Mexico City's coronavirus death toll may be 3 times higher than official count, report says

At least three times as many people in Mexico City may have died of complications from COVID-19 than have been officially reported, a new report by a Mexican activist group suggests.

Mexicans Against Corruption and Impunity says it found 4,577 cases in the Mexican capital in which death certificates linked the coronavirus to fatalities between March 18, when the country’s first coronavirus-related death was confirmed, and May 12.

The official number of confirmed and suspected COVID-19 deaths in Mexico City during that period was 1,060 — less than one-quarter of the cases cited in the new report. Mexicans Against Corruption and Impunity said it was opting to go with a more conservative estimate of a toll at least three times greater than the official numbers.

The group's analysis comes as the government of President Andrés Manuel López Obrador plans a gradual reopening of the economy despite spiking numbers of cases, widespread uncertainy about the scope of contagion and growing pressure on hospitals, morgues and funeral facilities in Mexico City and its environs. The first cases surfaced in Mexico about a month after initial infections were confirmed in the United States.

Mexico City represents the epicenter of the country's pandemic, accounting for about one-quarter of all 6,090 deaths nationwide as of Wednesday and almost one-third of all 56,594 infections, according to official government numbers. Even so, Mayor Claudia Sheinbaum said Wednesday that the capital — the heart of a sprawling metropolis that is home to some 22 million people — would gradually begin reopening June 1.

Mexicans Against Corruption and Impunity says it obtained a confidential database providing details on the 4,577 Mexico City deaths in which coronavirus or equivalent designations — such as "COVID-19," "COV" and "SARS COV2" — were mentioned on death certificates. The certificates are kept in civil registry offices.

In 3,532 of the cases, the report said, the virus was listed on death certificates as the confirmed, suspected, probable or possible cause of death, sometimes in combination with other ailments, such as severe respiratory infections. In another 1,045 cases, COVID-19 was listed as a cause of death, without specifying whether it was suspected, likely or confirmed.

“This study demonstrates that there is a significant undercount that is not being made public,” said Samuel Adam, one of the researchers on the project.

The group drew no conclusions as to why authorities had apparently missed so many deaths.

Asked Tuesday about the large discrepancy, Dr. Hugo López-Gatell, who heads the country's coronavirus response, told reporters that the "enormous majority" of the cases cited in the report were likely already incorporated into the official statistics. "It's not new information," López-Gatell told reporters.

Sheinbaum, the mayor, has acknowledged an under-count of coronavirus-related deaths and appointed a special scientific panel to examine death certificates, medical reports and other data in a bid to come up with a more accurate toll.

Mexican health officials have long recognized that official tallies don't capture the totality of coronavirus-related cases. That is the case in many countries, Mexican authorities note.

But the magnitude of the disparity in Mexico has become a matter of intense debate and has drawn fire from López Obrador, who has denied that authorities are "hiding the dead."

The president has also been a longtime critic of the group behind the new report, calling it politically biased against him, an allegation the organization denies.

Experts say the numbers gap arises in large part from Mexico’s extremely low testing rate — about 1,442 tests per 1 million people, among the lowest of heavily populated nations in the Western Hemisphere, outside Africa, according to the global statistics website Worldometer. Chile and Peru have testing rates about 15 times greater than Mexico, and the U.S. testing rate is almost 30 times greater.

"The undercount of cases and deaths because of COVID-19 is an international problem," Dr. Alejandro Macías, who headed Mexico's response to the swine flu epidemic a decade ago, wrote on Twitter following release of the new report. "In Mexico it may be particularly big because we do so few tests, but that doesn't necessarily mean that someone is trying to hide cases. Let's say it's more of a measuring error."

Since mid-April, Mexican health authorities have directed physicians filling out death certificates to designate someone as a "probable" COVID-19 fatality if it appears that he or she succumbed to the virus, even if there are no lab tests confirming it. However, that is not enough for the death to be added to the official tally, absent a positive test.

López-Gatell, the Mexican sub-secretary of health and the public face of the country's coronavirus reponse, has defended a targeted testing strategy focusing on seriously ill cases, calling it sufficient to allow authorities to monitor the spread of the infection. He has denied allegations that the Mexican government has skimped on testing as a cost-saving measure.

In his televised daily updates, however, López-Gatell has lately found himself having to explain multicolored charts indicating an ever-upwards trajectory of contagion and death. On Wednesday, Mexico officially reported a record one-day number of COVID-19 fatalities, 424, and a nationwide total topping 6,000 — a figure that López-Gatell had earlier projected would be the likely final death tally.

The fast-rising numbers of infections and death in Mexico City are straining the capital's medical and mortuary infrastructure.

As of Wednesday, almost 90% of the 75 hospitals treating coronavirus patients in Mexico City reported no or few available beds, according to official statistics. Morgues, cemeteries and crematoria are backed up and authorities this week dispatched refrigeration trailers to help preserve growing ranks of bodies at 16 hospitals in the capital's densely populated suburbs.

"Since April we have been saturated, and this month we've had to turn down a lot of business," said Arturo Franco, who runs the Grossman funeral agency and crematorium in Mexico City. "We've never seen anything like this before."

Special correspondent Cecilia Sánchez in Mexico City contributed to this report.