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Death certificate data suggests higher number of COVID deaths than state's total

According to several municipal clerks around Long Island, the number of Long Island fatalities officially attributed to COVID-19 appears to significantly undercount the virus’ true toll. Huntington Town Clerk Andrew Raia spoke about it with Newsday's Matt Clark on Tuesday. Credit: Newsday / Matt Clark

This story was reported by Jim Baumbach, Matt Clark, Paul LaRocco and David M. Schwartz. It was written by LaRocco

The number of Long Island fatalities officially attributed to COVID-19 appears to significantly undercount the virus’ true toll, according to a Newsday analysis of death certificate data kept by municipal clerks.

From March 1 through April 21, New York State reported 2,357 coronavirus deaths in Nassau and Suffolk counties, a figure that may underrepresent the reality by nearly one-third, the analysis found.

Over that same period, towns, cities and villages surveyed by Newsday handled at least 6,866 death certificates, an increase of 3,462, or 102%, from the 3,404 handled during the seven weeks in 2019.

If the state’s 2,357 COVID-attributed deaths are subtracted from this year’s spike as provided by the clerks, the remaining 1,105 fatalities would still represent a 32% increase. Clerks and experts cited a variety of factors — from likely misclassified deaths early in the pandemic to nursing homes’ lack of resident testing — all tied to one thing.

"This can only be explained by COVID," said University of California, Irvine Associate Professor Andrew Noymer, who has been researching pandemics for more than 13 years.

The sheer number of excess deaths, Noymer said, cannot be attributed to typical causes like the aging U.S. population, which might provide a bump of about 4% per year.

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"The baby boomers getting older does not increase mortality by [32%], I guarantee you," he continued. "There is significant undercount of COVID mortality, according to your numbers."

Municipal clerk’s offices covering towns as large as Hempstead, with more than 760,000 people, to incorporated villages as small as a few hundred record deaths in their jurisdictions. Newsday requested data from all of Long Island’s 13 towns, its two cities and its 15 most populous incorporated villages, or ones with large hospitals. Clerks representing all of the towns, the City of Glen Cove and  more than a dozen villages provided the data, representing the vast majority of the Island’s population and all jurisdictions with hospitals.

To gauge the accuracy of the state’s fatality tally, Newsday relied on three figures:

  • The number of deaths recorded from March 1 to April 21, 2019, before the pandemic.
  • The number of deaths recorded during the same period in 2020, covering the weeks before the pandemic was recognized locally, but when cases were likely present, through the peak of cases.
  • The state’s official count of COVID-19 fatalities in Nassau and Suffolk.

State health department officials said they could not confirm or release the complete set of numbers that Newsday obtained through the individual clerks, pointing to state law, which limits the release of death certificate data. The state maintains the Electronic Death Registration System, used by the clerks to provide numbers in response to Newsday's survey, but only releases death statistics after a more-than-yearlong vetting process. The most recent data available on the state health department's website is for 2017.

“The New York State Department of Health goes to great lengths to validate all data reported from approximately 1,400 registrars statewide,” health department spokeswoman Jill Montag said. “We are in the process of doing that while also providing unprecedented levels of specific data in real time related to the ongoing COVID-19 pandemic.”

Montag said the state's coronavirus tracker counts deaths in hospitals and other facilities, as well as those registered elsewhere, although death certificates may be delayed by up to 72 hours. A small percentage of medical examiner and coroner cases may be in a pending status, she said.

Despite the state’s reluctance to confirm the local clerks’ data, other experts said it shows how the earliest official counts from a pandemic are often wrong.

“You know that metaphor of being in the fog of a war?” said Dr. Howard Markel, the director for University of Michigan’s Center for the History of Medicine, who has studied record-keeping during pandemics. “Well, you don’t really get the most accurate numbers until several weeks after you’re done, and that is true of almost every epidemic I’ve ever studied.”

It could take a year or more to fully tally the impact of COVID-19, said Dr. Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. So far, most government-reported data about cases are only confirmed cases and don’t capture those who died but were never tested.

“Officially reported deaths are likely an underrepresentation of deaths from COVID-19,” Nuzzo said.

Early testing limitations and home deaths of undiagnosed patients could be the key factors in the underrepresentation, said Sabrina McCormick, a George Washington University associate professor focused on environmental and occupational health.

But regardless of the reason, she said, officials should acknowledge that their official counts may not reflect the totality of impact.

“People think, ‘Here are the official numbers released daily and, therefore, I am going to make decisions about my risk and my safety based on these numbers,’” said McCormick, who has studied deaths in extreme heat events. “But if the numbers are inaccurate and we are not making the right decisions, we really need to acknowledge the uncertainty.”

Once the dust settles, Long Island’s town clerks will have been through an experience unlike any other in their municipal careers.

Hempstead, America’s largest township, is seeing death totals it typically wouldn’t reach until July.  For the March 1 to April 21, periods, the total spiked from 521 to 1,307.

“Every day, I say, ‘How many deaths today?’” said Hempstead Town Clerk Kate Murray, noting that on one recent morning, her head registrar prefaced a number with, “Kate, are you sitting down?”

The worst of the death toll came earlier this month, at a rate five and six times normal. In Oyster Bay, 102 death certificates were issued between March 30 and April 21, 2019. That jumped to 567 this year.

The town clerk’s office is issuing burial permits, normally on a two-day turnaround, well into May because of cemetery backlogs.

“These deaths are happening at a pace that we’ve never seen before,” said Oyster Bay Town Clerk Richard LaMarca. “Seeing the numbers spike like this, it really gets at you. It’s quite depressing, actually.”

Islip Town Clerk Olga Murray said her cellphone dings every time a funeral home files a death certificate, a number that increased from 372 during the 2019 period to 712.

“Definitely the majority have COVID-19,” she said.

Huntington Town Clerk Andrew P. Raia, who was elected to the post in November after 17 years as a New York State assemblyman, said what was once maybe two deaths a day at the start of his tenure had ballooned to nearly 30 deaths a day at one point.

"When you see somebody that you know — when you see somebody you had dinner with two weeks before they died — it really hits home," Raia said. "These are people that I've been on vacation with."

North Hempstead, which includes North Shore University Hospital in Manhasset — Long Island’s largest hospital — recorded 344 more deaths between March 1 and April 21 this year compared with 2019. Nearly 320 of this year’s deaths are known to be COVID-related, said Town Clerk Wayne Wink, meaning the difference is almost entirely driven by the virus.

“It’s grueling in that there’s a human person and a family behind every one of these emails we get, and when you get 40 a day, it’s inevitable I’m seeing names I’m familiar with and friends of family,” Wink said. “You just don’t see them as statistics — sometimes to get through the day you have to view them that way — but they’re just not.”

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