The reduced count of Covid-19 deaths is higher in pro-Trump areas

TSeveral thousand Covid-19 deaths have not been reported in the United States, with far more losses in counties that strongly supported former President Trump, according to new research.

The figures suggest that political trends have helped to suppress the true scale of deaths. In cases where the deceased did not take the Covid-19 test, a coroner or coroner is free to interpret the symptoms.

“There is potentially latitude to make a conditional judgment on a set of beliefs about Covid and whether it represents a serious problem or a scam,” said Andrew Stokes, professor of global health at the Boston University School of Public Health who conducted the analysis. for STATE.

advertising

More than 413,000 people died in the United States with Covid-19 attributed somewhere on their death certificate. The actual number of deaths, as reflected in the number of excess deaths in 2020 compared to annual deaths from 2013 to 2018, is even greater. A separate study, led by Stokes, of 787 counties with more than 20 Covid-19 deaths from February 1 to October 17, 2020, found that while there were 199,124 official Covid-19 deaths in that period, an additional excess of 88,142 the deaths were not attributed to the virus.

Some of these excessive deaths are likely due to factors that were exacerbated by the pandemic, such as overdoses and suicide in response to isolation and economic hardship, or below average health care in a saturated system. But the researchers believe that many are deaths from Covid-19 that are not counted. Overall, the true number of Covid-19 deaths is 31% higher than the official figures, according to the study, which was submitted to PLOS Medicine.

advertising

The researchers found that deaths not attributed by Covid-19 were significantly higher in rural areas than in urban areas; in the South compared to other regions; and in areas with lower levels of education. All of these factors tend to correlate with support for Trump.

“We see a lot of variation in the excess of deaths and it’s kind of hard to explain,” said Katherine Hempstead, another study researcher and senior policy advisor to the Robert Wood Johnson Foundation. There appears to be a correlation between areas that were less inclined to take Covid-19 seriously and take preventive measures, such as wearing masks and social distance, and those with higher levels of Covid-19 deaths that were not recognized, she said.

Not all variations in excess deaths point to a Trump effect: low-income counties, which tend to vote for Democrats, also have much higher rates of excess deaths. But Stokes’ preliminary research, which is not part of the larger study, explicitly examined political correlations and found that the excess of unaccounted deaths attributed to Covid-19 are much more common in the counties that most support Trump, based on the presidentials of 2020 and 2016 electoral results, than at least.

In total, across the country, there were 44 excess deaths that were not officially recognized as Covid-19 for every 100 official Covid-19 deaths. But untold deaths are much higher in the 25% of counties with the highest number of Trump voters in 2020, with 163 excess deaths for every 100 Covid-19 deaths. In comparison, there were only 18 excess deaths per 100 Covid-19 deaths in the lower quarter of those counties.

During the pandemic, the response to Covid-19 was intensely partisan, and politicized reactions to the virus could easily shape how death itself is recorded. Former President Trump has spoken out against the test, falsely claiming he has created more cases. As patients are less likely to be registered as death by Covid-19 if they have not been tested, this would contribute to forgetting cases.

Test acceptance is likely to be less in areas that are more conservative, said Stokes. “People who have not been diagnosed are less likely to have Covid-19 assigned on their death certificate than people who are diagnosed.”

IIn areas where the pandemic is minimized or seen as a myth, the death reporting process leaves room for those who do not take Covid-19 seriously to leave the virus out of death certificates. Covid-19 is usually the basic cause of death, leading to illnesses like pneumonia or heart attack, which is the most direct cause. In cases where someone has not been tested, coroners are free to attribute death to the most direct condition and leave Covid-19 entirely out.

