March 22 and May 16.
              https://www.cdc.gov/nchs/nvss/vsrr/c...ess_deaths.htm

              By comparison FluTrackers confirmed death toll on May 16 was 88,607.
              https://flutrackers.com/forum/forum/...490#post861490
              Twitter: @RonanKelly13
              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

              Comment


              • #8
                CDC now showing an estimated 98,808 to 116,346 excess deaths between March 22 and May 23.
                https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard


                By comparison FluTrackers confirmed death toll on May 23 was 97,110.
                https://flutrackers.com/forum/forum/...597#post863597
                Twitter: @RonanKelly13
                The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                Comment


                • #9
                  CDC now showing an estimated 108,861 to 128,258 excess deaths between March 22 and May 30.
                  https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard


                  By comparison FluTrackers confirmed death toll on May 30 was 103,946.
                  https://flutrackers.com/forum/forum/...e13#post871315
                  Twitter: @RonanKelly13
                  The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                  Comment


                  • #10
                    CDC now showing an estimated 111,720 to 132,987 excess deaths between March 22 and June 6.
                    https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard


                    By comparison FluTrackers confirmed death toll on June 6 was 110,118.
                    https://flutrackers.com/forum/forum/...631#post867631
                    Twitter: @RonanKelly13
                    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                    Comment


                    • #11
                      Original Investigation
                      July 1, 2020Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020


                      Daniel M. Weinberger, PhD1; Jenny Chen, BS2; Ted Cohen, MD, DPH1; et alForrest W. Crawford, PhD3,4; Farzad Mostashari, MD5; Don Olson, MPH6; Virginia E. Pitzer, ScD1; Nicholas G. Reich, PhD7; Marcus Russi, BS1; Lone Simonsen, PhD8; Anne Watkins, BS1; Cecile Viboud, PhD2
                      Author Affiliations Article Information
                      JAMA Intern Med. Published online July 1, 2020. doi:10.1001/jamainternmed.2020.3391
                      COVID-19 Resource Center
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                      Estimation of Excess Deaths From COVID-19 in the United States, March to May 2020
                      Key Points

                      Question Did more all-cause deaths occur during the first months of the coronavirus disease 2019 (COVID-19) pandemic in the United States compared with the same months during previous years?

                      Findings In this cohort study, the number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths.

                      Meaning Official tallies of deaths due to COVID-19 underestimate the full increase in deaths associated with the pandemic in many states.

                      Abstract

                      Importance Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19.

                      Objective To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020.

                      Design, Setting, and Population This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020.

                      Main Outcomes and Measures Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data.

                      Results There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19–reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths.

                      Conclusions and Relevance Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.

                      Introduction

                      The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in December 2019 in Wuhan, China, and rapidly grew into a global pandemic.1 Without adequate capacity to test for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), during the early part of the pandemic, laboratory-confirmed cases captured only an estimated 10% to 15% of all infections.2 As a result, estimating the number of deaths caused by COVID-19 is a challenge.

                      Questions have been raised about the reported tallies of deaths related to COVID-19 in the United States. Some officials have raised concerns that deaths not caused by the virus were improperly attributed to COVID-19, inflating the reported tolls. However, given the limited availability of viral testing and the imperfect sensitivity of the tests,3,4 there have likely been a number of deaths caused by the virus that were not counted. Furthermore, if patients with chronic conditions turn away from the health care system because of concerns about potential COVID-19 infection, there could be increases in certain categories of deaths unrelated to COVID-19. In the midst of a large outbreak, there is also an unavoidable delay in the compilation of death certificates and ascertainment of causes of death. Overall, the degree of testing, criteria for attributing deaths to COVID-19, and the length of reporting delays are expected to vary between states, further complicating efforts to obtain an accurate count of deaths related to the pandemic.

