Michigan’s COVID-19 death toll is undercounted. So some want to test the dead.

A shortage in tests and autopsies mean many who die from COVID-19 will not be counted among its death toll. (Shutterstock image)


As the coronavirus death toll climbs in Michigan540 as of Saturday — another grim number will never be known: The dead who go uncounted as casualties of the worst pandemic in a century.

“I don’t know if our fatalities would be twice as many or 10 times as high, and we won’t know until we have ready access to tests,” said Dr. Russell Faust, medical director of Oakland County’s health division.

Because of a nationwide shortage of tests, there are few efforts to test the dead for coronavirus, especially for those who are elderly or have underlying conditions.

Oakland County is an exception, though, and has tested several bodies to avoid having to quarantine emergency workers who are called to help as people are dying. 

“The issue is there are a number of people who die ... outside of hospitals. EMS shows up and they do [cardiopulmonary resuscitation,] and the automatic assumption is that [the person’s] age or comorbidity — maybe emphysema — pushed them over the edge,” Faust said.

Without knowing if they’d been exposed to COVID-19, emergency crews would have to be quarantined for 14 days — something small towns can’t afford, Faust said.

Faust declined to say how many bodies had been tested, but he said a “handful” of those cases returned positive results.

“Had we not performed those tests, who would not have known they were COVID cases,” Faust said.

Tests remain at a premium in Michigan, whose hospitals and private labs have tested nearly 38,000 people for the virus as of Saturday. That’s roughly the same as Ohio and far fewer than Illinois, but Michigan has far more cases than its neighbors.

But nasal swab tests that detect the virus in mucus and saliva are increasing, and new tests have rolled out, including those that test the blood for antibodies produced by a COVID-19 infection.

In Detroit, infectious disease researcher Dr. Teena Chopra wants doctors at Detroit Medical Center to begin testing remains of patients whose deaths are suspected to be linked to COVID-19.

Doing so could bring the true impact of the virus into focus for the city, which officially had nearly 4,000 cases and 131 deaths as of Saturday.

Patients with coronavirus symptoms often die awaiting tests or results. Others died after tests indicate they were not infected with COVID-19, even though their symptoms matched the virus, said Chopra, an infectious disease researcher at Wayne State University who also leads infection control efforts at the DMC.

The reasons for the “false negatives” are unclear, she said.

“It may be that when we swab in [a certain stage of illness,] the virus is in a different place in its life cycle and is not detected. That’s a hypothesis only,” Chopra said.

    Dr. Teena Chopra is an infectious disease researcher at Wayne State University who also leads infection control efforts at the Detroit Medical Center.

    The U.S. Centers for Disease Control and Prevention has not recommended routine testing on deceased patients, although it released safety guidelines last week for postmortem testing.

    Clearer answers on causes of death may guide clinical protocols or pandemic planning, Chopra said. They also would allow policy makers to see the virus’ true impact on the state’s economy and social structure.

    There are also ethical and emotional considerations, she said.

    Family members deserve to know that health care workers and pathologists have done all they can to determine why their loved one died, Chopra said.

    It’s perhaps easy to understand how COVID-19 may go undetected considering how often it kills the elderly and those with underlying life-threatening conditions.

    Health care staff reported as much from the front lines early in the pandemic, and their reports were again confirmed this week in data released by the CDC.

    That report, released Tuesday and based on case reviews of 7,162 U.S. patients, found that people with diabetes, lung disease and cardiovascular disease face greater odds of the worst outcomes for COVID-19.

    While more than 1 in 3, or 37.6 percent, reported at least one underlying health condition or risk factor, they made up a larger portion (78 percent) of those in intensive care units than those who didn’t require hospitalization (27 percent).

    In the same review, researchers found that 173 of 184 patients (94 percent) whose full records were accessible had at least one underlying condition.

    For some, COVID-19 infection for some may appear nothing more than a bad cold — sneezing or coughing. 

