Why Accurate COVID-19 Death Counts Are Still Hard to Determine Years Later

A respiratory therapist treats a COVID-19 patient at Rush University Medical Center in Chicago on Jan. 31, 2022. Scott Olson/Getty Images

News Analysis

The number of deaths resulting from COVID-19 infections has been controversial and debated since the onset of the pandemic. Much of this stems from how doctors continue to report fatalities associated with the virus.

Shifting numbers from major health organizations have also contributed to the confusion, fueling speculation. This is because mortality rates based on “excess death” estimates from officials are subject to change.

The term “excess deaths” concerning COVID-19 refers to a theoretical number of fatalities not listed in official reports by individual countries’ health departments.

The Centers for Disease Control and Prevention (CDC) describes “excess deaths” as a difference between the number of observed and expected mortalities within a certain period.

And like any theory, it isn’t necessarily accurate.

In May, the World Health Organization (WHO) released a report on the global excess death count from COVID-19, putting the figure at 15 million. Barely a month later, scientists from the organization acknowledged mistakes in their estimates, resulting in adjusted excess numbers.

A sign at the World Health Organization in Geneva on April 24, 2020. Fabrice Coffrini/AFP via Getty Images

By contrast, the actual reported number of global fatalities from COVID-19 since the beginning of the pandemic is slightly more than 6.5 million.

The drastic differences in figures prompted some governments to fire back at the WHO’s excess death figures. India’s government openly called the estimates “speculative and misinformed.”

In March, the CDC also made a similar adjustment and removed 72,277 COVID-related fatalities from its data tracker.

A Matter of Opinion

Meanwhile, medical professionals in the United States are opening up about the dubious nature and challenges associated with reporting COVID-related deaths.

That’s because even today, there’s no across-the-board regulation for determining whether COVID-19 is an actual cause of death in a patient who tests positive, or just a coexisting condition. It’s entirely at the discretion of the attending physician, medical examiner, or coroner.

“Early on in COVID, that was a source of great controversy by people who said if you had an underlying illness that was severe and you got COVID, you shouldn’t have those patients listed as COVID deaths,” Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, told The Epoch Times.

Schaffner explained that some physicians countered the argument, saying that their patient would still be alive were it not for a COVID-19 infection.

The end result: COVID-19 was often labeled as the primary cause of death, despite significant or even life-threatening preexisting conditions, in many patients.

National Guard members assist with the transfer of COVID-19 fatalities into temporary storage in Los Angeles on Jan. 12, 2021. Los Angeles County Department of Medical Examiner-Coroner via AP, File

Consequently, that pushed the associated mortality rate even higher.

“It’s a judgment call by the doctor who fills out the death certificate,” Schaffner said.

Chief scientist and CEO of SyneuRx, Dr. Emil Tsai, told The Epoch Times that COVID-19 death reporting has become “increasingly murky” and that will likely continue.

“Statistically, we have an average number of deaths that occurred per year in the United States before the pandemic. There has been an excess of deaths, so we can assume those deaths, whether a primary or secondary cause, are COVID-related,” Tsai said.

“As the pandemic continues, those excess deaths will lessen and COVID infection will become harder to recognize. Reporting [deaths] will become increasingly more difficult.”

Tsai noted that many coroner’s offices were likely overwhelmed at the beginning of the pandemic, leading to struggles in determining which deaths should be counted as COVID-19-related.

Moreover, some experts assert that as the virus continues to mingle amidst other contagious diseases—such as during the flu season—identifying what role COVID-19 plays in resultant mortalities becomes another hurdle.

Testing and Misdiagnosis Challenges

The availability of tests for COVID-19 presented an enormous problem for diagnosis in the early months of the pandemic. Yet, after antigen and polymerase chain reaction (PCR) tests became widely available, false positives threw another curveball at the health care industry.

Considered the “gold standard” of tests for detecting COVID-19, the PCR is considered accurate within 95 to 100 percent. Even so, that would still leave a trail of thousands of false positives since official records began in 2020.

A medical worker places a nasal swab into a test tube after performing a COVID-19 PCR test in Boston on Dec. 20, 2021. Joseph Prezioso/AFP via Getty Images

This further muddles the dilemma of accurate death counts, since a person listed as a COVID-19 fatality generally isn’t retested, yet it’s the only way to determine if the first test was a false positive.

Testing aside, some health care insiders say part of the problem is accurate diagnostics stemming from how little time doctors spend with their patients currently.

“In the very beginning, when I first started practicing nursing, the focus was on the patient,” Donna Brown, a retired registered nurse, told The Epoch Times.

Having spent years working in hospitals, Brown has watched some big changes unfold within the health care industry. Chief among these is a decline in the time doctors are spending with patients to assess and diagnose a condition.

These days, you can measure it with a stopwatch.

“I’m sorry, but 10 to 15 minutes isn’t nearly enough time for physicians,” Brown said.

She added that this is especially true with elderly patients, where a deeper knowledge of previous diagnoses and existing conditions are critical.

Recent studies show the average time doctors interact with patients is between 13 to 24 minutes, with the low end of the average being more common.

Another pre-pandemic analysis revealed only 11 percent of patients and 14 percent of physicians felt their interaction provided the appropriate amount of time needed for the highest standards of care.

Tsai agrees that medical professionals have less time to spend with patients than years ago.

“Even before the COVID-19 pandemic, there were many more patients than physicians could help, and time was stretched thin,” he said.

“Many felt they didn’t have time to make the thorough assessment they wanted for each patient. Add COVID-19 to the mix, and there was even less time.”

While some of this is due to pandemic-related staff shortages, more time is also being spent working with electronic health records compared with patients directly. Due to changes in the way insurance providers and the government pay for health care, doctors now spend more time on computers than with their patients.

This applies to more than just hospital visits.

In a study of 57 U.S. physicians in different specialties, only 27 percent of their time was spent on “direct clinical face time” interactions with patients.

According to Brown, this trend became particularly noticeable once the Affordable Care Act went into effect under former President Barack Obama.

“Insurance companies started dictating the amount of time spent with patients,” she said. “That certainly doesn’t help doctors make an accurate diagnosis.”