                      To estimate the mortality burden of a new infectious agent when there is a lack of comprehensive testing, it is common to assess increases in rates of death beyond what would be expected if the pathogen had not circulated.5-7 The “excess death” approach can be applied to specific causes of death directly related to the pathogen (eg, pneumonia or other respiratory conditions), or this approach can be applied to other categories of deaths that may be directly or indirectly influenced by viral circulation or pandemic interventions (eg, cardiac conditions, traffic injuries, or all causes). The excess deaths methodology has been used to quantify official undercounting of deaths for many pathogens, including pandemic influenza viruses and HIV.7-9

                      In this study, we estimate the excess deaths due to any cause in each week of the COVID-19 pandemic across the United States. We compare these estimates of excess deaths with the reported numbers of deaths due to COVID-19 in different states and evaluate the timing of these increases in relation to testing and pandemic intensity. These analyses provide insights into the burden of COVID-19 in the early months of the outbreak in the United States and serve as a surveillance platform that can be updated as new data accrue.

                      Methods

                      Data

                      Data on deaths due to pneumonia, influenza, and COVID-19 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes U07.1 or J09-J18) and on deaths due to all causes were obtained from the National Center for Health Statistics (NCHS) mortality surveillance system.10 Data were stratified by state and week.

                      Data on all-cause deaths in previous years were obtained from https://data.cdc.gov/resource/pp7x-dyj2 and https://data.cdc.gov/resource/muzy-jte6. Data on all-cause deaths and pneumonia/influenza/COVID-19 deaths since January 26, 2020, were obtained from https://data.cdc.gov/resource/r8kw-7aab. The NCHS data are based on the state where the death occurred rather than the state of residence.

                      The NCHS reports deaths as they are received from the states and processed; counts of deaths from recent weeks are highly incomplete, reflecting delays in reporting. These “provisional” counts are updated regularly for past weeks, and the counts are not finalized until more than a year after the deaths occur.

                      Historical data on the proportion of deaths due to pneumonia and influenza in previous years were obtained from Centers for Disease Control and Prevention (CDC) weekly influenza death reports (https://gis.cdc.gov/grasp/fluview/mortality.html) via the cdcfluview package in R (R Foundation), and these were used to determine the number of pneumonia and influenza deaths in the baseline period. All data were accessed June 12, 2020.

                      Connecticut and North Carolina were missing mortality data for recent months and were therefore excluded from the analyses and from the baseline numbers.

                      We also compiled data on COVID-19–related morbidity to gauge the timing and intensity of the pandemic in different locations. We used CDC data on influenza-like illness,11 a long-standing indicator of morbidity due to acute respiratory infections, which has been used to monitor COVID-19. We also obtained information on influenza virus circulation to adjust baseline estimates.12 See the eAppendix in the Supplement for details.

                      To compare our excess mortality estimates with official COVID-19 tallies, we compiled weekly numbers of reported deaths due to COVID-19 in each state from the NCHS,13 and these data were supplemented with data from the COVID Tracking Project.14 State-specific testing information was obtained from the COVID Tracking Project14

                      These analyses use publicly available aggregate data and were deemed exempt from human subjects review by the Yale institutional review board (protocol 1411014890).

                      Excess Mortality and Morbidity Analysis

                      To calculate the number of excess deaths, we first needed to estimate the baseline number of deaths in the absence of COVID-19. We then subtracted the expected number of deaths in each week from the observed number of deaths for the period March 1, 2020, to May 30, 2020.

                      Each of the 48 states (excluding North Carolina and Connecticut) and the District of Columbia were analyzed individually. We fit Poisson regression models to the weekly state-level death counts from January 5, 2015, to January 25, 2020 (see the eAppendix in the Supplement for details). The baseline was then projected forward until May 30, 2020, to generate baseline deaths; excess mortality was defined as the observed mortality minus the baseline for the pandemic period March 1, 2020, to May 30, 2020. The baseline model was adjusted for seasonality, year-to-year baseline variation, influenza epidemics, and reporting delays. The model for pneumonia/influenza/COVID-19 mortality used all-cause deaths as a denominator and did not have a separate adjustment for reporting delays. Poisson 95% prediction intervals were estimated by sampling from the uncertainty distributions for the estimated model parameters.15 Pennsylvania was not highlighted in the data despite having a large number of excess deaths because the data were incomplete during March 2020. Deaths for New York City are reported separately by the NCHS, and we report estimates for New York City and the rest of New York State separately. To obtain national-level estimates, the observed count and predicted counts (median estimate from the model) for each state were summed for each week and compared. Estimates for excess all-cause deaths were rounded to the nearest 100 and for excess pneumonia/influenza/COVID-19 deaths to the nearest 10. Medians and 95% prediction intervals are presented.