    But a person who suffers from severe chronic obstructive pulmonary disease may incorrectly blame COPD for an onset of breathing difficulty when it was actually the coronavirus, according to Dr. Phillip Levy, professor of emergency medicine at Wayne State University and chief innovation officer for Wayne State University Physician Group. 
    Levy has led efforts for more routine COVID-19 testing of front-line responders in metro Detroit. Although testing capacity overall for the sick is “dramatically increasing,” Levy said, testing among the dead isn’t routine.

    The death of an elderly or very sick person may be assumed to be related to underlying conditions or age, said Mark Evely, director of Wayne State University’s mortuary science program.

    Undetected  COVID-19 deaths are “happening on a regular basis,” said Mark Evely, director of Wayne State University’s mortuary science program. 

    “For somebody who dies at home in their 70s or 80s with an underlying condition, the assumption is going to be atherosclerosis,  cardiovascular disease,” for example, he said.

    Nationally, there was no single set of protocols for death investigations even before the coronavirus pandemic. Practices vary across the United States, guided by different state laws and guidance by coroners, medical examiners, justices of the peace, and state and local governments, according to the National Association of Medical Examiners.

    Even if tests were readily available and performed and the deceased tested positive, that’s still not a determination of death and there’s no capacity for autopsies, noted Sally Aiken, the association’s president. 

    Plus, routine testing on the dead simply isn’t a priority at a time of scarce resources both in testing kits and in lab staff, leaving the true toll of COVID-19 impossible to calculate, she and others said.

    “Mass fatalities are subject to many practical considerations,” Aiken said.



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    Sat, 04/04/2020 - 7:51pm

    Uh, why not test those of us who are presumed positive but not test worthy because either we aren’t dying or answered no to the 3 CDC questions which are have you been to China? Have you traveled out of the country? Have you been exposed to someone confirmed positive? You answer no to these and you don’t get tested. This is ridiculous. These numbers are so much higher. And no one cares to test us. They want to do autopsy tests? Oh my gosh! What about us?

    Sun, 04/05/2020 - 12:02am

    It is actually much more likely that the numbers are overcounted.

    In Italy, if you die with covid-19 antibodoes in your system, the cause of death is always listed as coronavirus. However, in reality, the a large number of these deaths are actually the result of underlying health conditions - These people were at very high risk of death every time they caught a bug like the flu. You cannot say that the flu (or in this case, coronavirus) caused their death when they wouldn't have died without their underlying health condition. Take a moment and realize that being in your 80's (that is, being OLD) is in itself an underlying health condition. At that age, most people are lucky for every day they get.

    If we take the same approach as Italy, our numbers will be just as incorrect as theirs.


    Mon, 04/06/2020 - 5:40am

    How do you explain the deaths of otherwise healthy young people?


    Being old is not an underlying condition and underlying conditions alone do not kill these people, COVID 19 kills them.

    The issue is truth and truth can only be determined through testing, accurate inexpensive fast testing.

    Until the president invokes the full strength of the Defense Productions Act countless people will continue to needlessly die. It's that simple. We need local testing at local labs. All deceased people should be tested because if they test positive, in all likelihood, the virus killed them, not their underlying conditions. Why be afraid of over-counting rather than under-counting? We need to track the virus to contain it and understand it.

    Mon, 04/06/2020 - 11:08am

    Not about under or over counting. It’s about relevant usable data and what we can and are able to do with it. If a severely compromised patient say, stage 4 lung cancer or advanced emphysema, dies with corona virus or passes a couple weeks later with a common cold, what do we do with this? Maybe a picture of the spread? The death fact from a statistical vantage is a relatively meaningless issue and smacks a bit of propaganda since we have little certainty how anyone else or other nations are counting these individuals either. A healthy 20 or even 70 is of interest but that's not what was being argued.

    Wed, 04/08/2020 - 10:22am

    Uh, derp, how do you explain infants dying from the flu every year? Do you recall ever shutting the country down for that? Stop deflecting with unrelated/irrelevant arguments.

    Sun, 04/05/2020 - 6:26am

    Its bigger than we have been led to believe.

    Susan c
    Sun, 04/05/2020 - 8:42am

    Also means those that recovered also are not counted. Only those with respiratory issues are being tested. When writing an article the least you could do is consider both sides of the data!

