Counting COVID-19's Toll in New York City: 24,172 Excess Deaths in Spring 2020

On March 11, 2020, the World Health Organization declared COVID-19 a pandemic, and New York City recorded its first confirmed COVID-19 death. By May 2, the city had counted 13,831 laboratory-confirmed and 5,048 probable COVID-19 deaths. The city's health department asked how many deaths the pandemic had really caused.

Why confirmed counts fall short

Confirmed and probable counts miss people who were never tested, tested falsely negative, were infected after a negative test, died outside health care, or whose doctors didn't suspect COVID-19 — and they miss deaths caused indirectly by the pandemic. Excess deaths — deaths above the normal seasonal baseline, from any cause — capture the full impact.

The method

The health department's electronic death reporting gives a near-complete, near-real-time count of all deaths in the city. A seasonal regression model, the same kind used to track flu seasons, estimated expected deaths from data for January 2015 to May 2, 2020.

The results, March 11–May 2, 2020

Daily deaths in New York City: confirmed and probable COVID-19 deaths, and estimated all-cause excess deaths. NYC Department of Health and Mental Hygiene, via CDC.

The missing 5,293

These deaths may have been caused directly or indirectly by the pandemic:

• COVID-19 deaths among people with heart disease, diabetes or other chronic conditions may not have been recognized as such.
• Social distancing, overwhelmed hospitals and fear may have led people to delay or miss lifesaving care.

How many fall in each group is unknown. Excess-death counting captures factors that coincide with the pandemic without being caused by it — such as other infections circulating in the 2019–20 flu season — and did not account for reporting lags. But all-cause mortality surveillance is faster and more inclusive than counting diagnosed COVID-19 deaths alone.

Sources

Based on New York City Department of Health and Mental Hygiene COVID-19 Response Team, "Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak — New York City, March 11–May 2, 2020," MMWR, early release May 11, 2020; published by the Centers for Disease Control and Prevention and in the public domain.