As death rates spike across the nation, no one knows how many North Carolinians have died since the COVID-19 pandemic struck. 

New York City’s deaths from all causes soared 663% for the week ending April 11, while deaths rose 41% across the U.S. That’s compared to the same period in past years. 

North Carolina doesn’t have that data. 

It can take months to process death certificates here. We are one of three states still using a “dead tree” system. The General Assembly in 2015 paid for an electronic system to bring the state up to standard. But North Carolina lagged behind most states by several years in adopting an electronic system. It won’t operate statewide until winter 2021.

Without that data, experts can’t count COVID-19 deaths in North Carolina. Nor can they track the indirect effects of the pandemic — how many people died because of the shutdowns, delays in health care, and the damaged economy, said Dr. Steven Woolf, director emeritus of Virginia Commonwealth University’s Center on Society and Health. Policymakers lack the information to consider safely reopening schools and businesses and letting social activities resume.

The absence of data conceals both uncounted COVID-19 deaths and deaths caused by the fallout of the lockdowns. Hospitals canceled elective surgeries, and fear kept patients from seeking care. 

Academics, journalists, and policy groups have cut the state out of studies on deaths. The state reports confirmed COVID-19 deaths, but test shortages cloud that death count. State officials have denied reporters access to death certificates.

“We have no idea about how many people are dying, or what they’re dying of,” said Joe Coletti, John Locke Foundation senior fellow. “This is actually a reason why death certificates are in [the N.C. Division of] Public Health. This is a public health question. … This is the fog of COVID-19 data. We can’t answer questions.”

North Carolina hasn’t reported any all-cause “excess” deaths — or deaths above normal — since May 30, according to the data charts maintained by the Centers for Disease Control and Prevention. Those charts post warnings about incomplete data dating to Feb. 8.

“What happened to the electronic death registry?” said Coletti. “It took them four years to do this? That’s a long time to do something that was a dire need seven years ago.”

The N.C. Department of Health and Human Services didn’t have enough money to overhaul the system until fiscal year 2017, agency spokeswoman Kelly Haight Connor told Carolina Journal. State officials in 2016 told N.C. Health News the registry was “underway.”

When COVID-19 struck, hospitals and other medical practices braced for a surge in patients by cutting back elective procedures. As the pandemic lingered, a new set of worries emerged.

“There was a concern that people were in danger of dying not only because of the virus, but also because of the ripple effects,” Woolf told CJ. “The difficulties with accessing health care, the consequences of the lockdowns that were affecting people’s jobs, housing, food security, were all thought to be potential threats to health.”

Those threats have already sent death rates soaring. 

Deaths from diabetes rose 96% above normal levels during COVID-19’s early peak. Five states recorded a surge of deaths from Alzheimer’s disease (64%), heart disease (89%), and stroke (35%). In New York City, deaths from diabetes and heart disease more than tripled, according to a study Woolf authored.

North Carolina’s death count? No one knows. 

Any estimates come from the private sector and from unusual data-gathering methods. One such estimate says the state’s deaths were 13% higher than normal levels on April 23, according to the private nonprofit Health Care Cost Institute, which uses obituaries to track deaths across the nation.

“That is not a small number. It looks small when you compare it to New York City,” John Hargraves, HCCI director of data strategy and senior researcher, told CJ. “In other circumstances, it would be alarming. But we’re not living in those circumstances.”

The state is in the last phases of testing the electronic system, Connor said. It will roll out gradually during fall 2020 and winter 2021.

Until then, processing death certificates will remain a multistep process. North Carolina’s death records first head to the CDC, where they are coded. Then they return to the states, where they must be merged with demographic data.

That creates a three- to four-month lag, says Hargraves.

“North Carolina’s not been doing so well. In several studies, it’s been dropped from the analysis because there’s such a concern about delays in reporting and worries about getting accurate results,” Hargraves said. “All states are having some variation of that problem, but North Carolina has been having more difficulty.” 

The lack of data will affect the state’s ability to reopen its economy and prevent unnecessary deaths, Woolf said. He argues hospitals also need to brace for increasing numbers of non-coronavirus patients. 

“You need to be prepared,” Woolf said. “The opioid epidemic didn’t go away just because of the pandemic.”