WEDNESDAY, July 1, 2020 (HealthDay News) -- Nearly one-third of excess deaths in the early stages of the coronavirus pandemic in the United States were linked to causes other than COVID-19, but that doesn't mean that the virus didn't play a role in those deaths, a new study claims.
The researchers found there were just over 87,000 excess deaths in the United States between March 1 and April 25. Excess deaths are those above the number that would be expected based on averages from the previous five years.
Only 65% of the excess deaths that occurred in March and April were attributed to COVID-19, meaning that 35% were linked to other causes.
In the two most populous states -- California and Texas -- and in 12 other states, more than half of the excess deaths were attributed to an underlying cause other than COVID-19, according to study author Dr. Steven Woolf, director emeritus at Virginia Commonwealth University's Center on Society and Health.
Woolf said the data suggest that official death counts underestimate the actual number of pandemic-related deaths in America.
"There are several potential reasons for this undercount," Woolf said in a university news release.
"Some of it may reflect under-reporting; it takes a while for some of these data to come in. Some cases might involve patients with COVID-19 who died from related complications, such as heart disease, and those complications may have been listed as the cause of death rather than COVID-19," Woolf explained.
"But a third possibility, the one we're quite concerned about, is indirect mortality -- deaths caused by the response to the pandemic," he said. "People who never had the virus may have died from other causes because of the spillover effects of the pandemic, such as delayed medical care, economic hardship or emotional distress."
The researchers found a sharp rise in deaths from causes other than COVID-19 in states with the most COVID-19 deaths in March and April: Massachusetts, Michigan, New Jersey, New York -- particularly New York City -- and Pennsylvania.
At COVID-19's peak for March and April, diabetes deaths in those five states rose 96% above the expected number of deaths when compared to the weekly averages in January and February of 2020.
The five states also had spikes in deaths from heart disease (89%), Alzheimer's disease (64%) and stroke (35%).
In New York City, there was a 398% increase in heart disease deaths and a 356% increase in diabetes deaths.
In some cases, people may have died from heart attack or stroke because they didn't want to go the hospital because they feared getting the virus. Even those who did seek emergency care may not have been able to get the treatment they needed if the hospital was overwhelmed by pandemic cases, according to Woolf.
Other deaths may have been due to chronic health conditions such as cancer or diabetes that were exacerbated by the effects of the pandemic, or due to mental health struggles caused by job loss or social isolation, the findings suggested.
"We can't forget about mental health," Woolf said. "A number of people struggling with depression, addiction and very difficult economic conditions caused by lockdowns may have become increasingly desperate, and some may have died by suicide. People addicted to opioids and other drugs may have overdosed. All told, what we're seeing is a death count well beyond what we would normally expect for this time of year, and it's only partially explained by COVID-19."
The study was published July 1 in the Journal of the American Medical Association.
The U.S. Centers for Disease Control and Prevention has more on COVID-19.
SOURCE: Virginia Commonwealth University, news release, July 1, 2020