                      Adjusting for Reporting Delays

                      Reporting delays make it challenging to estimate excess deaths for recent weeks. To adjust for incomplete data in recent weeks, we adjusted the baseline based on an estimate for data completeness in that week. The estimate of completeness is based on the number of weeks that passed between the week in which the data set was obtained and the week in which the death occurred. We used a modified version of the NobBS package in R to estimate the proportion of deaths that were reported for each date and incorporated that as an adjustment in the main analysis16 (eAppendix in the Supplement). For instance, if we estimated that the data were 75% complete for a particular week, we multiplied the baseline by 0.75. These reporting delays were estimated using provisional data for deaths that occurred since March 29, 2020, and thus reflect changes in reporting that might have occurred during the pandemic. The completeness of the data varied markedly between states (eFigure 1 in the Supplement).

                      A study by Woolf et al17 of excess deaths in the US used the same database and a related harmonic regression method. The main differences in methodology are that Woolf et al did not adjust for reporting delays, the study period ended on April 25, 2020, and that study controlled for time trends using an adjustment for calendar year rather than epidemiological year.

                      Code and Data Availability

                      The analyses were run using R version 3.6.1. All analysis scripts and archives of the data are available at https://doi.org/10.5281/zenodo.3893882 and the current version of the repository is available at https://github.com/weinbergerlab/excess_pi_covid. More details about the data and methods are in the eAppendix in the Supplement.

                      Results

                      Across the United States, there were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. In comparison, there were an estimated 122 300 (95% prediction interval, 116 800-127 000) excess deaths during the same period (Table). The deaths officially attributed to COVID-19 accounted for 78% of the excess all-cause deaths, leaving 22% unattributed to COVID-19. The proportion of excess deaths that were attributed to COVID-19 varied between states and increased over time (Table and Figure 1).

                      The changes in mortality that occurred during the pandemic varied by state and region. In New York City, all-cause mortality rose 7-fold above baseline at the peak of the pandemic, for a total of 25 100 (95%prediction interval, 24 800-25 400) excess deaths, of which 26% were unattributed to COVID-19 (Table and Figure 2). In contrast, in the rest of New York State, the increase was more moderate, rising 2-fold above baseline and resulting in 12 300 (95% prediction interval, 11 900-12 700) excess deaths. There were notable per capita increases in rates of death due to any cause in many other states, including New Jersey, Massachusetts, Louisiana, Illinois, and Michigan, where the number of deaths greatly exceeded the expected levels (Table, Figure 2, and Figure 3; eFigure 2 in the Supplement for additional states). Other states, particularly smaller states in the central United States and northern New England, had some COVID-19 deaths reported in official tallies but small or no detectable increases in all-cause deaths above expected levels (Table).

                      The gap between the reported COVID-19 deaths and the estimated all-cause excess deaths varied among states (Table; eFigure 3 in the Supplement). For instance, California had 4046 reported deaths due to COVID-19 and 6800 (95% prediction interval, 6100-7500) excess all-cause deaths, leaving 41% of the excess deaths unattributed to COVID-19 (Table). Texas and Arizona had even wider gaps, with approximately 55% and 53% of the excess deaths unattributed to COVID-19, respectively. In contrast, there was better agreement between the reported COVID-19 deaths and the excess all-cause deaths in Minnesota, with 12% unattributed to COVID-19 (Table).

                      Some of the discrepancy between reported COVID-19 deaths and excess deaths could be related to the intensity and timing of increases in testing. In some states (eg, Texas, California), excess all-cause mortality preceded the widespread adoption of testing for SARS-CoV-2 by several weeks (Figure 4; eFigure 4 in the Supplement for additional states). In other states (eg, Massachusetts, Minnesota), testing intensity increased prior to or with the increase in excess deaths, and the gap between COVID-19 deaths and excess deaths was smaller (Figure 4).

