1/ THREAD: As of this morning, there have been 19,563 deaths in NYC reported as confirmed or probable #COVID19. Staggering. But also an undercount, as detailed in a new @CDCgov report. bit.ly/35SRiLm 
2/ The toll from Mar. 11 to May 2 includes 13,831 confirmed deaths (people who died and tested positive for SARS-CoV-2) as well as 5,048 probable deaths (those for whom the virus is listed by their physician as an immediate, underlying, or contributing cause of death).
3/ This graph shows that, during this period, there were 24,172 excess deaths—the number of people who died during this time above usual rates. That leaves 5,293 (!) excess deaths not confirmed or probable #COVID19. (24,172-13,831-5,048=5,293.)
4/ So what killed these 5,293 people? Some had #COVID19 but weren’t tested, diagnosed, or cared for. False-negative results are possible.
5/ Many patients died at home before they could access care or get tested for the virus. My friend and colleague Dr. Tony Dajer, working in a downtown Manhattan hospital, told me, “We’re seeing no angina.” n.pr/2LmsjXr
6/ For people with heart disease and diabetes, doctors may not have recognized their conditions as caused/exacerbated by #COVID19.
7/ Patients without #COVID19 who were in need of care may have avoided getting care because they were afraid of getting infected. on.wsj.com/3bvyset
8/ So, the 5,293 “excess” deaths are a combination of people who died from unrecognized #COVID19, people who died because they couldn’t get the care they needed during the pandemic, and people who died because of indirect effects of the pandemic.
9/ Many of these are people who were AFFECTED by the virus, but not INFECTED by it.
10/ Our goal isn’t merely to save lives from the virus, it’s to save lives. Every life is a universe.
11/ This problem—of deaths from the pandemic but not the virus—is a particularly horrifying risk in Africa, which has many fewer elderly people but much higher rates of other diseases that'll kill if health care is interrupted. Malaria is just one example. bit.ly/35R8AZy
12/ Protecting health care workers so health care can continue is a crucial component of confronting #COVID19 in every country. Safer health care enables a more robust response to the pandemic and ability to keep life-saving care going.
13/ It’s essential to analyze all-cause mortality when calculating the human toll of #COVID19. To put it into perspective, in 2017 (the most recent year for which a report was published) there were 54,314 NYC deaths by any cause in the ENTIRE YEAR. on.nyc.gov/3ctcVEy
14/ In Africa and elsewhere, @ResolveTSL is working with @WHO including @WHOAFRO to promote “Rapid Mortality Surveillance,” a new method of knowing, each day, how many people have died. More to come from us soon. Stay tuned.
15/ As William Farr wrote: “The death rate is a fact. Everything else in an inference.”
16/ By tracking deaths, we can have a safeguard that we’re not missing large outbreaks. We can also document more fully—as NYC has done—the human impact of the virus. And we can strengthen information systems that protect life.
17/ Each one of these deaths is a tragedy. There is a story behind each number. Thank you to publications such as @THECITYNY and @nytimes for collecting information on and memories of people we've lost. bit.ly/2Lj5HqV
