In our on-going efforts to form a clearer picture of the true scale of mortality in the COVID-19 crisis yesterday I referenced a tweet by the New York City Council’s health committee which noted a 10 fold run up in the number of deaths that are being reported in homes across New York City. Here’s a great piece of reporting from WNYC/Gothamist filling out the details of what is happening.

The gist is comparable to what we’ve seen reported in other jurisdictions and countries. Fatalities are not recorded as COVID-19 fatalities unless there is a laboratory confirmed test. In the nature of things few who die at home will have been tested. (Current protocols in New York City generally limit testing to those who are hospitalized.) It is important to remember that a substantial number of these fatalities will be people with non-COVID-19 medical crises who would have died soon after being brought to a hospital or perhaps been saved with adequate medical care.

One grim additional note: As of a few days ago, EMTs and paramedics in New York City have been instructed that patients over 18 in cardiac arrest should be resuscitated on the scene. If they cannot be resuscitated after 20 minutes they cannot be taken to an emergency room.

Some key details. As of Monday, 2,738 New York City residents had died with laboratory-confirmed COVID-19 infections. That comes to about 245 fatalities a day. But another 200 or so New Yorkers are dying at home each day compared to a normal number between 20 and 25. The article confirms that unless those people had confirmed COVID-19 tests they are not being included in the official tallies.

The Department of Health is not providing tests to the Medical Examiner’s office. Those are being reserved for the living. The Medical Examiner’s office is noting cases where they suspect COVID-19 as the cause of death. But the Department of Health isn’t including those in the official death toll.

The reporter, Gwynne Hogan, was also able to get statistics from the FDNY.

Statistics from the Fire Department, which runs EMS, confirm a staggering rise in deaths occurring at the scene before first responders can transport a person to a hospital for care. The FDNY says it responded to 2,192 cases of deaths at home between March 20th and April 5th, or about 130 a day, an almost 400 percent increase from the same time period last year. (In 2019, there were just 453 cardiac arrest calls where a patient died, according to the FDNY.) That number has been steadily increasing since March 30th, with 241 New Yorkers dying at home Sunday — more than the number of confirmed COVID-19 deaths that occurred citywide that day. On Monday night, the city reported 266 new deaths, suggesting the possibility of a 40% undercount of coronavirus-related deaths.

Clearly, there is a chaos of information that will only be able to be sorted out weeks or months or even years after the fact. But it is clear that the current death toll numbers greatly understate the true scale of excess mortality driven by the epidemic.