Only part of the discrepancy between excess deaths and official Covid deaths results from undercounting of Covid deaths. In New York City, when excess deaths between March 11 (the first recorded Covid-19 death) and May 2 were examined, only 57 percent had laboratory-confirmed Covid-19. Yet when probable deaths—deaths for which Covid-19, SARS-CoV-2, or an equivalent term was listed on the death certificate as an immediate, underlying, or contributing cause of death, but that did not have laboratory confirmation of Covid-19—were added in, 22 percent of excess deaths were still not attributed to Covid-19.

The indirect effect of the pandemic—deaths caused by the social and economic responses to the pandemic, including lockdowns—appears to explain the balance. For instance, people delayed needed medical care because they were instructed to shelter in place, were too scared to go to the doctor, or were unable to obtain care because of limitations on available care, including a moratorium on elective procedures…

Deaths from chronic, non-emergent conditions also increased as patients put off maintenance visits and their medical conditions deteriorated. In the second study of excess deaths, the five states with the most Covid-19 deaths from March through April (Massachusetts, Michigan, New Jersey, New York, and Pennsylvania), experienced large proportional increases in deaths from non-respiratory underlying causes, including diabetes (96 percent), heart diseases (89 percent), Alzheimer’s disease (64 percent), and cerebrovascular diseases (35 percent). New York City—the nation’s Covid-19 epicenter during that period—experienced the largest increases in non-respiratory deaths, notably from heart disease (398 percent) and diabetes (356 percent).