                      The increase in excess deaths in many states trailed an increase in outpatient visits due to influenza-like illness by several weeks (eFigure 5 in the Supplement).

                      We performed several sensitivity analyses. We refit the seasonal baseline without adjusting for influenza activity (eTable in the Supplement). Excluding influenza pulled the baseline upward and led to smaller excess estimates in some states. Furthermore, we created an empirical baseline by averaging the number of deaths in corresponding weeks of the previous years. This yielded weekly estimates of excess death that aligned closely with estimates from our model in April 2020. The estimates of excess deaths based on the empirical baseline were slightly higher than those calculated with the modeled baseline in March 2020 and much lower estimates for May (eFigure 6 in the Supplement). The difference in the estimates for May is driven by reporting delays, which are adjusted for in the modeling approach but not in the empirical baseline. This suggests that our modeling approach provides robust estimates of excess mortality while allowing for formal quantification of uncertainty and more timely estimates than other empirical approaches. Finally, we explored the accuracy of our adjustment for reporting lags (eFigure 8 in the Supplement). The reporting delay correction underestimates deaths by 5% to 8% 2 weeks after the deaths at the national level but then stabilizes after 3 weeks or more. Therefore, our excess mortality estimates for the most recent week are modestly conservative.

                      Mortality data are released regularly, and updated analyses, along with additional figures, are available at https://weinbergerlab.github.io/excess_pi_covid/.

                      Discussion

                      Monitoring excess deaths has been used as a method for tracking influenza mortality for more than a century. Herein, we used a similar strategy to capture COVID-19 deaths that had not been attributed specifically to the pandemic coronavirus. Monitoring trends in broad mortality outcomes, like changes in all-cause and pneumonia/influenza/COVID-19 mortality, provides a window into the magnitude of the mortality burden missed in official tallies of COVID-19 deaths. Given the variability in testing intensity between states and over time, this type of monitoring provides key information on the severity of the pandemic and the degree to which viral testing might be missing deaths caused by COVID-19. These findings demonstrate that estimates of the death toll of COVID-19 based on excess all-cause mortality may be more reliable than those relying only on reported deaths, particularly in places that lack widespread testing.

                      Syndromic end points, such as deaths due to pneumonia/influenza/COVID-19, outpatient visits for influenza-like illness, and emergency department visits for fever, can provide a crude but informative measure of the progression of the outbreak.18 These measures themselves can be biased by changes in health-seeking behavior and how conditions are recorded. However, in the absence of widespread and systematic testing for COVID-19, they provide a useful measure of pandemic progression and the impact of interventions.

                      The gap between reported COVID-19 deaths and excess deaths can be influenced by several factors, including the intensity of testing; guidelines on the recording of deaths that are suspected to be related to COVID-19 but do not have a laboratory confirmation; and the location of death (eg, hospital, nursing home, or unattended death at home). For instance, deaths that occur in nursing homes might be more likely to be recognized as part of an epidemic and correctly recorded as due to COVID-19. As the pandemic has progressed, official statistics have become better aligned with excess mortality estimates, perhaps due to enhanced testing and increased recognition of the clinical features of COVID-19. In New York City, official COVID-19 death counts were revised after careful inspection of death certificates, adding an extra 5048 probable deaths to the 13 831 laboratory-confirmed deaths.19 As a result, the all-cause excess mortality burden from March 11 to May 2, 2020, is only 27% higher than official COVID-19 statistics.19 This aligns well with our estimate of 26% for a similar period in New York City, using a slightly different modeling approach.

