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While Donald Trump painted himself as the country's cheerleader last week, by Saturday he was predicting many coronavirus COVID-19 fatalities this week. To go along with that confusion, public health experts and government officials agree that the extremely large pandemic death toll in the United States has been underestimated.
With some disapproving voices stating the Trump administration hasn't done enough to handle the lack of ventilators for struggling COVID-19 patients, Trump complained that some governors are asking for more units than they will actually need.
"Fears of shortages have led to inflated requests," he said of the requests the White House has received from governors hoping to score some from the strategic national stockpile.
To date, the United States has the world's highest recorded number of known cases of COVID-19. On Sunday the total number of people who had tested positive was counted as 337,925, while the number of deaths stood at 9,664, a number that is sure to reach past 10,000 on Monday.
Trump wasn't alone with the grim prognostication. The White House Coronavirus Task Force announced an estimate last week predicting the U.S. could see between 100,000 and 240,000 deaths due to the coronavirus pandemic, but they remain hopeful that with stringent guidelines, this number can be reduced.
"We are coming up to a time that is going to be very horrendous," Trump continued at the White House on Saturday. "We probably have never seen anything like these kind of numbers. Maybe during the war, during a World War One or Two or something."
New York Gov. Andrew Cuomo announced the unimaginable number of 630 people who died in his state on Friday. Health experts believe New York will reach its peak in the pandemic in about a week.
"We're not yet at the apex, we're getting closer. ... Our reading of the projections is we're somewhere in the seven-day range," Cuomo said on Saturday. "It's only been 30 days since our first case," he continued. "It feels like an entire lifetime." His brother, CNN host Chris Cuomo, is battling COVID-19 from home.
While facing these grim statistics, experts and officials have admitted the virus is most likely wiping out a larger number of Americans, as there are many deaths not attributed to COVID-19 yet should be.
The Centers for Disease Control and Prevention only includes deaths of people who had been confirmed by a lab test to have COVID-19. "We know that is an underestimation," said Kristen Nordlund, agency spokeswoman.
Epidemiologists say there was a lack of tests earlier in the outbreak that was later identified as a pandemic by the World Health Organization. To this day there are still some who die at home or in overwhelmed nursing homes who have not been tested.
The process of postmortem testing by medical examiners differs throughout the nation. Some officials reason that testing those who have passed is not a wise use of limited resources that could do more for those who still have a fighting chance. Additionally, there are also false negatives with the test.
Scientists who regularly analyze mortality statistics from influenza, as well as other respiratory illnesses, believe it's too early to estimate how many COVID-19 deaths have not been included in the total. They believe deaths among those who tested positive are only a fraction of the entire deadly path the virus has caused.
"You can't rely on just the laboratory-confirmed cases," said epidemiologist Marc-Alain Widdowson, who left the CDC last year. He's now the director of the Institute of Tropical Medicine Antwerp in Belgium. "You're never going to apply the test on everybody who is ill and everybody who dies. So without doubt — it's a truism — the number of deaths are underestimated globally because you don't apply the test."
West Virginia's "coronavirus czar," Clay Marsh, agrees, acknowledging that the state's number is most likely incorrect. West Virginia was the last state to report a positive COVID-19 case. To date, only three deaths have been recorded there.
"Based on the best recent information about limited testing and sizable false-negative rates of testing, we are likely underestimating the number of deaths," added Marsh, who is the vice president and executive dean for health sciences at West Virginia University. He also believes the number is low because of its small, rural population and because the state closed schools and nonessential businesses early in the process.
The CDC is now trying to use national data on illnesses, hospitalizations, and death certificates to estimate the total of COVID-19 infections and deaths. These types of statistics are already posted weekly for influenza, with the realization that laboratory-confirmed cases and deaths are only a fraction of the total number.
"We're probably getting more information on COVID-19 because there's a greater awareness in the community of what it is," said Nordlund.
The national death toll is being politicized, which could also be why the true number is not known. Trump's allies say the official number is higher than it should be because it includes all the people who died after testing positive even if there was another cause of death, such as cancer or heart disease.
Epidemiology professor Marc Lipsitch of Harvard said there are probably people dying WITH COVID-19 who are not dying OF the virus. He notes it's a problem with any cause of death. Yet, it's a minor issue that is "swamped by the opposite problem: deaths that are caused by COVID but never attributed, so the death count is underestimated."
It's also been questioned whether some countries report lower numbers purposely. There were 31 recorded COVID-19 deaths in Nembro, a town in northern Italy. However, the town's mayor, Claudio Cancelli, said the total number of those who died in that timeframe was 158. That number is four times higher than the average for that time of year.
"The difference is enormous and cannot be a simple statistical deviation," wrote Cancelli in a newspaper article that was co-written with a medical executive.
France started including previously unreported COVID-19 deaths in nursing homes, which added more than 2,000 deaths to the total.
China, where the novel coronavirus originated, has been accused of intentionally reporting lower infection and death rates. Some media outlets have counted cremation urns in Wuhan and noted there has to be a much higher death count than 2,500.
Trump said last Wednesday that China's "numbers seem to be a little bit on the light side, and I'm being nice when I say that." Chinese officials deny adjusting the total and have said U.S. officials are trying to pass the responsibility for the number of American deaths onto them.
The official number of U.S. COVID-19 deaths is also lower because deaths caused by the virus weren't being recorded until March 24, weeks after the first U.S. death. Using death certificate data is part of the CDC's new effort to more correctly estimate the total number of COVID-19 deaths.
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