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The Covid-19 death count is highest in the pro-Trump areas

tFor millennia, the deaths of Covid-19 have not been reported in the United States, with many more being missed in counties that strongly supported former President Trump, according to a new study.

The figures suggest that political leanings have helped suppress the true scale of deaths. In cases where the deceased has not had a Covid-19 test, the forensic doctor or medical expert is free to interpret the symptoms.

“There is potentially freedom to make a sentencing decision based on a set of beliefs about Covid and whether it is a serious problem or a fraud,” said Andrew Stokes, a professor of global health at Boston University School of Public Health who conducted the STATISTICS analysis.


More than 41

3,000 people have died in the United States from Covid-19, attributed somewhere in their death certificate. The true number of deaths, as reflected in the number of redundant deaths in 2020 compared to the annual deaths from 2013 to 2018, is even higher. A separate study conducted by Stokes in 787 counties with more than 20 Covid-19 deaths from February 1 to October 17, 2020, found that although there were 199,124 Covid-19 deaths during that period, an additional overrun of 88,142 deaths were not attributed to the virus.

Some of these redundant deaths are probably due to factors that have been exacerbated by the pandemic, such as overdose and suicide in response to isolation and economic hardship, or underpaid health care in an oversized system. But researchers believe that many of the deaths of Covid-19 do not count. Overall, the true death toll from Covid-19 is 31% higher than official figures, according to a study presented to PLOS Medicine.


The researchers found that unreported Covid-19 deaths were significantly higher in rural areas than in urban areas; to the south compared to other regions; and in areas with lower levels of education. All of these factors tend to correlate with support for Trump.

The difference between redundant deaths and deaths officially attributed to Covid-19 is greatest in most rural areas and smallest in most urban areas.
Patrick Skerret / STAT
Source: Andrew Stokes

“We see a lot of variation in unnecessary deaths, and it’s hard to explain,” said Catherine Hempstead, another researcher in the study and a senior policy adviser at the Robert Wood Johnson Foundation. There appears to be a link between areas that are less likely to take Covid-19 seriously and take preventative measures, such as wearing masks and social distancing, and those with higher levels of unrecognized Covid-19 deaths, he said. she.

Not all variations in redundant deaths show a Trump effect: Lower-income counties that tend to vote for Democrats also have far higher levels of redundant deaths. But the Stokes preliminary study, which is not part of the larger study, explicitly examines political correlations and found that unnecessary deaths not attributed to Covid-19 are much more common in Trump-backed counties based on both presidential presidencies in 2020, and in 2016 the election results than the least.

There were a total of 44 redundant deaths in the country that were not officially recognized as Covid-19 for every 100 official Covid-19 deaths. But the untold deaths are far higher in 25 percent of the counties with the most Trump voters in 2020, with 163 redundant deaths for every 100 Covid-19 deaths. By comparison, there are only 18 redundant deaths per 100 Covid-19 deaths in the lower quarter of these counties.

During a pandemic, the response to Covid-19 is highly addictive, and politicized responses to the virus can easily shape the way death itself is recorded. Former President Trump has spoken out against testing, saying it has created more cases. Because patients are less likely to be registered as dead from Covid-19 if they have not been tested, this would contribute to the omission of cases.

Test absorption is likely to be lower in areas that are more conservative, Stokes said. “People who aren’t diagnosed are less likely to get Covid-19 at the time of death than people who are diagnosed.”

There were higher levels of unnecessary deaths not officially attributed to Covid-19 in the counties with the highest percentage of Trump voters than those with the fewest Trump voters.
Patrick Skerret / STAT
Source: Andrew Stokes

IIn areas where the pandemic is downplayed or seen as a myth, the death reporting process leaves room for those who do not take Covid-19 seriously to leave the virus out of the evidence of death. Covid-19 is usually the leading cause of death, leading to conditions such as pneumonia or heart attack, which is the more direct cause. In cases where someone has not been tested, coroners are free to attribute death to the more direct condition and leave Covid-19 entirely.

