The hidden toll

Another reason why the reported death count from COVID-19 is too low: People who didn’t know they were infected and die at home may never be tested or counted.

As coronavirus cases surge, inundating hospitals and leading to testing shortages, a rapidly growing number of Houston area residents are dying at home, according to an NBC News and ProPublica review of Houston Fire Department data. An increasing number of these at-home deaths have been confirmed to be the result of COVID-19, Harris County medical examiner data shows.

The previously unreported jump in people dying at home is the latest indicator of a mounting crisis in a region beset by one of the nation’s worst and fastest-growing coronavirus outbreaks. On Tuesday, a record 3,851 people were hospitalized for the coronavirus in the Houston region, exceeding normal intensive care capacity and sending some hospitals scrambling to find additional staff and space.

The uptick in the number of people dying before they can even reach a hospital in Houston draws parallels to what happened in New York City in March and April, when there was a spike in the number of times firefighters responded to medical calls, only to discover that the person in need of help had already died. These increases also echo those reported during outbreaks in Detroit and Boston, when the number of people dying at home jumped as coronavirus cases surged.

While far more people died of COVID-19 in those cities than have died so far in Houston, researchers and paramedics say that the trend of sudden at-home deaths in Texas’ largest city is concerning because it shows that the virus’s toll may be deeper than what appears in official death tallies and daily hospitalization reports.

Many people who die at home are not tested for COVID-19, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. In New York City, for example, only 16 percent of the 11,475 at-home deaths between February and June have been attributed to COVID-19, according to data from the U.S. Centers for Disease Control and Prevention.

“There’s no reflexive testing,” Faust said, noting that medical examiners are selective about the cases they take. “There’s no pressure to call it a COVID death.”

The rise in at-home deaths may also reflect people who are afraid to go to the hospital because of COVID-19, and who die of heart attacks, strokes, diabetes and other conditions not tied to the coronavirus, Faust said.

Ultimately, Faust said, public health experts trying to assess the toll from COVID will need to study how many excess deaths there are in a particular region and whether the demographics of those who died are different from what one might expect. “If there’s a huge spike in at-home deaths but no real spike in overall deaths, it’s just sort of rearranging deck chairs.”

There’s more, so go read the rest. I don’t have anything to add other than the usual disclaimer that none of this had to happen. We could have had a federal government that actually prepared for COVID-19. We could have had a state government that cared about reopening in a safe and scientifically-driven manner. We have neither of those things – yet – and so here we are. Keep that in mind, today and every day, not just through this November, but through November of 2022.

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14 Responses to The hidden toll

  1. Jen says:

    Thank you for making it clear once again that Governor Greg Abbott is responsible for the current tragic mess we are in. If he had allowed the mask orders and followed his own rules before reopening we would be in an OK place right now. Having to wear a mask is not a big deal and never was, and would have saved a lot of hardship and heartbreak. Hardship and heartbreak is a nice way of saying BIG PILES OF DEAD BODIES.

  2. Jason Hochman says:

    Jen: if wearing a mask would’ve saved so many lives, please let’s blame Fauci for lying about masks. Please be thankful for the leaders of Texas who have kept excess deaths way below what New York saw. Also, please read the CDC site which says that the totals of cases and deaths that they post include confirmed and probably cases. If the Methodist Hospital is so concerned about delaying surgeries to make room for COVID patients, please ask the hospital why it selfishly continues its strip out demolition of the Mary Gibbs Jones Building. I heard that a worker fell last week and was injured. Why risk having injured workers taking up emergency services? As well, strip out demolition doesn’t allow for easy distancing between the workers. The hospital really needs to explain its logic.

  3. Wolfgang says:


    Folks: The daily case increase graphs look rather scary. In Houston, the N of active cases is a multiple of the cumulative N of recovered cases for the past several months, for the entire Harris County & Houston the active cases are roughly 200% of the recovered cases.

    See here (you can toggle between combined, Houston, and Harris County using the tabs in the top right corner):

    A case curve for the Greater Houston Area can be found on the TMC website:

  4. Jason Hochman says:

    Wolfgang, it is not that scary when you read the message takeaways for today. The TMC facilities are only 8% into the phase two plan. They don’t anticipate moving into phase 3 in the next two weeks. Also, keep in mind that the ICU units at the hospitals are almost always full or nearly full, anytime. With our for profit medical system, hospitals are not creating ICU units that won’t be used simply to wait for exceptional events.

