Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19. This observational study estimates the burden of all deaths related to COVID-19 in the United States from March to May 2020. Findings indicate that official tallies of deaths due to COVID-19 underestimate the full increase in deaths associated with the pandemic in many states.

The authors obtained public data of the entire US population from the National Center for Health Statistics (NCHS) and evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020. They compared these numbers with those from the same period of previous years.

Main findings include:

• There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, which is 122 ,300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year
• There were 95,235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020
• The number of excess all-cause deaths was 28% higher than the official tally of COVID-19–reported deaths during that period
• In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records
• There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths