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Institute Estimates 40% More Florida COVID Deaths Than State's Tally

Florida still performs better than most states when it comes to reporting deaths, according to the Institute for Health Metrics and Evaluation. USF epidemiologist Jason Salemi breaks down the numbers.

More than 51,100 Floridians have died from COVID-19 in Florida, according to estimatesfrom the Institute for Health Metrics and Evaluation.

The research institution, based out of the University of Washington, produces COVID-19 models that have been closely watched by health officials around the country throughout the pandemic.

This month, the IHME updated its projections to reflect its own calculations of COVID-19 deaths, rather than figures reported by states and countries.

It’s estimate for Florida is about 40% higher than the nearly 37,000 deaths reported by the Florida Department of Health as of Wednesday.


The IHME explains how it conducted its analysis here.

Health News Florida's Stephanie Colombini talked about what these projections mean with Jason Salemi, an epidemiologist with the University of South Florida:

To get these new estimates, the IHME looked at how many more people died this year and last year than were expected to die had the pandemic never happened. And then it tried to factor in whether things like delaying health care or drug overdoses would have increased deaths, and also whether the pandemic reduced deaths in other areas like the flu or traffic fatalities.

Their conclusion overall was to assume, for now, that all excess deaths we've seen are due to COVID-19. Why are their numbers higher than what's been reported?

I think we've known from the beginning that it's an immense challenge, not just for Florida, but for every other state in the United States and every country in the world to try and accurately estimate all things COVID.

You think back in particular to early on in the pandemic, when we didn't have expansive testing. It could have been, especially in these long-term care facilities, that people were dying from COVID-19, but because we weren't able to test them, they never tested positive, maybe they didn't eventually get flagged as having died from COVID-19. We just tracked it as another death. And so for that reason, and many more throughout the pandemic, we think we might be under-counting certain COVID-19 metrics.

This is just one group's effort to try and quantify that under-estimation, and give us a sense of what they think is the true number of COVID-19 deaths.

You looked at the ratios the IHME calculated to sort of rank the degree of underreporting in states, where does Florida stand compared to the rest of the country?

So the United States average ratio was 1.58, that is, relative to what's being reported, we think the number of deaths that were actually due to COVID-19 was 58% higher. And so, Florida actually fell below that their ratio was 1.41, 41%, underreporting. I think ultimately it ranked 16th-lowest among all states.

And when you look at the five largest states in the U.S., again Florida was right in the middle of the pack. New York and Illinois were estimated to have slightly less underreporting, and Texas and California were reported to have slightly larger underreporting. Just to give you a point of comparison, whereas Florida’s ratio was 1.41, California’s was 1.93, 93% underreporting.

So again there’s a lot that underlies these estimates, there’s a lot that goes into very complex statistics and a lot of assumptions you have to rely on, but if we trust the IHME’s approach to estimating underreporting, then Florida looks like they’re doing pretty well, they’re not at either of the extremes.

What can we take away from these estimates?

Ultimately, we need context, we want to do comparisons, because it's very easy to point out, like I could have said, “Well, the IHME found that Florida had this ratio of 1.41 so they are underreporting COVID-19 deaths.” And if you take that in isolation and run with it, you can tack on, “Is this nefarious? Are they intentionally doing this?” So all of these numbers really deserve a lot of context.

What I mean by that in this case is to first of all explain that underreporting in COVID-19 deaths happens everywhere and here are some of the reasons that it happens. The other thing is let’s compare it to other states and jurisdictions, and even those comparisons deserve context. The fact that states have different approaches to collecting data, and had different impacts of the pandemic at different points in time.

But to at least say when we look at all of the jurisdictions in the U.S., the fact that Florida seems to be in the middle of the pack, that certainly takes out of play this sense that there is something intentional going on or that Florida has been disproportionately impacted. Every state has been impacted by COVID-19 and every state has their own challenges with collecting information and reporting on it.

We’re always trying to strive at the truth, and so the truth does two things. It allows us to better quantify the actual number of people that have died from COVID-19, but maybe by also saying why did certain states tend to underreport more than others, what could we do if we're in this situation again, how can we improve reporting?

I think there's a lot that can be learned from this for states that these models predict maybe did a little bit worse or a little bit better, and how we can improve data collection and reporting in the future.

The other thing and this is very common for people like myself, epidemiologists or statisticians, is we can get caught up in the numbers. And sometimes we forget that every one of those numbers, whether it's 50,000, or 50,500 and we think we're making a better estimate, each of these demonstrates that just untold numbers of people have been impacted by COVID-19.

Copyright 2021 WUSF Public Media - WUSF 89.7

Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters, WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.