  5. Bill Daniels says:

    For all the doom and gloomers wringing their hands over crowded local hospitals:

    There are plenty of hospitals in rural counties that have been worried about having to close for lack of business for a while now. I’m sure they would be GLAD to get the overflow from Houston and other large urban areas.

    You folks are not seeing the benefit here. People who are having their elective procedures cancelled here (like having knee replacements, for example) can simply go to a hospital in a rural area to get that care. When life hands you lemons, make lemonade!

    Have we already forgotten the gross waste of sending hospital ships out to treat virtually no one? Building hospitals at the George R. Brown and the Javits Center that would end up treating no one?

    Let’s not make the same mistakes again, OK?

  6. Wolfgang says:

    Bill: George R. Brown ? — That was going to be the GOP Convention center, the “field” hospital was planned for the NRG, wasn’t it?

    (I mistype all the time myself, so by-all-means feel free to correct me … for example, left out a “not” just yesterday, regarding NO reason given for a SCOTX justice “not participating” in a case a/k/a recusal or disqualification.

    Jason: Regarding hospital capacity utilization being close to 100% under regular operating conditions….. That’s indeed a good and valid point. Hence the need to reduce non-urgent procedures (or even prohibit them by executive order) to create additional COVID capacity. Epidemics are obviously not part of the regular demand projection and workflow planning for hospitals.


    What I am worried about is the surge in cases, which reflects uncontrolled community spread … the hospital demand will be lagging behind.

    It’s a lot worse than what the numbers were early in the outbreak & stay-at-home mitigation locally.


    Merkelandia, by contrast, is down to the 300’s for daily positive case growth and single digits for deaths – that’s for the whole country, about 83 mil to 29 for Texas. It sure doesn’t hurt having a scientist for a prime minister (Kanzlerin, to use the proper German-gendered job title). And mind you, Germany has a very federal system, too, with plenty of intergovernmental-relationship issues.

    For the COVID-situation in data terms, see current Robert Koch Institute Report here for more info: (updated each day, which is also an emulation-worth best (public communication) practice, in addition to the dashboards & dynamic maps available from various institutions, incl. John Hopkins.)

  7. Jason Hochman says:

    Wolfgang, that is correct, in a for profit medical system, there is not an incentive to build an ICU and keep it empty just waiting for an emergency or crisis. The TMC should be set up to handle this increase in patients. AS of last week, the R naught for the Houston area had dropped below one, so new cases should begin to slow down. This will take some time, as those already infected will start to become sick in the days ahead. Also, the hospital populations will need some time to come down, as patients work toward discharge, or sadly, some will die. Don’t get me started on the testing. The PCR method was never designed for diagnostic use. It was meant for lab research. The inventor of the test, Karly Mullis, claimed to have invented it while under the influence of LSD. He believed that the HIV virus did not cause AIDS. He quit science but was awarded the Nobel in 1993. He died at age 75, last year, from pneumonia (when people still got pneumonia, colds, flu, COPD, etc back in the days before everything was COVID).

  8. Bill Daniels says:


    No, you’re right, it was NRG….thanks for the save. You know, wasting $ 20M of taxpayer money here, there….it all just kind of blends together for me after a while.

    What do you think about my solution to divert patients to rural hospitals that need the business? Workable solution, or not?

    I’m sure plenty of hospitalized patients aren’t in any imminent danger and could be shipped out. People recovering from infection, for example….are they getting their drip lines in the ambulance? OK then, they’re being treated and monitored. Ship ’em out, open the bed for someone in more serious condition.

  9. C.L. says:

    Bill/Jason, I’m confused. Bill, on one hand, seems to believe in the health crisis, but Jason seems to think it’s a hoax perpetrated by Dr. Fauci – why else would there be construction work in the MedCtr.

    Can you two get on the same page ?

  10. Wolfgang says:

    Re: Patient diversion to rural hospitals to handle overload

    That seems to make sense, assuming the patients are selected to match the spare capacity and capabilities of the rural hospitals. I hear, though, that the rural hospitals (in the Valley area) don’t have the wherewithal to provide intensive care (such as ventilators) so the transfers go the other way, if at all.

