COVID’s death toll in North Carolina far exceeds the official count | Opinion
On March 25, 2020, North Carolina reported its first COVID-19 death – an unidentified Cabarrus County resident.
Almost three years later, the state Department of Health and Human Services reports that North Carolina’s COVID deaths have reached 28,432. But that number, as terrible as it is, does not account for the pandemic’s full fatal impact.
Around the world, the nation and in North Carolina, mortality rates over the past three years rose to levels only partially explained by deaths directly attributed to COVID. What accounts for the remainder?
For now, public health officials, epidemiologists and biostatisticians can only speculate, but it’s clear COVID was deadlier than the official numbers show.
Zack Moore, the state epidemiologist, said, “We have numbers that we have, but we’ve always tried to communicate that these don’t reflect the whole picture of deaths related to the pandemic.”
One explanation for the shortfall, Moore said, is patients’ fear of getting COVID by visiting medical facilities reduced the detection or treatment of cancer, diabetes, heart disease and other conditions.
“That’s definitely a factor that played into some of those excess deaths due to causes that weren’t flagged in our system as COVID deaths,” he said.
Just how much the official toll underestimates COVID-related deaths is difficult to assess, but the federal Centers for Disease Control and Prevention (CDC) has a website that shows how many deaths have exceeded normal mortality rates.
Justin Lessler, an epidemiology professor at the University of North Carolina at Chapel Hill, reviewed the CDC website for North Carolina’s numbers. Since March 2020, he said, the state’s deaths exceeded those that would be normally expected by 39,685 – more than 11,000 above the state’s count of COVID deaths.
Some of the gap may be explained by a lack of COVID testing early in the pandemic and deaths at home that were not attributed to the virus. Lessler said there may be an additional explanation: Some people who survived COVID infections may have been left more vulnerable to other illnesses or conditions that caused their deaths.
“It looks like almost 40,000 people more than expected died between March 2020 and today from something,” he said. “And the biggest difference there in terms of a health threat is COVID. So, if you don’t believe it was COVID, you need some alternate explanation for why these people are dying. I don’t think anybody has ever offered a plausible alternative explanation for the overall increase in mortality.”
Now that vaccines and limited immunity acquired by infection have sharply reduced deaths from COVID, some say that many state governments overreacted to the virus. But as more analysis reveals a higher number of deaths during the pandemic, the lesson may be that more prevention was needed. That’s particularly true in rural counties where public health systems were weak and resistance to vaccines and masks was strong.
Joe Wasserman of the Center for Health Analytics, Media and Policy at RTI International, said deaths above the expected mortality rates spiked in North Carolina’s rural counties. Most rural counties have death rates 10 to 55 percent higher than expected, he said, while death rates in large urban counties, including Wake and Mecklenburg, are 5 to 25 percent higher.
One misstep in the COVID response was underestimating the persistence of the virus and the various effects of past and new COVID infections.
“If we had planned for a longer battle with the virus, we would have better contained its impact,” Lessler said. “Clearly we are at or past the time to change the way we deal with it from an acute emergency to a persistent health threat, but that doesn’t mean forgetting about it. The strategy needs to be focused on long-term risk management and treatment because it’s going to be here for a while.”
Associate opinion editor Ned Barnett can be reached at 919-829-4512, or nbarnett@ newsobserver.com