                      Many European countries have experienced sharp increases in all-cause deaths associated with the pandemic. Real-time all-cause mortality data from the EuroMomo project (https://www.euromomo.eu/) demonstrate gaps between the official COVID-19 death toll and excess deaths that echo findings in our study. These gaps are more pronounced in countries that were affected more and earlier by the pandemic and had weak testing. Very limited excess mortality information is available from Asia, Africa, the Middle East, and South America thus far; these data will be important to fully capture the heterogeneity of death rates related to the COVID-19 pandemic across the world. Prior work on the 1918 and 2009 pandemics has shown substantial heterogeneity in mortality burden between countries, in part related to health care.8,20

                      Limitations

                      These analyses are all based on provisional data, which are incomplete for recent weeks in some states because of reporting delays. We have attempted to correct for these reporting delays in the analysis. Sensitivity analyses suggest that these corrections might result in estimates that are conservative (smaller estimates of excess) in the most recent week (eFigure 8 in the Supplement) at the national level, but the correction might overestimate excess deaths in the most recent week in some states. Since several months of data have accrued, and pandemic activity is currently low nationally, any inaccuracies in correcting for reporting delays in recent weeks would likely have a minor impact on the overall estimates of excess deaths.

                      An alternative approach to the one presented here would be to simply apply the observed number of deaths to the average number of deaths in the corresponding weeks from previous years (eFigure 6 in the Supplement). While this would yield similar answers during certain periods (particularly in April 2020), using an empirical baseline would ignore secular trends in death rates, the potential impact of influenza epidemics in the early part of the COVID-19 pandemic, and reporting delays in more recent weeks. While it would be ideal to wait until the pandemic is over and analyze complete data, there is a need for timely data and analysis during public health emergencies, so the trade-off between data completeness is warranted.

                      The number of excess deaths reported herein could reflect increases in rates of death directly caused by the virus, increases indirectly related to the pandemic response (eg, due to avoidance of health care), as well as declines in certain causes (eg, deaths due to motor vehicle collisions or triggered by air pollution). Further work is needed to determine the relative importance of these different forces on the overall estimates of excess deaths.

                      The national estimates do not include data from Connecticut and North Carolina. Together, these account for only 4.5% of the US population and are unlikely to have a large influence on the national-level estimates.

                      We used a Poisson regression model for analysis. While there was modest overdispersion in some of the larger states, the 95% prediction intervals provide adequate coverage during the prepandemic period (eFigure 7 in the Supplement).

                      We present a comparison of excess deaths with influenza-like illness. Influenza activity declined to historically low levels starting in March 2020. At the same time, health care–seeking behavior changed drastically. Therefore, analyses of influenza and influenza-like illness need to be interpreted with caution. Regardless, this analysis demonstrates the expected time lag between outpatient visits for influenza-like illness and excess deaths (eFigure 8 in the Supplement).

                      Conclusions

                      Monitoring syndromic causes of death can provide crucial additional information on the severity and progression of the COVID-19 pandemic. Estimates of excess deaths will be less biased by variations in viral testing, but reporting lags need to be properly accounted for. Even in situations of ample testing, deaths due to viral pathogens, including SARS-CoV-2, can occur indirectly via secondary bacterial infections or exacerbation of comorbidities. There can also be secondary effects on mortality due to changes in population behavior brought about by strict lockdown measures and an aversion of the health care system. Together with information on official tallies of COVID-19 deaths, monitoring excess mortality provides a key tool in evaluating the effects of an ongoing pandemic.

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                      Article Information

                      Corresponding Author: Daniel M. Weinberger, PhD, PO Box 208034, New Haven, CT 06520 (daniel.weinberger@yale.edu).

                      Accepted for Publication: June 15, 2020.

                      Published Online: July 1, 2020. doi:10.1001/jamainternmed.2020.3391

                      Author Contributions: Dr Weinberger had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

                      Concept and design: Weinberger, Chen, Cohen, Pitzer, Reich, Russi, Simonsen, Viboud.

                      Acquisition, analysis, or interpretation of data: Weinberger, Crawford, Mostashari, Olson, Reich, Russi, Watkins, Viboud.

                      Drafting of the manuscript: Weinberger, Russi, Watkins, Viboud.

                      Critical revision of the manuscript for important intellectual content: Weinberger, Chen, Cohen, Crawford, Mostashari, Olson, Pitzer, Reich, Simonsen, Watkins, Viboud.

