Lost Lives, Invisible Deaths


More than one million people have died from COVID-19 in the U.S. in the past two years.

We’ve all seen the dashboards. They report the past week’s COVID-19 cases and deaths. These numbers helped us gauge the severity of the pandemic since March 2020. Well, what if the pandemic’s death count has actually been worse than the dashboards told you?

COVID-19 mortality is monitored primarily using death certificates that list the virus as the cause. Excess deaths are the difference between the observed and “expected” number of deaths (based on prior years) within a specific time. According to the CDC, 545,600 to 660,200 deaths between January 2020 and February 2021 were excess deaths that we can presume were primarily related to COVID-19.

Calvin Ackley, Andrew Stokes, and colleagues looked at county-level mortality reports to conclude which counties had the highest level of excess deaths. Then, they determined how many excess deaths could be attributed to COVID-19. They found that of the excess deaths, 87.5% were assigned to the virus; the remaining 12.5% listed other causes.

The map above shows the distribution of the excess deaths. The darker the blue, the more excess deaths. So, why aren’t these observed-to-expected differences the same across all states, or at least all counties in one state?

The authors suggest the underreporting of COVID-19 in some places is due to states not having standardized death reporting. Some require a post-mortem test, some require a medical diagnosis of COVID-19, and others require the family to confirm the cause. Lack of funding for forensic examination staff, lack of test availability, and disbelief in COVID-19 all can contribute to misreporting.

Without accurate death certificates, we cannot know what is killing Americans. This study shows we don’t have a clear picture of the pandemic’s effects. To help with this, the research team is launching a website to display death counts by county on an interactive map.

Databyte via Calvin A. Ackley, Dielle J. Lundberg, Lei Ma, Irma T. Elo, Samuel H. Preston, Andrew C. Stokes, County-level estimates of excess mortality associated with COVID-19 in the United States, SSM – Population Health, 2022.