BUSPH researcher joins forces with journalists and academics to reveal hidden COVID-19 mortality



Dr Andrew Stokes, Assistant Professor of Global Health, Provides Mortality Data and Modeling to Project COVID-19 Documenting and Muckrock in Collaboration to Identify Extent of Underreported COVID-19 Deaths in American counties.

As the official death toll from COVID-19 in the United States surpasses 805,000, a Boston University School of Public Health (BUSPH) researcher partners with a team of investigative journalists and academics to Understanding a hidden aspect of COVID-19 mortality: direct and indirect deaths from the pandemic that have not been attributed to COVID-19 and, therefore, are excluded from official COVID-19 death totals.

Dr Andrew Stokes, assistant professor of global health at BUSPH, has studied death rates from COVID-19 throughout the pandemic and has conducted several studies that suggest the actual number of COVID deaths in the United States is probably much higher than the records indicate; and that almost all uncounted deaths occur at home. These results show that around 20% of excess deaths, i.e. the number of deaths beyond what would have been expected in a normal year, were not reflected in the number of deaths. COVID-19 deaths among U.S. counties. These hidden deaths appear to occur more often in counties with fewer primary care doctors, less access to health insurance and more home deaths, and disproportionately among communities of color.

Dr Stokes shares data and modeling from his work in a multi-pronged initiative with Project Documenting COVID-19, an online repository of local, state and federal public documents obtained through open case requests by reporters from the Brown Institute for Media Innovation and the collaborative news site Muckrock. Journalists working on the project are using this data and modeling to guide field reporting in local counties across the United States to uncover the true scale of underreported deaths from COVID-19. They relate their findings in a series of USA today articles over the next year.

“Accurate and rapid mortality monitoring is essential to pandemic preparedness and response efforts,” says Dr Stokes, including the team of researchers from BUSPH, University of Pennsylvania and the Robert Wood Johnson Foundation , analyzed mortality data in more than 3,000 US counties. . “Without accurate mortality data, it becomes very difficult to design effective policy responses or develop fair and equitable responses targeting the hardest hit communities. “

The first two articles of the USA today A series, released December 9 and 22, examines national data and social and racial inequalities related to excess mortality, including the results so far of undercoverage in rural Louisiana, Missouri and Mississippi counties. . The following articles will dig deeper into these locally hidden deaths in other US counties, with the aim of understanding why and how these deaths are excluded from official COVID records in each region.

The documentation of COVID-19 also draws on the knowledge and expertise of local journalists, public health researchers, community organizations, forensic pathologists, coroners and the general public, and encourages people to participate in this. initiative. The team will soon be posting a “reporting recipe” – a set of journalists can use to support their own local reporting on COVID mortality – as well as an open access form on the online platform AirTable, where everything anyone can view or download, or share their thoughts or stories about these hidden deaths. Anyone who shares information on the database has the option to do so anonymously. Dozens of journalists have already joined the effort.

“Using the data and modeling provided by Dr Stokes’ team, we will continue to report underestimated deaths in local areas as to why these discrepancies are occurring, as the reasons will be different in each area,” a said Dillon Bergin, investigative reporter at Muckrock, and part of the COVID-19 Documenting Project and the reporting team for the USA today series. “We want to help journalists find their stories, so we’ve also built a basic set of tools to help local news groups find the data in their areas and conduct the surveys they want, but don’t may not have the resources to do so. “

The fact that so many of these unaccounted for deaths occur at home, and not in a hospital where testing is most common, is a factor that warrants further investigation, says Dr Stokes.

“Much of the underreporting appears to be concentrated among deaths occurring at home, where testing is extremely limited. In these cases, the cause of death is frequently attributed to other conditions such as heart disease or diabetes. “he said. “A lot of people are afraid to go to the hospital and potentially contract COVID, or lose contact with loved ones, so they get sick and stay home, then die without their death ever being reported as a COVID death. “

The underestimation of deaths from COVID also has policy implications, says Dr Stokes. Since most death inquiries take place at the county level, the official cause of death is often determined by elected coroners who may be politically motivated to minimize the pandemic (and who typically receive less formal training. than forensic pathologists).

“When we find evidence of underreporting in a community, there is a direct link to a county coroner or examiner who is responsible for certifying these deaths,” says Dr. Stokes. “Our focus on counties means the estimates have direct implications for county death investigation systems.”


Boston University School of Medicine



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