    Sun, 04/05/2020 - 12:56pm

    Yes, test everyone, but definitely test the dead. Otherwise will won't have that option in the future to understand the full scope of the pandemic. We are failing in this fight miserably. Where is the five minute test the president was touting, the one he took? Why are we so behind with everything? Why won't the president use the Defense Production Act across the board so we can stop this in it's tracks with monitoring and needed supplies? We've seen this coming for a while because it presented in other countries and we're comporting ourselves like we have never seen this anywhere. I know two people who have died so far. This will touch everyone personally very soon. It's awful.

    Sun, 04/05/2020 - 11:42am

    '“I don’t know if our fatalities would be twice as many or 10 times as high, and we won’t know until we have ready access to tests,” said Dr. Russell Faust, medical director of Oakland County’s health division.'

    I appreciate Dr. Faust's frustration with the lack of testing, but I think it's important, especially these days, for folks in authority to carefully consider their words, when talking about the pandemic.

    Does Dr. Faust really believe that Covid-19 deaths might be 10 times what's being reported in Oakland County? The latest figures I've seen (from the NY Times) say there are 142 reported coronavirus deaths in Oakland County. Have there been 1400 more deaths in Oakland County in the past month, attributed to some type of respiratory problem (but not tested for Covid-19), than what there have been in a "typical" March/April 30-day period in the past?

    According to State of Michigan data, in 2018, there were 10,700 deaths reported in Oakland County.

    That's about 900 deaths per month. One might suspect that if there had been 1400 Covid-19 deaths in roughly a one-month period, that would stand out. The pandemic is very serious, and people making claims that minimize it are not helping - but neither are people who throw around numbers that exaggerate the problem, either.

    Wed, 04/08/2020 - 10:24am

    You are missing a key piece of data - The flu shot worked very well for this last season, and a lot of people that would normally have died during the flu season did not. Now normally they would have been taken by the next flu season but instead, coronavirus got them first. A vast majority of these people were already going to die, it's just happening all in a cluster in one time of the year instead of being spread out over a slightly larger time period next flu season.

    Sun, 04/05/2020 - 11:43am

    The cynical side of me says by artificially keeping the ability to test low the numbers look better than they would if there was full on testing of everybody. Not suggesting states are doing this. Perhaps coming from the federal level.

    Mon, 04/06/2020 - 5:51am

    Well when the president talks about all the states without stay-at-home orders, he suggests they are doing a better job of containment, like doing nothing is a good thing. Let's be real they just aren't testing, live or dead people. They have no idea how prevalent COVID 19 is in those states. "Nothing to see here, folks, because we're doing a great job, unlike those bad states." I trust Fauci, but not so much Birx. You need scientists to talk more than politicians. Scientists have to speak the truth and not try to please/praise the boss incessantly.

    Sun, 04/05/2020 - 12:42pm


    Mike Alexander
    Mon, 04/06/2020 - 1:07pm

    What I'd like to know is why is there so little testing in Michigan. We have lots more cases than Louisiana, but far less tests. Louisiana has less than half the population and a similar GDP per capita, and yet they manage to perform one-third more total tests than Michigan does. It is especially egregious when you consider tests per case 4.9 tests run per case compared to only 2.9 tests per case.

    Alistair Maclean
    Sat, 04/11/2020 - 5:24pm

    Probably the death counts are way inflated. The NIH is telling doctors to count anyone who dies who may have possibly had the Chinese flu as a statistic. And hospitals are being reimbursed by Medicare at twice the rate if the patient coded for having the Kung Flu. There is a lot of pressure to inflate these numbers.

    Mon, 04/13/2020 - 2:00am

    I lost my beloved brother on March 20. He died suddenly, unexpectedly and alone in Franklin Hills, Mi. We requested an autopsy, which was refused. The death certificate listed various issues, that, taken together, laid out massive organ failure. We suspect that he was overcome within hours by a cytokine storm. For those of us who have lost loved ones “returning to normal” is forever beyond reach. TEST THE DEAD! It’s the last blessing they can bestow on the living. My heart is broken. JRS 7/16/1961-3/20/2020.