Over the past few days, reports from different corners of the world confirmed that coronavirus deaths are being under-reported. These included New York City, China and South America.
Early data in the pandemic only included in the death toll those who had tested positive to the virus and then died subsequently, usually in hospitals.
But last Wednesday, NYC officials added 3,700 coronavirus deaths to the records. All were presumed to have died from coronavirus, but were never tested. According to The New York Times, over the preceding three days, 766 people were found dead in their homes.
Similarly, on Friday Chinese state media admitted that 1,300 deaths from during the initial outbreak in Wuhan were not accounted for. China’s national death toll was revised up to 6,632.
“In the early stage, due to limited hospital capacity and the shortage of medical staff, a few medical institutions failed to connect with local disease control and prevention systems in a timely manner,” a Wuhan official was reported in state media as saying.
Whatever else you might say about the reliability of Chinese state media, the explanation makes sense. Mortality from coronavirus is closely linked to the health system’s capacity to keep up with the number of cases.
For instance, even in the worst-hit city in South Korea, Daegu, the fatality rate (relative to confirmed cases) was 2.4%. In Italy, where hospitals were quickly overwhelmed, the fatality rate has been 13.2%.
The following graphs, showing data in NYC up to early April, illustrates the concept. Whenever Covid-19 hits harder, the data is likely to get less reliable.
whether it’s because of undercounting covid deaths or because deaths from other causes are going up, it’s clear that the coronavirus death count is understating the toll of the virus pic.twitter.com/C5cesIZNch— Josh Katz (@jshkatz) April 10, 2020
The tendency toward under-reporting is likely to be most extreme in the Global South. This is clear in the case of Guayaquil, Ecuador, a city of some 2 million people and one of the first places in South America to suffer a major outbreak.
It was recently reported that approximately 11,000 people died in Guayaquil of all causes from 1 March – 15 April. The usual mortality rate for such a period is 2,700 people.
This leaves roughly 8,000 deaths likely attributable to Covid-19. During this same period, the government was reporting only 8,000 total cases nationwide!
Like the Spanish Flu of 1918, the true toll of Covid-19 will most likely never be known.