Over 155,000 COVID-19 deaths were missed in early U.S. pandemic data, mainly in rural and underserved areas due to testing limits, flawed reporting, and untrained coroners.

A new study estimates over 155,000 COVID-19 deaths went uncounted in the U.S. during the pandemic’s early months, primarily outside hospitals, raising the official death toll significantly. Using machine learning, researchers found that about 16% of deaths were missed, especially in rural and underserved areas like Alabama, Oklahoma, and South Carolina. Contributing factors included limited at-home testing, under-resourced death investigations, and elected coroners without medical training who may have faced political or family pressure not to list COVID-19 as a cause of death. Systemic healthcare disparities and outdated reporting systems further hindered accurate data collection.