Texas passed a grim milestone Friday as the state reported 1,004 coronavirus deaths.
As the state proceeds into a second phase of economic reopening, Texas has confirmed 36,609 cases of the novel coronavirus and performed 477,118 tests, according to the latest state data. But experts say that morbid marker may actually have come days or weeks ago, pointing to numerous indicators that deaths related to the virus have been severely undercounted, largely due to scarce testing.
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“It’s not an accurate count at all,” Mark Hayward, a mortality statistics expert at the University of Texas at Austin, said of the official state figures. “There are a lot of deaths, probably, in Texas that were never identified as COVID-related deaths.”
The state’s first known victim of the virus, Eddie F. Roberts, died March 15. The 97-year-old mortician spent decades burying his neighbors in rural Matagorda County.
Since then, the virus has taken the lives of Texans young and old, male and female, many sick but some reportedly healthy. Among them were Phillip Perry, a beloved 49-year-old Waco principal who was leading a troubled middle school into a more successful future; 70-year-old Akbar Nurid-Din Shabazz, a Muslim chaplain for in Texas prisons who served as prayer leader to the first American prisoner to be executed by lethal injection; Bartolo Infante, a 72-year-old inmate in a prison near Texarkana; Selma Esther Ryan, a 96-year-old resident of an Austin assisted living facility whose older sister died of the Spanish flu more than a century ago; 52-year-old Anthony Brooks, a Live Oak city councilman, and his husband, 42-year-old businessman Phillip Tsai-Brooks.
Compared with other large states, Texas seems to have fewer to mourn. In New York, more than 21,000 people have died; in California, fatalities topped 2,500 this week. According to the COVID Tracking Project, more than a dozen states have already passed the threshold of 1,000 deaths, including Connecticut and New Jersey, whose populations are dwarfed by Texas’.
Still, experts acknowledge that Texas’ current figures offer an incomplete picture of the virus’s toll.
“I don’t know that we will ever be able to go back with any specificity and capture every COVID-19 death,” said Angela Clendenin, an epidemiologist and biostatistician at Texas A&M University School of Public Health. “We’re getting closer, as far as our ability to be accurate with cause of death, but there will always be a gap.”
To estimate an upper bound of possible coronavirus-linked deaths, some experts use the metric of excess deaths, comparing fatalities from year to year.
Provisional death counts from the Centers for Disease Control and Prevention found that Texas saw 824 more deaths than usual from March 22 to April 11 of this year. During the same time, Texas had reported just 249 deaths linked to the coronavirus.
Hayward said undercounts were “probably huge” at the beginning of the outbreak in Texas, when tests were even more scarce and medical examiners and coroners may not have known to look for signs of the virus. Asymptomatic or mildly symptomatic patients may never have been tested at all, especially if they died outside hospitals.
Some COVID-19 patients with pre-existing conditions, like heart disease, may have died of them, but perhaps more quickly than they would have without contracting the virus. Cases like that make it difficult to pinpoint an exact tally.
“What really was the cause of death? Was it the cardiac condition or was it the COVID?” Clendenin questioned. “Can we really say that somebody who has a pre-existing condition would have had more days, or not?”
In many Texas counties, particularly in rural areas, coroners who mark cause of death have little or no medical training. Some are elected justices of the peace or even funeral directors, Hayward said, while urban areas are more likely to employ medical examiners who perform autopsies. There is likely a lot of variation in reporting across the state, he said.
“Everybody’s caught up with the numbers, and people tend to think that because somebody’s death isn’t in that count that maybe it didn’t matter,” Clendenin said. “But every death counts. Every death matters. Because we learn more and more about this disease.”
Ren Larson contributed reporting.