    I think some of the that sort of thing — optimizing capacity reallocation on regional scale — may already be happening, but perhaps only among the urban systems, like TMC and the miscellaneous hospital systems. Perhaps someone better informed can weigh in this.

    In NY, the State (Gov. Cuomo) took steps to create a consortium of sorts (not sure about the ling) for the public hospitals (with centralized reporting of data, needs, and allocation of limited supplies) and transfers of patients depending on need/supply patterns, and then got the private ones into that sort of arrangements too, if I recall correctly. I remember hearing (at one of his daily press conferences) about transfers also from NY metro to upstate NY, though I am not sure how much of that actually took place, and transfer of personnel, of course to fill shortages in surge spots.

  11. Jason Hochman says:

    CL, Not sure why Bill and I should be on the same page…we’re two different people, with different opinions.

    I DO NOT believe this is a hoax. There is some real virus, but not exactly what the “experts” and the “news” are telling us. I Methodist Hospital and all their officials are going on and on about rising numbers, and how we must all sacrifice. It’s fair to ask them, then, why are they not delaying their construction? Sacrifice for thee, not for me. The construction puts workers at risk, who may then take up an emergency bed. Also, they can’t distance very well in a strip out demolition. If nothing else, it looks bad. Just like when Trump doesn’t wear his mask, or when our local officials lead a giant protest whilst telling us that large gatherings must be banned.

    Larry Kramer wrote an open letter to Fauci many years ago, calling him an imbecile responsible for thousands of deaths. Once again, he is. He lied to us about masks, to prevent us from buying up all the masks from healthcare workers.

    Moving forward a month or two, Fauci then said masks could help. But now you can make your own masks! Or use a bandana! Or buy one on late night TV from Sham. Wow. He never did retract what he said, which is that masks put you MORE at risk because you’ll keep fiddling with it. Indeed, that’ s what everyone is doing. Pulling them down around their necks. Constantly having to adjust them because they are home made, or bought off late night TV and don’t fit properly. It’s hot here and the masks are all sweaty, people walking outside with a mask pulling it out of the way to drink some water. Everyone touching their hot mess of germs made from an old bed sheet and some rubber bands. So what’s the truth?

    Let’s look at our situation today. The bars closed on June 20 something. They have been identified as a source of illness, and indeed, the Rt number for Houston started to drop and was below one last week. On July 3d, the governor made his mask proclamation. Now the Rt for Houston is back up to about 1.4. Fourth of July is being labeled as the culprit. But, bars were closed. Beaches were closed. Freedom Over Texas cancelled. However, there was a protest downtown. And everyone was required to wear a mask. Clearly the masks are doing what Fauci said–making us more at risk. Or is Fauci a liar? Or a fool? In any case he needs to be fired.

    On a tangential note, I just read a piece by Jeremy Samuel Faust. He states that comparing COVID and flu is “apples and oranges.” The way that flu deaths have been reported by the CDC is all wrong! The real death toll of the influenza is about 3,000 to 14,000 per year! Not the high numbers we’re hearing to scare us to get a flu vaccine yearly. They lied to us. So now they want us to accept their COVID numbers. Why should we trust these infallible experts? When all of the COVID tests have an accuracy well below 100%. When the CDC totals include confirmed and probable cases, based on a list of symptoms (fever, cough, fatigue, breathing difficulty) which can be caused by any of 100s of conditions. Can anyone explain this?

  12. C.L. says:

    Jason, Fauci and Kramer were actually friends…

    But yeah, it’s because of the Dr., we’re at where we are.

  13. Jason Hochman says:

    CL: read the open letter.

    Do you have an answer about why the science said that masks put us more at risk, and now the science says that they keep us safe? Keep in mind that there was no new study done, and that mask wearers are doing everything Fauci said they would. Also that the spread has increased since the governor made the mask mandate.

  14. Jason Hochman says:

    BTW, here is the link to the article about the CDC counting flu deaths wrong, and using that to terrify you to get a flu shot:

    I’m all for abolishing the CDC after we get the police abolished.

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