                      Statistical analysis: Weinberger, Crawford, Reich, Russi, Viboud.

                      Obtained funding: Weinberger.

                      Administrative, technical, or material support: Chen, Olson, Russi, Viboud.

                      Conflict of Interest Disclosures: Dr Weinberger reported receipt of consulting fees from Pfizer, Merck, GlaxoSmithKline, and Affinivax for topics unrelated to this work and being principal investigator on a research grant from Pfizer on an unrelated topic. Dr Pitzer reported having received reimbursement from Merck and Pfizer for travel expenses to scientific input engagements unrelated to the topic of this work and being a member of the World Health Organization Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC). No other disclosures were reported.

                      Funding/Support: This study was supported by grants R01AI123208 (Dr Weinberger), R01AI137093 (Drs Weinberger and Pitzer), R01AI112970 (Dr Pitzer), and R01AI146555 (Dr Cohen) from the National Institute of Allergy and Infectious Diseases/National Institutes of Health; by grant 1DP2HD091799-01 (Dr Crawford) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; by grant R35GM119582 (Dr Reich) from the National Institute of General Medical Sciences/National Institutes of Health; by grant 1U01IP001122 (Dr Reich) from the CDC; and by grant CF20-0046 (Dr Simonsen) from the Carlsberg Foundation.

                      Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

                      Disclaimer: This study does not necessarily represent the views of the National Institutes of Health or the US government. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the New York City Department of Health and Mental Hygiene, or the CDC.

                      Additional Contributions: We thank Andrew Ba Tran, BA, The Washington Post, for feedback on the analysis code. No compensation was received.

