4 reasons why U.S. coronavirus death toll likely underreported: media

Far from being inflated as alleged by the Trump administration and its supporters, the COVID-19 death toll in the United States is likely underreported, according to a HuffPost report on Sunday.

"The crisis is devastatingly real. And far from being exaggerated, experts believe the true number of people who have died from COVID-19 is actually higher than what's been reported -- nearly 80,000 in the U.S. so far," said the report.

The report listed four reasons why the coronavirus death toll is most likely an undercount instead of an overcount.

First, "there was a massive testing shortage early on in the crisis."

"With so few tests, the agency essentially had to ration them. There are certainly more people who got sick with COVID-19 toward the beginning of the crisis than are part of the official record, and some of them probably died. Just how many more is unclear," said the report.

Second, "We don't know exactly when the virus arrived here and where it went."

New York Governor Andrew Cuomo estimated that more than 10,000 residents might have contracted the disease by the time his state confirmed its first official case on March 1, the report said.

"There are probably lots of unreported deaths in March in the big cities in the northeast and maybe Southern California," Dr. Eili Klein, a professor of emergency medicine at Johns Hopkins University, told HuffPost.

"There are probably very, very few unreported deaths in other parts of the country," Klein added.

Third, "it can be difficult to decide how to fill out a death certificate when someone with the virus had a major underlying illness, and states aren't all doing it the same way."

"What exactly killed a patient can sometimes be a tough question for doctors and medical examiners in charge of filling out the certificates in normal times. In the current crisis, figuring out how many people have died because of the virus is complicated by inconsistent reporting practices between the states," said the report.

"Even though testing capability has improved vastly across the country since February, tests are prioritized for the living -- meaning that it can be difficult to confirm a patient had COVID-19 after their death," it said.

Fourth, "with so many variables, public health experts say that looking at 'excess deaths' may actually be the key to understanding the virus' true impact."

"In many states, the number of recorded COVID-19 deaths is actually smaller than the number of excess deaths from any other cause during certain weeks," the report said.

"New Jersey documented around 5,500 excess deaths over a four-week span between March and April, but only about 2,200 of them were categorized as COVID-19 deaths, according to a New York Times analysis. That leaves a gap of some 3,300 deaths," it said.

"In New York City, the number of people dying at home is six times higher than normal, according to a mid-April ProPublica report. In Detroit, the number is almost four times higher," it said.

"All told, a full picture of the virus' deadly impact will probably not be known for several more months," the report concluded.