The claim: Heroin overdoses killed more people in the U.S. on March 19 than the coronavirus

A Facebook user wrote a post in March that said heroin-related overdoses had killed more people in the U.S. than the new coronavirus on one day that month. 

The post, which has been shared more than 75,000 times, appeared as many citizens and politicians critique the government’s handling of the pandemic by comparing it to other public health threats like the flu or — in this case — the opioid crisis.

USA TODAY reached out to the author of the post for comment but did not receive a response.

Activists and journalists have written about the complicated relationship between opioid addiction and the coronavirus outbreak. They cite how the emotional distress and economic volatility of a public health crisis could lead vulnerable people to abuse opioids.

NPR reported that lawmakers, in response, suspended a federal law that “required patients to have an in-person visit with a physician before they could be prescribed drugs that help quell withdrawal symptoms,” a move doctors have spent years fighting for.

But there are still obstacles for addicts, including the inability to attend in-person peer-support group meetings, prolonged loneliness, an increased risk for contracting the virus and a lack of qualified doctors to help addicts.

What the data show

The post reads: “Heroin still killed more people in the US yesterday than this (expletive) virus but you don’t see that trending everywhere.” It was published March 20, so “yesterday” in this case means March 19.

On March 18, long before most experts’ models of the projected peak of the pandemic’s curve, the U.S. Centers for Disease Control and Prevention reported 97 deaths in the country. On March 19, the total death toll increased to 150.

For comparison, the CDC estimates on average 130 Americans die from opioid overdoses each day and that one-third of those deaths involve heroin as opposed to prescription or synthetic opioids, according to their website. 

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Courtney Lenard, a CDC spokeswoman, said in an email the death toll of heroin-related overdoses cannot be tracked at the day-to-day level because “in order to confirm the involvement of a specific substance in an overdose, post-mortem toxicology testing may be required.” These tests may take “several weeks to several months to complete.”

Another reason for delayed reporting is that the National Center for Health Statistics, the arm of the CDC dedicated to collecting health data, “needs approximately 12 months at the end of the calendar year to compile, verify, and prepare final mortality data for release to the public,” Lenard said.

So on average about 43 people in the United States die every day due to a heroin-related overdose, which is less than the estimated 53 COVID-19 deaths on March 19.

More: Fact check: What’s true and what’s false about coronavirus?

Uncertainty in counts

But there is a considerable degree of uncertainty to both of these data points. 

Olga Khazan recently reported for The Atlantic that a team of researchers discovered many opioid overdoses go unrecorded as a result of a suspected lack of medical examiners and variability between different counties’ assessment of deaths. 

University of Rochester researchers Elaine Hill and Andrew Boslett found through their research on the subject “in more than 20 percent of the cases, the record said the type of drug could not be specified, perhaps because an autopsy had not been performed. In other words, the person had died of a drug overdose, but the death record didn’t say which drug,” Khazan wrote.

In addition, the CDC’s most recent data is from 2018, so the daily average number of deaths may have since changed. The center reported a 4.1% decrease in opioid-related overdoses between 2017 and 2018. 

The death toll of the coronavirus similarly is uncertain for a number of reasons.

When the CDC updates its count of COVID-19 deaths each day, there is typically a one- to two-week lag, a spokesperson for the CDC told The New York Times. Although counts at the state level are more prompt, the lack of timely reporting at the federal level leaves a hole in experts’ understanding of the situation.

State-level reporting is flawed as well. The New York Times reported that “the undercount is a result of inconsistent protocols, limited resources and a patchwork of decision making from one state or county to the next.” 

For example, coroners in rural communities are struggling to secure sufficient testing supplies and many nurses and doctors have reported people who they suspect may have been infected dying before getting tested. 

A county in Idaho requires a positive test to officially attribute the virus as the cause of death but in Alabama “the state health department requires a physician to review a person’s medical records to determine whether the virus was actually the root cause of death,” the Times reported.

The widespread lack of testing means the case fatality rate of the virus, the number of deaths out of the number of confirmed cases, continues to be an unknown statistic.

The lack of accurate data regarding the death toll of both public-health crises impairs experts’ ability to appropriately implement solutions. 

Our ruling: More information needed

Due to a lack of conclusive and comprehensive data about the number of deaths caused by both heroin overdoses, and the evolving nature of the coronavirus pandemic, it is nearly impossible to conclude the true death toll of each on a day-to-day basis. For this reason, more information would be needed to determine the validity of the claim.

Our fact-check sources:

Facebook post, March 20, 2020

The Washington Post, There’s a more accurate way to compare coronavirus deaths to the flu, May 2, 2020

The Washington Post, How the coronavirus is creating other threats for addicts, May 1, 2020

NPR, Coronavirus Crisis Spurs Access To Online Treatment For Opioid Addiction, May 5, 2020

Harvard Health Blog, “A tale of two epidemics: When COVID-19 and opioid addiction collide,” April 20, 2020

The Wayback Machine, “Coronavirus Disease 2019 (COVID-19), Cases in U.S.,” March 19, 2020

The Wayback Machine, “Coronavirus Disease 2019 (COVID-19), Cases in U.S.,” March 20, 2020

Centers for Disease Control and Prevention, “America’s Drug Overdose Epidemic: Data to Action”

Centers for Disease Control and Prevention, “Heroin Overdose Data”

The Atlantic, “The Opioid Epidemic Might Be Much Worse Than We Thought,” February 27,2020

The New York Times, Official Counts Understate the U.S. Coronavirus Death Toll, April 5, 2020

Email interview, Courtney Lenard, Senior Press Secretary, CDC’s Health Communication and Science Office , May 7, 2020

This article originally appeared on USA TODAY: Fact check: Which killed more people in a day, heroin or coronavirus?

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