As the coronavirus pandemic has ripped through Louisiana, the ever-increasing tally of deaths has become a sad but familiar statistic.

But new data raises questions about whether there could be secondary effects of the pandemic that have cost the lives of Louisianans beyond the 1,644 whose deaths have been directly attributed to the virus.

The data, so far, is murky and incomplete. But an analysis of state and local statistics from New Orleans and Jefferson Parish, the two locations hit earliest and hardest in the state, show the early signs of an uptick in deaths in March that cannot be blamed on COVID-19 alone.

State health officials warn that while the data should be watched carefully for further evidence of a trend, it may be too early to say definitively whether the pandemic is having ripple effects that may be leading to tragic outcomes even for those who never tested positive for the virus. And, if there is a trend, it is not clear whether additional deaths would represent undiagnosed cases of the coronavirus or something else, such as a reluctance or inability to seek medical help for serious conditions due to fear of infection and isolation in hospitals.

“It’s a theory, there’s no question about it,” said Dr. Joseph Kanter, with the Louisiana Department of Health. “Just as time goes on and we get more data in, that theory will get more or less likely depending on what the data shows.”

An increase in non-COVID deaths even as the toll from the virus rises would track with a disturbing trend in hot spots around the world.

New York City, for example, saw 3,800 more people die between mid-March and late April than would typically be expected during that period, even aside from the more than 15,400 COVID-19 deaths it had counted as of earlier this week, according to an analysis by The New York Times. Overall, the death rate in New York City was four times what would be expected, according to the Times.

Other countries that have grappled with the coronavirus have also seen thousands of excess deaths that have not been attributed to the coronavirus.

In many of those areas, the sheer scale of the outbreaks taxed or overwhelmed medical systems, something that did not occur to nearly the same extent in Louisiana.

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Complete statistics on March deaths for Louisiana are not yet available. In part, that’s because counting deaths even in normal times is not an instantaneous process.

While coroners, funeral homes and others report many deaths to the state’s Vital Records office soon after they occur, officials say that even 30 days after a month ends they typically have received only 86% of those reports.

With some parishes overwhelmed with victims of COVID-19, it is possible that getting a full accounting could take even longer.

Still, there are signs in state and local data that deaths in the state may have increased beyond those that can be attributed to the coronavirus.

Take Jefferson Parish, for example. By the end of March, officials had counted 57 dead due to coronavirus in the parish.

As of Friday, the state had counted a total of 446 deaths in the parish in March. Even excluding those who died of COVID-19, that would leave the number of deaths about 5.4% higher than it was in the same month in each of the past two years, with the potential to rise further as more data comes in.

“I just don’t know if it signifies a trend or if it’s a blip like the previous years have shown episodic blips,” said Kanter, who said a clearer picture could emerge as the state gains a more complete picture of deaths as more reports come in. “But I’m glad the conversation is being had.”

Data from Jefferson Parish Coroner Gerry Cvitanovich point toward what could be an even sharper increase. In the month after the outbreak, his office dealt with 253 COVID cases. But setting those aside, the 472 other cases the office handled was up 43% from the same period last year.

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Cvitanovich said there may be other factors behind the increase other than a higher death rate for the parish. Not every death is handled by the coroner and some of those deaths could represent people who would have died anyway and would not have come through his office, he said.

But Cvitanovich said he believed the increase was significant and said it could be attributed in part to either undiagnosed COVID victims or people putting off other care because of fears of what would happen to them in hospitals filled with coronavirus patients.

“Some of them are COVID we didn’t call,” Cvitanovich said. “A significant number of them may be people who were having chest pains and are afraid to go to the hospital because they don’t want to go to the hospital. Or they have the worst headache of their life but don’t want to go the hospital.”

There may be signs of similar trends in New Orleans.

New Orleans EMS officials said this week that they have seen a 25% drop in calls for serious medical conditions, something they worry is also being driven by those putting off aid during the pandemic, according to WWL-TV. Similar drops have been reported at hospital emergency rooms, according to the station.

The New Orleans Police Department responded to 228 deaths outside of medical facilities since the beginning of March that were not related to homicides, auto crashes or suicides. That’s a nearly 60% increase over the number they responded to in March and April last year.

Dr. Jennifer Avegno, director of the city’s health department, said earlier this month that officials were carefully watching those statistics and agreed.

“People are afraid to go to the hospitals, they don’t want to go to the hospitals because they don’t want to be alone,” Avegno said, referring to restrictions on visitors to medical centers aimed at containing the virus.

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The state’s statistics do not currently show an increase in March deaths in New Orleans that would not be accounted for by the coronavirus. In fact, without the 101 people who died after contracting COVID-19 in the city, its numbers would be lower than last year’s.

But it remains unclear how many deaths there are left to count.

The Orleans Parish Coroner’s Office did not respond to questions about the deaths they have handled during the COVID-19 outbreak except with an emailed statement saying they were following guidelines in classifying deaths.

Beyond those factors, there’s also the question of how local officials are handling deaths likely caused by the virus but for which there was never a test to confirm that diagnosis. That count currently stands at 59 statewide, a marked increase from the dozen the Department of Health had tallied a week ago.

Kanter said the increase in the “probable” coronavirus deaths was largely due to outreach from the agency to coroners’ offices, to ensure they knew of new guidance from the state and CDC that allowed them to use that classification.

While the state will continue to tally those deaths suspected to be linked to the virus, Kanter also said the Department of Health continues to prefer that coroners confirm cases with tests so there can be a definitive ruling.

“It’s better for the family and better for public health mitigation purposes when it’s practical,” Kanter said. “But it’s not always practical.”

-Staff writer Gordon Russell contributed to this report.