If someone is hospitalized with breathing problems, tested and found to have Covid-19 and dies from these breathing problems, then the virus is obviously the main cause. “These deaths are relatively easy to track,” said Greg Hess, chief medical expert in Pima County, Ariz. “In a death certificate, you would mention the fact that you diagnosed the person with Kovid and they died of viral pneumonia due to Covid. “

But other cases are less clear, Hess said. The patient may be diagnosed with Covid-19 while in hospital for a hip fracture, and this may worsen their underlying heart disease and diabetes. They could then recover from Covid-19, but eventually die from their deteriorating overall health. So what happens to a death certificate? Well, it really depends on who writes it, “said Hess.

The US death registration system is fragmented. Although most deaths are reported by a doctor when the patient dies at home and is not in the care of a doctor, usually a medical professional or coroner will usually be called to announce the death.

A study conducted by Stokes found that counties that used coroners who were elected and could be lay had higher mortality rates than Covid-19 than counties with medical experts who were appointed to medical care. employees.

Counties with selected forensic investigators had higher levels of unnecessary deaths not attributed to Covid-19 than those with medical experts.
Patrick Skerret / STAT
Source: Andrew Stokes

“They will vote for you. I’m sure there’s pressure, that’s one of the difficulties in choosing, “said Sally Aiken, a medical expert in Spokane County, Washington, and chairman of the board of directors of the National Association of Medical Experts. “There are fewer voters in these smaller areas, so it doesn’t take that much to get rid of you.”

Death investigators are accustomed to facing pressure from family members. “There are certain expectations that families have, or some stories they have in mind about why their loved one died, that may contradict or be supported by what is on the medical record,” Hess said. “Sometimes someone can adjust the way a death certificate is written to try to get some relief from a family member who may be bothering or annoying them.” There is no evidence that this is happening locally, he added.

Aiken said she had investigated several deaths in which the family insisted Covid-19 could not play a role. “There is an element of pressure from certain people who simply, frankly, do not believe that Kovid exists. So they don’t want that on the death certificate, “she said.

Most of them gave up after the deceased was tested, but she said one family insisted, even when the test was positive, that their relatives’ other basic conditions were the real cause, not Covid-19.

“Families cannot decide what the death certificate will contain, at least in my jurisdiction, but in some jurisdictions that are likely to affect what is in the death certificate, especially in borderline cases where someone has a major natural disease, then they get Kovid, ”Aiken said.

The South has higher levels of unnecessary deaths that are not due to Covid-19 than other regions.
Patrick Skerret / STAT
Source: Andrew Stokes

Covid-19 mortality is more likely to be missed in areas of the country where there are fewer tests. If the patient dies without a Covid-19 test, then the death investigator must choose to order a post-mortem test. Although both Hess and Aiken have done so for all cases where Covid-19 is suspected, Hess said it is not possible for all coroners and medical experts to do so systematically across the country. “There’s just no bandwidth in the system to do that,” he said. “There will be deaths that occurred during this pandemic where Covid was a component of death and was not registered.”

The cost of ordering a test is also a deterrent, especially in areas where coroners have to pay for post-mortem testing outside their budget, Aiken said. “This is probably not happening in some poorly funded, many rural death investigation systems,” she said. “Even maybe they were exposed or you know, maybe the investigator doesn’t believe it, maybe the family doesn’t believe it, they just think they got the flu or got sick or died suddenly. ”

Political beliefs and finances are not the only reasons Covid-19 can be left without a death certificate. In New Jersey, the state health department announced that Covid-19 should be cited as the primary, not the leading cause of death; the specific cause, such as pneumonia or heart disease, must be included in the death certificate.

Sherry Bensimon, director of funerals in New Jersey and New York on the Metropolitan Funeral Directors Association, said she received death certificates that simply listed Covid-19 and when she called to explain that will be rejected, doctors simply switch out one root cause to another without adding Covid-19 as the root cause. “I’ve seen many times when doctors will just leave him,” she said. “They are exhausted, busy and have to be chased by the funeral director.”

Unfortunately, Aiken said, even the strictest system would miss some Covid-19 deaths. Most Covid-19 death certificates are signed by hospital or municipal physicians who receive little training on how to sign death certificates. And there are many false negatives from Covid-19 tests that have not been studied for accuracy after death.

The true mortality of Covid-19 may never be definitively determined, but it is certain that deaths from the virus are reported less, Aiken said. “It’s a real disease. People are dying. This should not be something political, but just the truth. “

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