The past year was a dangerous one. Over 600,000 people in the United States are confirmed to have been killed by COVID-19 since the first American death of the pandemic in February 2020.

Since its first death from coronavirus on April 4, 2020, Yavapai County has officially counted 513 deaths from the novel coronavirus, according to Yavapai County Community Health Services. It was a deadly year, with 158 deaths in the month of January alone, at the height of the pandemic.

Higher Death Toll

An analysis of mortality records kept by the Arizona Department of Health Services suggests the past year was even more dangerous in Yavapai County than the COVID- 19 death count would suggest.

In the period from April 2020 through April 2021 [the latest month with available data], 4,133 deaths were recorded in Yavapai County, an increase of 720 from the same 13-month period from 2019 to 2020, when 3,413 deaths were recorded. The average number of deaths during those 13 months over the five years before the pandemic was 3,285, though that number is likely skewed lower due to population growth since 2015.

During the 2020-2021 period, there were 501 COVID deaths, according to YCCHS. This means that even accounting for the pandemic, there were 119 more deaths in Yavapai County in the past year than there were the year before.

Cause Unclear

It is difficult to ascertain what caused this statistical anomaly, as cause of death is not always determined for all deaths in the county. The Yavapai County Medical Examiner’s Office assesses roughly a third of deaths in the county, mostly of those where something unusual may have happened. The medical examiner’s office did not find any signifi­cant reason for elevated deaths in the past year, such as increased crimes, increased overdoses, increased suicides, or other infectious diseases, at least not in numbers that would explain the 119 additional deaths.

“We don’t have an expla­nation for that fluctuation,” Ambree Borg, medical legal death investigator for Yavapai County, said.

Mortality statistics have been used by some epidemiologists to esti­mate potential coronavirus undercounts.

The Institute for Health Metrics and Evaluation on May 13 published a study examining mortality rates on a week-by-week basis throughout the globe suggesting that the United States’ death toll from the virus may be higher than 900,000, 50% greater than the official count.

YCCHS insisted that there is not an under­count in its coronavirus death count, but it did not respond further to numerous requests for comment.

There are other poten­tial explanations for the outsized mortality rates besides the coro­navirus. The effects of the shutdowns and social distancing may have led to unexpected or unquantified effects on people’s health — for example, elderly individuals may have faced difficulty from less access to in-person care.

The number of cases like this may be impossible to quantify, just as it would be difficult to know if people who died of appar­ently natural causes may have been infected by the virus but not tested before their deaths.

Borg also suggested that there may have been coro­navirus cases in the county that were not counted in the official numbers because they were individuals from other areas — such as the Navajo Nation, which got hit extremely hard early in the pandemic — that were moved to Yavapai County hospitals to deal with hospital overcrowding. Those deaths would not have been included in the county’s coronavirus deaths count, but would show up in the mortality statistics kept by the state.

“There is a possibility that some of those are COVID deaths that are not counted in Yavapai County because they were trans­ferred off the reservation,” Borg said.

Northern Arizona Healthcare did not respond to repeated requests for comment on how many people may have been moved to Yavapai County from other areas.

Even among the death toll, there are some posi­tive signs in the data.

After high death rates in December and January, by February, death rates in the county fell to close to where they had been the year before and in previous years, with 300 deaths in 2021 compared to 274 the year before — a smaller difference than the 79 offi­cial COVID-19 deaths that month. This coincides with the beginning of vaccina­tions in the county in late December, and especially with vaccinations of the most at-risk populations, such as nursing homes, in January.

April 2021, the latest month with available data, showed something posi­tive, and surprising, in a year of virus and death. For the first month since the pandemic hit a year earlier, there were fewer deaths than the year before — 252 in 2021, compared to 277 in April 2020, the first month of pandemic deaths in the county. The county may be moving past the pandemic.