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Previous studies of excess deaths (the gap between observed and expected deaths) during the coronavirus disease 2019 (COVID-19) pandemic found that publicly reported COVID-19 deaths underestimated the full death toll, which includes documented and undocumented deaths from the virus and non–COVID-19 deaths caused by disruptions from the pandemic.1,2 A previous analysis found that COVID-19 was cited in only 65% of excess deaths in the first weeks of the pandemic (March-April 2020); deaths from non–COVID-19 causes (eg, Alzheimer disease, diabetes, heart disease) increased sharply in 5 states with the most COVID-19 deaths.1 This study updates through August 1, 2020, the estimate of excess deaths and explores temporal relationships with state reopenings (lifting of coronavirus restrictions).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: September 15, 2020.
Corresponding Author: Steven H. Woolf, MD, MPH, Center on Society and Health, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, 830 E Main St, Ste 5035, Richmond, VA 23298-0212 (firstname.lastname@example.org).
Published Online: October 12, 2020. doi:10.1001/jama.2020.19545
Author Contributions: Drs Woolf and Chapman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Woolf, Chapman, Sabo, Weinberger.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Woolf, Sabo.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: All authors.
Administrative, technical, or material support: Chapman.
Supervision: Woolf, Chapman.
Conflict of Interest Disclosures: Dr Weinberger reported receiving personal fees from Pfizer, Merck, Affinivax, and GlaxoSmithKline outside the submitted work and being the principal investigator for a research grant from Pfizer to Yale University. No other disclosures were reported.
Funding/Support: Drs Woolf and Chapman and Ms Hill received partial funding from grant UL1TR002649 from the National Center for Advancing Translational Sciences. Drs Woolf and Chapman also received partial funding from grant R01AG055481 from the National Institute on Aging. Dr Weinberger was funded by grant R01AI137093 from the National Institute of Allergy and Infectious Diseases.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Cassandra Ellison, MFA, art director for the Virginia Commonwealth University Center on Society and Health, for her assistance with graphic design; she was not compensated beyond her salary.
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