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N.Y.C. Death Toll Soars Past 10,000 in

Revised Virus Count
The city has added more than 3,700 additional people who were
presumed to have died of the coronavirus but had never tested
positive.

A triage tent at Elmhurst Hospital Medical Center in Queens, which has been inundated with patients
during the coronavirus outbreak.  James Estrin/The New York Times

By J. David Goodman and William K. Rashbaum

April 14, 2020

New York City, already a world epicenter of the coronavirus

outbreak, sharply increased its death toll by more than 3,700
victims on Tuesday, after officials said they were now including
people who had never tested positive for the virus but were
presumed to have died of it.

The new figures, released by the city’s Health Department, drove

up the number of people killed in New York City to more than
10,000, and appeared to increase the overall United States death
count by 17 percent to more than 26,000.

Coronavirus Deaths in New York City

Confirmed deaths Probable deaths
500

400

300

200

100

March 11 April 1 April 12 March 11 April 1 April 12

Source: New York City Department of Health and Mental Hygiene · Note: All data are preliminary and
subject to change. Data as of April 13.

The numbers brought into clearer focus the staggering toll the
virus has already taken on the largest city in the United States,
where deserted streets are haunted by the near-constant howl of
ambulance sirens. Far more people have died in New York City, on
a per-capita basis, than in Italy — the hardest-hit country in
Europe.

And in a city reeling from the overt danger posed by the virus, top
health officials said they had identified another grim reality: The
outbreak is likely to have also led indirectly to a spike in deaths of
New Yorkers who may never have been infected.

Three thousand more people died in New York City between March
11 and April 13 than would have been expected during the same
time period in an ordinary year, Dr. Oxiris Barbot, the
commissioner of the city Health Department, said in an interview.
While these so-called excess deaths were not explicitly linked to
the virus, they might not have happened had the outbreak not
occurred, in part because it overwhelmed the normal health care
system.

“This is yet another part of the impact of Covid,” she said, adding
that more study was needed. Similar analysis is commonly done
after heat waves and was performed in the wake of Hurricane
Maria in Puerto Rico.

“What New Yorkers are interested in, and what the country is
interested in, is that we have an accurate and complete count,” Dr.
Barbot added. “It’s part of the healing process that we’re going to
have to go through.”

The revised death toll renewed focus on shortcomings in testing

that have hamstrung city and state officials since the beginning of
the outbreak. A limited number of tests have been available, and
until now, only deaths where a person had tested positive were
officially counted among those killed by the virus in New York.

But for weeks, the Health Department also had been recording
additional deaths tied to the virus, according to two people briefed
on the matter. Those cases involved people who were presumed to
have been infected because of their symptoms and medical history.

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They were not included in the counts given publicly by Mayor Bill
de Blasio because no tests had confirmed that the victims had the
disease, Covid-19.

Where People Died of Coronavirus in New York City

Confirmed deaths Probable deaths
0 25 50 75% 0 25 50 75%

Hospitals

Nursing homes

Residences

Other

Source: New York City Department of Health and Mental Hygiene · Note: Showing cases with complete
location data only. All data are preliminary and subject to change. Data as of April 13.

Mr. de Blasio decided, after another round of briefings over the

weekend, to release the presumptive cases, the people said. Most
of the added deaths took place in hospitals, according to the data.
Others occurred in nursing homes or other long-term care facilities
and in residences.

“In the heat of battle, our primary focus has been on saving lives,”
said Freddi Goldstein, the mayor’s press secretary. “As soon as the
issue was raised, the mayor immediately moved to release the
data.”

Flowers are left outside refrigerated trucks used as makeshift morgues at Wyckoff Heights Medical Center
in Brooklyn.  Sarah Blesener for The New York Times

New York City is among a handful of places in the country,

including Connecticut, Ohio and Delaware, that are beginning to
disclose cases where infection is presumed but not confirmed.

In California and Washington — locations of early cases in the

American outbreak — officials said they included deaths as
connected to Covid-19 only when the disease was confirmed by
testing. Louisiana and Chicago followed the same protocol.

The new numbers in New York cover the weeks between March 11
to April 13, beginning at a time when the virus had already been
spreading throughout the city and its surrounding suburbs. Mr. de
Blasio and Gov. Andrew M. Cuomo shut down large swaths of the
city and state by the third week of March.

Coronavirus Deaths in New York Cityʼs Boroughs

Confirmed deaths Probable deaths

0 10 20 30% 0 10 20 30%

Queens

Brooklyn

Bronx

Manhattan

Staten
Island

Source: New York City Department of Health and Mental Hygiene · Note: Showing cases with complete
location data only. All data are preliminary and subject to change. Data as of April 13.

New York City has been reporting the probable cases to the federal
National Center for Health Statistics for more than a week, health
officials said. But Dr. Barbot said that the city would continue
reporting only confirmed cases to the Centers for Disease Control
and Prevention for its coronavirus tracker, because the agency
requested those statistics. “We are more than happy to report on
probables,” she said.

The C.D.C., in its guidance to local governments, has recommended

that cases of “assumed” coronavirus infection be noted on death
certificates since before New York City recorded its first death on
March 14.

On Tuesday, the city’s count of confirmed cases went up to 6,589.

The city and the state have at times differed in their counts of the
dead in New York City. As of Monday, the state said that 7,349 had
died of the virus in the city. City officials have complained that they
are at the whim of the state, which has been slow to share the data
it receives from hospitals and nursing homes. The state Health
Department explained on its website that the discrepancy is
caused by the city and state using “different data systems.”

The state Department of Health did not immediately respond to a

request for comment on the city’s decision to report suspected
cases.

The sheer volume of additional deaths in the city has been felt
daily. Emergency responders have seen the number of people
dying at home jump significantly. Overwhelmed morgues have
filled refrigerated trucks with bodies outside of hospitals.

And on Hart Island, the city’s old potter’s field, the number of
unclaimed dead has grown markedly — as many people are buried
there in a day now as would have been buried in a week before the
pandemic arrived.

While the city has been uniquely overwhelmed by cases and

deaths, the newly released data suggested that the toll elsewhere
in the nation and the world may be much higher than reported.

“This is quite portentous,” said Andrew Noymer, associate

professor of public health at the University of California, Irvine. He
said the revised New York figures provided “a sobering reality that
confirmed and probable Covid-19 deaths exceed deaths from all
other causes.”

Public health officials say that counting the dead from a pandemic
disease like Covid-19 presents difficulties because many of those
who die are older or suffering from other serious health conditions.
And the full effects of the outbreak on mortality in New York City,
and around the country, could take many more months to study
and understand.

Epidemiologists who study such events said a complete account

would include an analysis of the number of the excess deaths.

Such an analysis can be “very hard to do” as an event is unfolding,

said Sabrina McCormick, an associate professor of environmental
and occupational health at George Washington University, who has
studied excess deaths in heat waves. “This virus is moving so fast,”
she said.

But, she added, an analysis of excess deaths is “the simplest and

most straightforward way of measuring how many people have
died from an extreme event” and can offer a more accurate
accounting of the actual impact than the daily death counts
provided by officials.

The Coronavirus Outbreak

Frequently Asked Questions and Advice

Updated April 11, 2020

• When will this end?

This is a difficult question, because a lot depends on how well the virus is
contained. A better question might be: “How will we know when to reopen
the country?” In an American Enterprise Institute report, Scott Gottlieb,
Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked
out four goal posts for recovery: Hospitals in the state must be able to
safely treat all patients requiring hospitalization, without resorting to crisis
standards of care; the state needs to be able to at least test everyone who
h t th t t i bl t d t it i f fi d
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