More people are dying in SC, and coronavirus doesn't explain it completely

Anna B. Mitchell
Greenville News

There has been a notable increase in deaths during the first four months of 2020, according to a review of statewide mortality data by The Greenville News, and the increase is far more than can be accounted for by the official count of those dying of the coronavirus.

A total of 18,180 people in South Carolina died in the first four months of 2020, according to records. This was 1,261 more than died in the first four months of 2019. It was also 792 more than the state's previous four-month high of 17,388 in 2018.

By the end of April, South Carolina health officials reported 288 people had died after contracting COVID-19, a new virus for which the population has no immunity and which entered the state some time in early 2020.

The new disease accounts for some of the surge in deaths this year. But with hundreds more than that dying, COVID deaths are either being under-reported or other factors likely related to the pandemic are leading to more deaths in general — or there is some combination of the two, according to experts interviewed by The News.

Meanwhile, one major killer of South Carolinians — highway deaths — is actually down compared to recent years.

"I have also had a theory all along that there could be some under-reporting of the COVID deaths," said Kathleen Cartmell, an associate professor of public health sciences at Clemson University. "But especially because I'm a health services researcher, I've always worried if people were afraid to go in and get care, to get procedures that were needed, to get treatment for their diseases because they think they are at risk for COVID. 

The number of deaths in South Carolina historically fluctuate from month to month and season to season, and they typically increase annually between 1% and 3%. In 2020, however, there has been a notably larger increase in deaths per month compared to past years.  SOURCE: South Carolina Department of Health and Environmental Control

"I always wondered what effect that would have on people's health and ultimately on mortality."

She and Scott Baier, an economics professor at Clemson, said the numbers themselves open up more questions than answers.

"It's really hard to disentangle where it's coming from," Baier said of the surge in deaths.

Baier agreed that COVID-19 deaths might be under-reported, and he said spending data confirms people during the pandemic are not visiting emergency rooms and going for regular treatments and checkups like they were previously.

"In the state of South Carolina, health care spending is down nearly 30% from where we were before the start of the pandemic," he said.

Totals vary from month to month, but the number of deaths in South Carolina increases every year in line with its growing and aging population. From 2015 to 2019,  the annual increase in deaths ranged from 0.9% to 2.7%.

With a 7.5% surge in deaths so far in 2020 compared to 2019, however, the state is on pace to well exceed recent growth trends.

The state Department of Health and Environmental Control provided The News with the mortality data. An agency spokesperson said she'd work to arrange an interview with an expert to offer perspective and meaning, but that interview did not come by Monday night.

Omar Salas prepares samples from COVID-19 tests at Precision Genetics in Greenville Wednesday, April 15, 2020. Precision Genetics is working with Prisma Health to complete testing for patients.

In her review of the data, Clemson's Cartmell said the trend that struck her was the widening gap in monthly deaths during 2020 compared to past years. 

Starting in December 2019, deaths were up 4.3% compared to the year before; they were 5.5% higher in January 2020 compared to a year before; 5.7% higher in February, 7.7% higher in March and 11.2% higher in April.

"I tried to take a scientifically very conservative approach and look and compare all those trend lines for the other years," Cartmell said. "But it really stands out, the last four months."

She said researchers expect blips in the data -- the occasional swing up or down.

"But I mean over those four years of data, it's striking the gap (in 2020) continues to increase month by month by month," Cartmell said, "and all of them are substantially higher than pretty much the differences in every other year."

Whether the upswing in deaths can be attributed to COVID-19 fully, she said, is impossible to know from the data, but she said a good proxy measure would be the age of those who have died.

"If we could get some data that show was it primarily the much older population because that's the pop that's getting hit so hard with COVID," Cartmell said. "That would give us a sense if there's under-reporting especially among the elderly."

The Greenville News has submitted a Freedom of Information request to the South Carolina Department of Health and Environmental Control for a list of all deaths in the state since January 2018. The request, which did not ask for the name of any decedent, seeks to learn their age, gender, race, cause of death, where they died and county of residence.

That request is still pending.

Baier, the economics professor, also reviewed the mortality data. Baier, who has been tracking the impact of the pandemic on the economies of Georgia and South Carolina, said the mini-recession brought on by COVID-19 likely isn't behind the climb in deaths. Deaths by suicide typically go up, he said, but that's more than offset by a drop in highway deaths.

According to the South Carolina Highway Patrol, 84 fewer people so far in 2020 have died in fatal accidents compared to 2019.

"One thing that typically happens and is almost counter-intuitive is that during most recessions, the death rate falls," Baier said. "It's probably because fewer people are going to work and there are fewer car fatalities."

Baier said that even though South Carolina is opening back up, the economy is not fully online yet, with small business employment still down more than a fifth.

Anna B. Mitchell covers growth and local government in Greenville County. You can follow her on Twitter @AnnaBard2U and on Facebook.