Further, in the midst of a large outbreak, there is an unavoidable delay in compilation of death certificates and ascertainment of cause of deaths, which contributes to uncertainty about severity and burden. Even in situations of ample testing, deaths from viral pathogens, including SARS-CoV-2, can occur indirectly via secondary bacterial infections or exacerbation of chronic conditions. With the limited availability of testing for the novel coronavirus and imperfect sensitivity of the tests, 3, 4 there have undoubtedly been a number of deaths caused by the virus that are not counted in official tallies. Typically, a large proportion of deaths caused by infectious diseases are not attributed to a specific pathogen. 2 Although most countries have adopted the strategy to preferentially test severe cases, estimating the number of severe infections and deaths caused by COVID-19 will be a challenge. Without adequate capacity to test for the SARS-CoV-2 virus causing COVID-19 for much of February and March 2020, available laboratory-confirmed cases captured only an estimated 10–15% of all infections.

Many countries, including the US, were caught off-guard by the speed with which COVID-19 spread from China. 1 Tracking the severity and impact of COVID-19 is, at the time of writing, a critical need, hampered by testing issues and reporting lags for key epidemiological indicators. The novel coronavirus SARS-CoV-2 first emerged in December 2019 in Wuhan, China and rapidly grew into a large-scale global pandemic.

Us covid deaths earlier than thought