The more positive tests for SARS-CoV-2 a New York neighborhood had in early 2020, the more sudden deaths occurred outside of hospitals there during the same period, a new study has found. Notably, these deaths weren't recorded as being COVID-19 related. Claims the death toll was inflated, with deaths from other causes being wrongly recorded as from COVID-19, had it backwards the new data suggests. Instead, COVID-19 was causing many deaths, directly or indirectly, that didn't make the official figures.
Mortality rates shot up in March and April in cities where the virus was common. Besides COVID-19 patients dying in hospital, the major mortality category was out-of-hospital sudden death (OHSD). In New York, the OHSD rate during the pandemic's first wave peak was almost three times what it had been the year before, suggesting a correlation between increased sudden deaths and the extent of infection in a neighborhood.
Scientific caution made epidemiologists reluctant to jump to the obvious explanation: people were dying of COVID-19 related conditions, but not being taken to hospitals either because medical facilities were overloaded, or the symptoms appeared too rapidly. Meanwhile, those keen on minimizing the seriousness of the virus played up uncertainty, often blaming the deaths on lockdowns or other attempts to control the crisis, rather than the virus itself.
Dr Stavros Mountantonakis of Lenox Hill Hospital in New York City reports in the journal Heart Rhythm that the rate of OHSD per 10,000 residents for New York zip codes varied from 0 to 22.9 between March 20 and April 22, an appalling number for a single month. Such variation doesn't fit well with city-wide control efforts being responsible, but provides plenty of scope to test for factors that might explain it.
Mountantonakis and co-authors started by comparing deaths with rates of positive tests for SARS-CoV-2 antibodies reported across the same zip codes. These also showed a wide variation, from 12.4 to 50.9 percent. Predictably, there was a substantial although far from perfect correlation.
This comparison alone can't rule out the possibility of other underlying causes (most obviously socioeconomic factors) that might make an area vulnerable to both increased COVID transmission and high deaths from other causes. To address this Mountantonakis compared his data with sudden deaths during the same weeks in 2019. This did indeed show some neighborhoods are more OHSD-prone even without a global pandemic, something health authorities might want to address.
Nevertheless, the distribution of OHSD in spring 2020 don't match those in 2019 well enough for this to be the whole story; COVID-19 hotspots played a major part.
“It remains to be seen whether this is due to cardiac complications related to the virus or poor access to healthcare in neighborhoods that suffered the most during the first wave of the COVID-19 pandemic," Mountantonakis said in a statement. Either way, the Mayo Clinic's Dr John Giudicessi points out in an accompanying editorial, the findings demonstrate the way to stop future OHSD deaths is to prevent the spread of the virus, and maintain access to health care, rather than blaming control measures.
