The true number of people who have died during the coronavirus pandemic in America could be double the official figure, an adviser to the Centres for Disease Control (CDC) has warned, as evidence emerges that large numbers of seriously ill people have failed to seek medical attention for life-threatening conditions because of the contagion.
The current total of Covid-19 deaths in the US stands at 75,000, with more than 1.2 million infections, according to tracking carried out by organisations such as Johns Hopkins University. That figure itself is likely an undercount, given the delay and difficulty in obtaining data.
But health experts say such counts do not show the full devastation of the virus because they do not include deaths from conditions such as heart failure, strokes or cancer of people who failed to get treatment, either because they were too scared to go to hospital, or else their appointment was cancelled as health departments were obliged to halt non-urgent procedures.
While Donald Trump has yet to comment directly on such deaths, White House press secretary Kayleigh McEnany alluded to them this week when speaking to reporters. Urging Americans who were ill to visit their doctor, she added: “I’ve been disturbed to read many quotes from doctors, [and] stories of people who are staying home with chest pain and don’t go to the hospital when they could be on the verge of having a heart attack; who are missing on important appointments like mammograms, screenings like colonoscopies.”
Hospitals across the country have warned they are seeing fewer patients than they normally do in the emergency room, or else attending clinics, the impact of officials warning people to remain at home.
Mark Hayward, a sociology professor at the University of Texas at Austin who advises the CDC on its mortality statistics, said it was very difficult to assess what he termed the “full mortality burden” of the disease.
One reason was for the time-lag in cases being reported, and how information about the disease included in coroners’ reports was not always complete. Factors such as a person dying because they were too afraid to go hospital would likely not be included.
“I think the undercount is enormous. The overall burden of mortality from Covid, which covers all the causes that you talked about, could be enormously higher,” he said.
He suggested that figure could be double the current death toll of 75,000. “The true number of deaths that we’re looking at is probably at least one per cent of the current cases,” he said. “Which is about 1.2 million people. Right now we have about 75,000 deaths. I think probably we’re going to have closer to double that.”
Cassie Sauer, CEO of the Washington State Hospital Association (WSHA), said its members were reporting “abnormally low” volumes of patients seeking routine medical care, while those that are arriving have been more severely ill.
“People are waiting to seek medical attention – and endangering themselves as a result,” she said in a statement. “Life is on pause right now, but your health care needs are not, Do not delay needed care – you could get worse.”
The clearest evidence yet that people with serious conditions are staying away from hospitals has emerged in the world of cardiology. Last month, ProPublica reported several cities, including Boston and Detroit, had seen a spike in cases of people dying at home from heart attacks. In New York there had been a ninefold increase of people dying at home in this manner.
New figures, taken from nine hospitals located across the country, has suggested an almost 40 per cent drop in reported heart attacks. Dr Santiago Garcia, who reported the findings in the Journals of the American College of Cardiology, said he did not believe fewer people were suffering heart problems. Rather, those people were staying away from hospitals, and some were dying or else suffering damage to their heart.
“The message that came out to public initially was “Don’t go to the hospitals – that’s where the Covid patients go”, Dr Garcia told The Independent, speaking from the Minneapolis Heart Institute.
“So people are having a hard time reaching out to their physicians. The reasons are not clearly understood. But what it is clear is that patients are not coming to the hospital for cardiovascular emergencies.”
People suffering from cancer have also been missing out. In Minneapolis, Alliana Health, which operates 13 hospitals and more than 90 clinics throughout Minnesota and western Wisconsin, was obliged to postpone 4,000 surgeries last month, some of them for cancer patients.
Yet, the problem is national. A survey by the American Cancer Society Cancer Action Network discovered half of all cancer patients who had recently undergone treatment found the virus had impacted their care. Of those, 25 per cent reported a delay.
“The health effects of this pandemic stretch well beyond those diagnosed and suffering from Covid-19, and are having an acute and adverse impact on cancer patients, many of whom can’t afford treatment delays,” said the network’s president, Lisa Lacasse.
The scale of the problem reaches beyond these diseases, and beyond actual deaths. Dr Garcia of the Minneapolis Heart Institute said one of his colleagues reported a patient losing their eyesight after failing to get to their macular degeneration test, which checks the health of the retina.
“This is not just about mortality, but morbidity,” he said. “It’s about quality of life.”
As some states in the US prepare to lift restrictions to try and kickstart the economy, there appears to be a growing awareness that the figure of 75,000 deaths does not tell the full story.
Andrew Cuomo, the governor of New York state, which has been the hardest hit, said this week at one of his daily briefings: “I think this is all going to change ... I think it’s going to be worse when the final numbers are tallied.”
Theo Vos, professor of health metrics sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington – the modelling system frequently mentioned by the White House – has been studying “excess deaths” from Wuhan, China. He has done this by comparing data sets taken before and after the coronavirus struck late last year, trigging the pandemic.
Mr Vos said the data suggested Wuhan had also seen an increase in the number of heart attacks following the Covid attack. Asked if the team believed it was because people were stating away from hospitals, he said: “We can only speculate. But given that it is particularly for things that can cause immediate death, and that with appropriate care you can reduce that risk – like heart attacks and stroke – that is a plausible explanation, we think.”
Mr Vos was cautious about comparing what had happened in Wuhan to the US, but said it was likely the nation would record “a noticeable increase” in deaths other than Covid “at least for some, some time period”.
Esther Choo, an emergency physician and associate professor at the Oregon Health and Science University in Portland, said she too had detected fewer patients visiting but that it was difficult to quantify. A hospital “cannot count what doesn’t come in”, she said.
“It’s an impossible number to get in some ways,” she said, referring to a total death toll. “We’ll have an estimate, at some point retrospectively, because we’ll look at death rates from previous times, we’ll subtract out clearly Covid-related deaths.”
She added: “Some things will be very hard to trace. If you present late for your cancer biopsy, and so you’re diagnosed two or three or four months later than you otherwise would have. And that impacts your survivability in a way that plays out over many years. We’ll never capture that probably. I mean, how do you capture something that’s subtle like that?”
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