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Official counts understate the US coronavirus death toll

WASHINGTON — A coroner in Indiana wanted to know whether the coronavirus had killed a man in early March but said that her health department denied a test. Paramedics in New York City say that many patients who died at home were never tested for the coronavirus, even if they showed telltale signs of infection.

In Virginia, a funeral director prepared the remains of three people after health workers cautioned her that they each had tested positive for the coronavirus. But only one of the three people had the virus noted on the death certificate.

Across the United States, even as coronavirus deaths are being recorded in terrifying numbers — many hundreds each day — the true death toll is likely much higher.

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More than 9,100 people with the coronavirus have been reported to have died in this country as of this weekend, but hospital officials, doctors, public health experts, and medical examiners say that official counts have failed to capture the true number of Americans dying in this pandemic, as a result of inconsistent protocols, limited resources, and a patchwork of decision-making from one state or county to the next.

In many rural areas, coroners say they don’t have the tests they need to detect the disease. Doctors now believe that some deaths in February and early March, before the coronavirus reached epidemic levels in the United States, were likely misidentified as influenza or only described as pneumonia.

With no uniform system for reporting coronavirus-related deaths in the United States and a continued shortage of tests, some states and counties have improvised, obfuscated, and at times backtracked in counting the dead.

“We definitely think there are deaths that we have not accounted for,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins University Center for Health Security, which studies global health threats and is closely tracking the coronavirus pandemic.

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Late last week, the Centers for Disease Control and Prevention issued new guidance for how to certify coronavirus deaths, underscoring the need for uniformity and reinforcing the sense by health care workers and others that deaths have not been consistently tracked. In its guidance, the CDC instructed officials to report deaths where the patient has tested positive or, in an absence of testing, “if the circumstances are compelling within a reasonable degree of certainty.”

In infectious outbreaks, public health experts say that under typical circumstances it takes months or years to compile data that is as accurate as possible on US deaths. The reporting system during an epidemic of this scale is particularly strained. And while experts say they believe that virus-related deaths have been missed, the extent of the problem is not at all clear.

Public health experts say that an accurate count of deaths is an essential tool to understand a disease outbreak as it unfolds: The more deadly a disease, the more aggressively authorities are willing to disrupt normal life. Precise death counts can also inform the federal government on how to target resources, like ventilators from the national stockpile, to the areas of the country with the most desperate need.

For families who have lost a loved one, there is an urge to know: Was it the coronavirus?