                      References
                      1.
                      WHO director-general’s opening remarks at the media briefing on COVID-19, 11 March 2020. World Health Organization website. Accessed June 19, 2020. https://www.who.int/dg/speeches/deta...-11-march-2020
                      2.
                      Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2).  Science. 2020;368(6490):489-493. doi:10.1126/science.abb3221PubMedGoogle ScholarCrossref
                      3.
                      Yang Y, Yang M, Shen C, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv. Preprint posted February 17, 2020.
                      4.
                      Kucirka L, Lauer S, Laeyendecker O, Boon D, Lessler J. Variation in false negative rate of RT-PCR based SARS-CoV-2 tests by time since exposure. medRxiv. Preprint posted April 10, 2020.
                      5.
                      Serfling RE. Methods for current statistical analysis of excess pneumonia-influenza deaths.  Public Health Rep. 1963;78(6):494-506. doi:10.2307/4591848PubMedGoogle ScholarCrossref
                      6.
                      Czaja CA, Miller L, Colborn K, et al. State-level estimates of excess hospitalizations and deaths associated with influenza.  Influenza Other Respir Viruses. 2020;14(2):111-121. doi:10.1111/irv.12700PubMedGoogle ScholarCrossref
                      7.
                      Buehler JW, Devine OJ, Berkelman RL, Chevarley FM. Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States.  Am J Public Health. 1990;80(9):1080-1086. doi:10.2105/AJPH.80.9.1080PubMedGoogle ScholarCrossref
                      8.
                      Simonsen L, Spreeuwenberg P, Lustig R, et al; GLaMOR Collaborating Teams. Global mortality estimates for the 2009 influenza pandemic from the GLaMOR project: a modeling study.  PLoS Med. 2013;10(11):e1001558. doi:10.1371/journal.pmed.1001558PubMedGoogle Scholar
                      9.
                      Charu V, Simonsen L, Lustig R, Steiner C, Viboud C. Mortality burden of the 2009-10 influenza pandemic in the United States: improving the timeliness of influenza severity estimates using inpatient mortality records.  Influenza Other Respir Viruses. 2013;7(5):863-871. doi:10.1111/irv.12096PubMedGoogle ScholarCrossref
                      10.
                      Kniss K, Malcolm B, Sutton P, Brammer L. US pneumonia and influenza mortality surveillance: a new era.  Online J Public Health Inform. 2014;6(1).Google Scholar
                      11.
                      National, regional, and state level outpatient illness and viral surveillance. Centers for Disease Control and Prevention FluView Interactive website. Accessed April 9, 2020. https://gis.cdc.gov/grasp/fluview/fl...dashboard.html
                      12.
                      National Respiratory and Enteric Virus Surveillance System. Centers for Disease Control and Prevention website. Accessed April 9, 2020. https://www.cdc.gov/surveillance/nrevss/index.html
                      13.
                      Provisional death counts for coronavirus disease 2019 (COVID-19). National Center for Health Statistics website. Accessed April 10, 2020. https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm
                      14.
                      The COVID Tracking Project. Accessed April 9, 2020. https://covidtracking.com/
                      15.
                      Lauer SA, Sakrejda K, Ray EL, et al. Prospective forecasts of annual dengue hemorrhagic fever incidence in Thailand, 2010-2014.  Proc Natl Acad Sci U S A. 2018;115(10):E2175-E2182. doi:10.1073/pnas.1714457115PubMedGoogle ScholarCrossref
                      16.
                      McGough SF, Johansson MA, Lipsitch M, Menzies NA. Nowcasting by bayesian smoothing: a flexible, generalizable model for real-time epidemic tracking.  PLoS Comput Biol. 2020;16(4):e1007735. doi:10.1371/journal.pcbi.1007735PubMedGoogle Scholar
                      17.
                      Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess deaths from COVID-19 and other causes, March-April 2020.  JAMA. Published online July 1, 2020. doi:10.1001/jama.2020.11787
                      ArticleGoogle Scholar
                      18.
                      Olson DR, Heffernan RT, Paladini M, Konty K, Weiss D, Mostashari F. Monitoring the impact of influenza by age: emergency department fever and respiratory complaint surveillance in New York City.  PLoS Med. 2007;4(8):e247. doi:10.1371/journal.pmed.0040247PubMedGoogle Scholar
                      19.
                      Olson DR; New York City Department of Health and Mental Hygiene (DOHMH) COVID-19 Response Team. Preliminary estimate of excess mortality during the COVID-19 outbreak—New York City, March 11–May 2, 2020.  MMWR Morb Mortal Wkly Rep. 2020;69(19):603-605. doi:10.15585/mmwr.mm6919e5PubMedGoogle ScholarCrossref
                      20.
                      Murray CJL, Lopez AD, Chin B, Feehan D, Hill KH. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis.  Lancet. 2006;368(9554):2211-2218. doi:10.1016/S0140-6736(06)69895-4PubMedGoogle ScholarCrossref
                      https://jamanetwork.com/journals/jam...QBFLxzg1u7rWUI
                      Twitter: @RonanKelly13
                      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                      Comment


                      • #12
                        CDC now showing an estimated 114,508 to 135,795 excess deaths between March 22 and June 6.
                        https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard


                        By comparison FluTrackers confirmed death toll on June 6 was 110,118.
                        https://flutrackers.com/forum/forum/...631#post867631
                        Twitter: @RonanKelly13
                        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

                        Comment


                        • #13
                          CDC now showing an estimated 124,892 to 147,995 excess deaths between March 22 and June 13.
                          https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard

                          By comparison FluTrackers confirmed death toll on June 13 was 115,674.
                          https://flutrackers.com/forum/forum/...762#post869762
                          Twitter: @RonanKelly13
                          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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                          • #14
                            CDC now showing an estimated 139,910 to 170,728 excess deaths between March 22 and July 11. (the most recent two weeks are partially complete)
                            https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard

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                            By comparison FluTrackers confirmed death toll on July 11 was 135,281.
                            https://flutrackers.com/forum/forum/...177#post877177
                            Twitter: @RonanKelly13
                            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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                            • #15
                              CDC now showing an estimated 148,482 to 184,157 excess deaths between March 22 and July 18. (the most recent two weeks are partially complete)
                              https://www.cdc.gov/nchs/nvss/vsrr/c....htm#dashboard

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                              By comparison FluTrackers confirmed death toll on July 18 was 140,564.
                              https://flutrackers.com/forum/forum/...169#post879169
                              Twitter: @RonanKelly13
                              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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