The uncounted dead

Yet another reason why experts say we’re not overcounting COVID-19 deaths is that we’re now counting them in much the same way as we have always counted deaths from infectious disease. The methodology is longstanding and is used for all sorts of diseases — and there’s never been cause to think that the methodology made us overcount the deaths from those other diseases.

If you look at the CDC’s annual report of flu deaths, for example, you’ll see that it’s “estimated,” modeled on official flu deaths reported, deaths from flu-like causes reported, and what we know about flu epidemiology. The calculation is done this way precisely because public health officials know that a straight count of formally diagnosed flu deaths would be an undercount of actual flu deaths.

While flu tests aren’t in short supply and essentially anyone who wants to be tested for the flu can be, not everyone who catches it gets tested. Plenty of people get sick with the flu and never go to a doctor, said Alberto Marino, a research officer at the London School of Economics who has studied disease case and death counts for both LSE and the Organization for Economic Cooperation and Development. If they die — especially if they are also old or have some underlying condition — the role the flu played in their deaths can easily go unnoticed and unrecorded. We don’t record “probable” flu deaths (again, the tests aren’t rationed), but we do record deaths due to “flu-like illnesses” — and plenty of people who die from the flu don’t have that listed as the cause on their death certificates.