If someone is hospitalized with respiratory problems, is tested and diagnosed with Covid-19, and dies from these respiratory problems, the virus is clearly an underlying cause. “These deaths are relatively easy to track,” said Greg Hess, chief coroner of Pima County, Arizona. “In a death certificate, you would mention the fact that you diagnosed the person with Covid, and he died of viral pneumonia due to Covid. “

But other cases are less clear, said Hess. A patient can contract Covid-19 while in the hospital due to a hip fracture, which can aggravate his heart disease and diabetes. They could then recover from Covid-19, but eventually die due to the general deterioration of their health. “So now what happens on a death certificate? Well, it really depends on who is writing it, ”said Hess.

The system of recording deaths in the United States is fragmented. Although most deaths are declared by a doctor, when a patient dies at home and is not under the care of a doctor, a coroner or coroner will usually be called in to declare the death.

The study led by Stokes found that counties that used coroners, who are elected and may be laymen, had higher death rates from Covid-19 in excess than counties with coroners, who are appointed medical officers.

“They are going to vote for you. I am sure there is pressure, that is one of the difficulties of being elected, ”said Sally Aiken, coroner of Spokane County, Washington, and chairman of the board of directors for the National Association of Medical Examiners. “In these smaller areas, there are fewer voters, so it doesn’t take much to get rid of you.”

Death investigators are used to facing pressure from family members. “There are certain expectations that families have or certain narratives that they have in mind about the reason for the death of a loved one that can be contrary to or supported by what is available in the chart,” said Hess. “Sometimes, someone can adapt the way a death certificate is written to try to get some relief from a family member who may be bothering or harassing him.” There is no evidence that this is happening locally, he added.

Aiken said he investigated several deaths in which the family insisted that Covid-19 could not have played a role. “There is an element of pressure from certain individuals who, frankly, do not believe that Covid exists. So, they don’t want that on the death certificate, ”she said.

Most of them relented as soon as the deceased was tested, but she said a family insisted, even when a test was positive, that the other underlying conditions of their relatives were the real cause, rather than Covid-19.

“Families do not decide what goes on the death certificate, at least in my jurisdiction, but in some jurisdictions that probably influence what goes on the death certificate, particularly in borderline cases where someone has a significant underlying natural disease, so they get to Covid, ”said Aiken.

Covid-19 deaths are more likely to be lost in areas of the country where there is less testing. If a patient dies without a Covid-19 test, then it is up to the death investigator to choose to request a post-mortem test. Although Hess and Aiken have done this for all cases where Covid-19 is suspected, Hess said it is not possible for all coroners and coroners to do this systematically across the country. “There is simply no bandwidth in the system to do this,” he said. “There will be deaths that occurred during the course of this pandemic, where Covid was a component of the death, and that is not on record.”

The cost of requesting a test is also a deterrent, especially in areas where coroners have to pay for post-mortem tests outside their budgets, said Aiken. “This is probably not happening in some poorly funded and very rural death investigation systems,” she said. “Even though maybe they had an exposure, or you know, maybe the coroner doesn’t believe it, maybe the family doesn’t believe it, they just think they had the flu, got sick or died suddenly. “

Political beliefs and finance are not the only reasons why Covid-19 can be omitted on a death certificate. In New Jersey, the state health department stated that Covid-19 should be listed as the root cause, not the leading cause of death; the specific cause, such as pneumonia or heart disease, must be included on the death certificate.

Sherry Bensimon, a funeral director from New Jersey and New York on the board of the Metropolitan Funeral Directors Association, said she received death certificates that simply declare Covid-19 and, when she calls to explain that they will be rejected, doctors simply change a primary cause to another, without adding Covid-19 as an underlying cause. “I have seen this many times where doctors simply drop it,” she said. “They are exhausted, busy and have an undertaker chasing them.”

Unfortunately, Aiken said, even the most stringent system will miss out on some Covid-19 deaths. Most Covid-19 death certificates are signed by hospital or community doctors, who receive little training in how to sign death certificates. And there are many false negatives in Covid-19 tests, which have not been studied for their post-mortem accuracy.

The true number of deaths from Covid-19 may never be definitively determined, but deaths from the virus are certainly underestimated, said Aiken. “This is a real disease. People are dying. It shouldn’t be anything political, it should just be the truth. “