Throughout the coronavirus pandemic, deaths have been the statistic that has seemed the most immutable.

Other numbers, particularly infection rates, are subject to a variety of factors: lag in results being reported, limits to the availability of testing and the question of whether symptoms ever get bad enough to prompt a test at all. All those caveats mean the 23,928 cases identified in the state as of Sunday represent an undercount, possibly a dramatically lower figure than the true infection rate.

By contrast, the death toll has often been viewed as a reliable statistic. Though it also tends to lag reality, most experts see it as a more solid – and final – figure to measure the virus’s toll.

But death, too, has its caveats, and officials and experts are now looking at whether there could be deaths attributable to the coronavirus that so far have not been counted. This week, Louisiana is expected to begin releasing statistics on the number of people whose deaths are suspected to stem from COVID-19, even if they were never tested, a development experts welcome.

“I do think it’s important to capture what will ultimately will be recorded as the true impact of this pandemic in human costs,” said Susan Hassig, an epidemiologist at Tulane University. “Having as much clarity as we can is very valuable, even if it’s not a definitive diagnosis.”

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The effort to more fully measure the toll of the coronavirus comes as other areas, such as New York City, have started adding probable COVID-19 deaths to their official counts. While state officials say the number of suspected deaths will not change Louisiana’s count of 1,296 counts dramatically -- at least not immediately -- experts say it's important to get as concrete an understanding as possible.

Currently, Louisiana’s official death toll counts only victims who tested positive for the coronavirus and didn’t die from an obviously unrelated reason, such as a car crash. So far, there haven’t been any deaths excluded because they were due to non-medical issues, said Dr. Joseph Kanter, with the state Department of Health.

The state is now aware of 12 suspected coronavirus deaths that are not in the official statistics, all but one of them from New Orleans or Jefferson Parish.

Jefferson Parish Coroner Dr. Gerry Cvitanovich said that, early in the outbreak, when tests were scarce, he was wary of using tests that could have gone to identifying cases among the living simply to confirm undiagnosed victims in the morgue. Since the CDC issued new guidance recently on how to determine whether the coronavirus was likely a contributor to a death, the office has been sending investigators to talk to doctors to help figure that out.

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As a result, Cvitanovich said he believes there may have been some COVID-19 cases early in the outbreak that his office missed and likely will never be included in the official count.

“It is important to know (how many died) epidemiologically, but how accurate are we going to be? I don’t know,” Cvitanovich said.

Cvitanovich, like others whose work involves tallying the lives taken by the virus, was wary of feeding into conspiracy theories that the death count was being inflated to exaggerate the impact of the virus. There would be no reason to do so, he said.

“If anything, we’ve undercounted,” he said.

The number of possible coronavirus deaths in Louisiana is currently small compared to what has been seen elsewhere. New York City, for example, added cases where COVID-19 likely contributed to a death to their official count on Tuesday. That drove the city’s estimate of the official toll the coronavirus has taken up by more than 3,700, an increase of more than a third.

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The relatively low number of suspected but unconfirmed COVID deaths in Louisiana may be the result of how coroners report that information. But Kanter believes it may also reflect the relatively wide availability of testing in Louisiana, which has one of the highest per-capita testing rates in the nation.

The Department of Health has also pushed doctors and coroners throughout the outbreak to do tests on deceased victims if they thought coronavirus was a potential factor.

“We were strongly encouraging hospitals and coroners to do a test, for a couple reasons: I think it’s the right thing to do for the family, so they know. There are exposure mitigation efforts that would get triggered and we want that information,” Kanter said.

Officials with the Department of Health are readying a process to count and publicly update the figures for suspected coronavirus deaths this week. Those numbers will be presented alongside the official statistics.

Tracking deaths is inherently murky, Hassig said. It could vary from place to place, but also it’s not the easiest thing to determine when a death should be attributed to something like this that can contribute to various manners of death.

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“It’s hard, in terms of trying to articulate the true impact of the disease on the population,” she said. “Think back to the Hurricane Maria mortality experience – in that case, you had an event that disrupted refrigeration and power. And you had people who were diabetics and couldn’t keep their insulin refrigerated, and they died. Were they killed by the hurricane? It may get kind of muddy.”

The true death toll of Maria has been a hotly debated topic, just as it was with Hurricane Katrina in southeast Louisiana. More than 1,000 people drowned in Katrina, but hundreds, perhaps thousands of others died from stressors that came in the storm’s wake.

Jeffrey Shaman, an expert on infectious diseases and director of the climate and health program at Columbia University’s Mailman School of Public Health, noted that trying to accurately count the dead is important both for the historical record and also to help prepare for impacts in places with substandard medical care.

"We need a good record of deaths to provide good quantification of the infection fatality rate, and to know what that means for mortality on a global scale, including in places where they lack the means to keep track of the effects of this disease altogether," like the Central African Republic, Shaman said. "Without a full record of its effects, the history of this outbreak will just be distorted."