Two recent, related COVID news items:

  • The U.S. death toll from COVID passed 750,000 earlier this month, according to both the National Center for Health Statistics and Johns Hopkins University. JHU further estimates that world COVID deaths have topped 5 million.
  • A new Kaiser Family Foundation poll indicates that nearly two-thirds of Americans either believe “the government is exaggerating the number of COVID deaths” (38%) or at least they don’t know it’s not exaggerating (22%).

History provides plenty of reasons to be skeptical of government pronouncements. But in this case, I believe the U.S. COVID death numbers are either spot-on or underestimate the count. I’ll explain why below.

But before doing so, let’s take a moment to consider some of the reasons people give for why they don’t accept the COVID numbers. I’ve encountered some who believe that authorities are outright fabricating the death count. Others, however, believe the numbers are inflated because of various classification errors:

  • Some people who were not infected with COVID, but who died of causes like influenza & pneumonia and chronic lower respiratory disease that have similar symptoms to COVID, are being wrongly attributed to COVID.
  • Some people who were infected by COVID but died of other causes are being wrongly attributed to COVID.
  • For some people, COVID may have been the immediate cause of death, but these people were in deteriorating health already, so COVID isn’t really increasing the national death toll as much as the numbers suggest.

Those explanations aren’t unreasonable, but I don’t think any of them are distorting the NCHS and JHU numbers. My evidence for this comes from a fascinating, if macabre, series of publications: the Centers for Disease Control’s annual Morbidity in the United States reports. Those, in turn, aggregate data from the CDC’s Morbidity and Mortality Weekly Reports, which are generated using death certificate information submitted by state health departments.

The reports provide snapshots in time of what kills Americans. In recent years, year-end and year-out—until 2020—around 0.85% of U.S. residents died each year. To be more accurate, over the years 2012–2019, the percentage of Americans dying each year grew from 0.81% to 0.87%.

This increase is attributable to the aging of the American population, with the median age growing by one year over the eight-year time span. Because many causes of death correlate with aging, an older America means a slightly higher percentage of Americans die each year. For that reason, the CDC reports include age-adjusted data for comparing death rates over different years (and different diseases and geographic areas). Figure 1 presents both the “raw” and age-adjusted death rates for the United States for 2012–2019. Notice that as the raw rate increases from 810.3 to 869.5 deaths per 100,000 people per year, the trend for the age-adjusted rate is basically flat, varying between 723.6 and 741.3.

Not only does the age-adjusted death rate hold steady over this time frame, but so do the rates for most of the top 10 causes of death. These are graphed in Figure 2. The top two killers by far are heart disease and cancer, combining for nearly half of all U.S. deaths. (A bit of good news: notice that both are trending downward, indicating some success in combating these killers.) Significantly below them are deaths from unintentional injuries, chronic lower respiratory disease, stroke, Alzheimer’s disease, diabetes, influenza & pneumonia, kidney disease, and suicide. (And a bit of bad news: notice the upward trends in unintentional injury and Alzheimer’s deaths.)

But things changed in 2020. Total deaths jumped from 2,854,838 in 2019 to 3,358,814, according to provisional CDC data. The raw death rate for 2020 rose by 17.7% (while previous years ranged from 0.6% to 3.3%), from 869.5 to 1,019.4 per 100,000. The age-adjusted rate increased 15.5%, from 723.6 to 835.4. A new cause of death had become the nation’s #3 killer, with an age-adjusted death rate of 85.0: COVID. See Figure 3.

Meanwhile, the top-10 causes of death over 2012–2019 basically continued along their long-term trends. There’s no indication that deaths from influenza & pneumonia and chronic lower respiratory disease were being wrongly included in the COVID 19 deaths: the age-adjusted death rate from flu & pneumonia increased from 12.3 to 13.1 (despite all of the social distancing, sanitizer use, and mask-wearing), while the rate for chronic lower respiratory disease fell only from 38.2 to 36.4. No other causes of death experienced significant declines.

Moreover, though COVID’s dead were predominantly aged, it doesn’t appear that much of that death toll can be dismissed as simply depriving a few weeks of life from already-deteriorating victims. Again, half-a-million-plus more people died in 2020 than 2019.

Something else worth noting: As previously said, a half-million more people died in 2020 than 2019, but the CDC attributes only 345,323 of those deaths to COVID. It’s possible that future analyses will indicate that another 50,000 to 100,000 deaths should be added to that count.

And the grim beat has continued in 2021. In the first quarter of this year, the total age-adjusted death rate rose to 898.7 per 100,000 and the age-adjusted rate for COVID increased to 149.6, again according to provisional CDC data. This was before the more transmissible delta variant became dominant in the United States. An additional 400,000+ COVID deaths so far in 2021 seems likely, if not low.

So, I doubt the grim government death statistics for COVID are exaggerated; if anything, they’re optimistic.


Thomas A. Firey is a Cato Institute senior fellow and managing editor of Cato’s policy journal Regulation

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