COVID-19 Ripple Effects Mean Related Deaths Likely Undercounted

COVID-19 Ripple Effects Mean Related Deaths Likely Undercounted Interview with:

Dr. Woolf

Steven H. Woolf, MD, MPH
Center on Society and Health
Virginia Commonwealth University School of Medicine
Richmond What is the background for this study?

Response: Our concern since the pandemic began was that lives would be lost not only to the virus but also to the ripple effects of how society responds to the crisis, such as reduced access to health care, extreme economic hardships, and psychological stress. What are the main findings?

Response: The main finding of our study is that COVID-19 explained only two thirds of the excess deaths that occurred in the first weeks of the pandemic (March-April 2020). The remaining deaths were attributed to causes other than COVID-19. Although some of these cases could represent delays in, or miscoding, of deaths from COVID-19, a certain number may have involved people who died of causes unrelated to the virus.

The second major finding is that the 5 states with the most COVID-19 deaths during those early weeks (NY, NJ, MA, MI, PA) saw huge spikes in deaths from heart disease, stroke, diabetes, Alzheimer’s disease, and other causes. What should readers take away from your report?

Response: Readers should know that the alarming number of COVID-19 deaths they hear on the nightly news is unfortunately an undercount. The pandemic is claiming thousands more lives than these daily tallies would suggest. People in cities and states now experiencing surges in COVID-19 deaths, particularly public officials and health systems, should expect spikes in deaths from conditions other than COVID-19 and should institute systems to ensure people in their communities can receive care for all urgent physical and mental health needs. What recommendations do you have for future research as a result of this work?

Response: Further research is needed to determine how many of the the excess deaths not attributed to COVID-19 occurred among people who were infected with the virus and died from unrecognized complications or among people who were not infected but died of other causes. These people may have died from the ripple effects of the pandemic, such as delays in care for acute emergencies, poor management of chronic diseases because of poor access to doctors or medical supplies, or stresses that compound depression or addiction, leading to suicides or drug overdoses. Is there anything else you would like to add?

 Response: As noted, one third of the excess deaths that occurred in nationwide were attributed to causes other than COVID-19, but the undercount was worse in some states. Notably, in the two most populous states—California and Texas—more than half of the excess deaths were linked to causes other than COVID-19. 


Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess Deaths From COVID-19 and Other Causes, March-April 2020. JAMA. Published online July 01, 2020. doi:10.1001/jama.2020.11787


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Last Modified: Jul 7, 2020 @ 12:15 am 

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