It seems like in wealthy Western countries with bad outbreaks of COVID-19, total excess mortality is about 1.5x higher than confirmed COVID-19 deaths. Quick thread on how I think about this. https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html

Does that mean you can just multiply confirmed COVID-19 deaths by 1.5 to get the "real" death count? Well, in some cases, it might not be a terrible approach. But you'd have to be careful.

For instance, NYC *is* trying to count *probable* COVID-19 deaths, and their total (confirmed + probable) death count is about 1.5x as high as their confirmed count. https://www1.nyc.gov/site/doh/covid/covid-19-data.page

Still, inferring from excess mortality data can be tricky. Being in lockdown with heavy strain on hospitals can have various effects that push other types of deaths up (e.g. you have a heart attack, the ambulance takes longer to come & you die) and down (fewer traffic accidents).

Plus, jurisdictions can vary in how thorough they are. France has done an admirable job of trying to count nursing home deaths, for instance. And if a place *is* trying to count probable deaths, as in NYC, there's going to be considerably less undercounting.

Also, all of those qualifiers I put at the top are important: "wealthy Western countries with bad outbreaks of COVID-19". That's where these numbers, at least the ones that are getting highlighted in the media, mostly come from.

I'd be especially careful about making inferences outside of that narrow band of countries/places. There is possibly less undercounting in wealthy Western places with *mild* outbreaks (e.g. Canada, Utah) because their medical and record-keeping systems are less overwhelmed.

There could be much more underreporting in poorer places with less access to medical care and worse record-keeping systems, by contrast, or places that are in some form of denial about the extent of their outbreak.

Overall though, this data puts some boundaries on what the real death counts are in the US and Western Europe. Unless places are explicitly trying to count probable deaths (e.g. NYC), there is clearly likely to be an undercount. But it is not likely, say, a 3x or 5x undercount.