We need to stop repeating that the number of cumulative deaths from the coronavirus in the United States is some 216,000 (and climbing). That is the number of deaths reported by, among many others, the New York Times as of October 15, based on its own calculations. It also closely tracks the number given on the global map of the Johns Hopkins Coronavirus Resource Center. Coming from these two paragons of accuracy, the number has all the appearance of statistical solidity. But it is very misleading as a measure of how the pandemic has increased rates of death in the United States and the rest of the world.

A better way to measure the true toll is to use the metric of “excess deaths.” This may be an unfamiliar notion, but it is not complicated. Researchers typically take the average number of deaths in a particular place over the same period (say, a specific month) during the past five years, and subtract that number from the total for the same period this year. The result is “all-cause” excess mortality. Here’s why that’s a better way to assess the mortality caused by the coronavirus than the supposed number of Covid deaths.

The Times states that its number reflects data from “state and local health agencies and hospitals.” It’s not hard to imagine how much variation there might be in the ways in which all those different institutions report their data, no matter how hard they might try to be consistent. Much of the early counting of deaths relied on good-faith attempts to report “confirmed” cases of Covid-19 mortality. Eventually, understanding that there were probably many other cases of deaths caused by Covid that were not recognized as such at the time, record-keepers added to the “confirmed” cases those of “probable” deaths from Covid. This was certainly an improvement.

But even this change of procedure couldn’t really capture what has been going on, because the arrival of the coronavirus has changed people’s behavior in ways that affect mortality. For example, the pandemic frightened many people into staying away from their health care providers and hospitals out of fear that they might become infected with the virus. Since they had heard that people with “underlying conditions” were especially endangered, they reasonably enough decided to avoid a potentially infectious setting. And older people learned quickly that they were at particular risk, resulting in a shift of infections toward younger people.

Then there were the deaths only indirectly caused by the coronavirus; these were more attributable to the side-effects of the crisis than to the virus itself. Millions of people have lost their jobs, been forced from their homes, or been forced to stay at home for extended periods with little private space and few opportunities for respite from their circumstances. These developments have led a number of people to commit suicide—a tragic outcome, to be sure, but not one caused by the physical effects of the virus itself. Meanwhile, New York City has seen an upsurge of homicides, which some believe are caused, at least in part, by the many abnormal social conditions created by the pandemic. These homicides may be a result of the Covid crisis generally speaking, but not of the virus per se.

It should also be noted that some deaths have probably been prevented by the crisis; this is widely thought to be the case when it comes to deaths from car accidents, for instance, because people have simply been driving less since the pandemic began.

Here’s where the idea of excess deaths comes in. Calculating the number of deaths that exceed the recent five-year average gives us a better idea of the overall social impact of a public health crisis than simply its nominal death toll. It is a reminder that, as public health professionals rarely tire of repeating, there are “social determinants of health.” People don’t generally die simply for reasons peculiar to them as individuals; rather, they die because of who they are and where they are located in the social structure.

Employing the notion of excess deaths, the editor-in-chief and executive editor of the prestigious Journal of the American Medical Association (JAMA) have just published an editorial predicting a possible excess death count for the United States of 400,000 during 2020. The figure is based on an analysis in the same journal estimating that between March 1 and August 1, 2020, the United States experienced a 20% increase in deaths over the expected number. Extrapolating from that experience, the JAMA editors predict that we will witness a total of 400,000 excess deaths before the end of the year.

To its credit, the Times had already published an article on August 12, 2020—two months ago—with a banner headline stating that “the true coronavirus toll has already exceeded 200,000,” a claim that has proved broadly in keeping with the findings of the JAMA analysis. Clearly, with measures such as excess death rather than supposed deaths from Covid, we are getting a better view of the catastrophe the coronavirus has visited upon the country. Bear in mind that 400,000 is approximately the number of American soldiers who died in World War II, but that was over four years.

With better metrics, we have a more clear-eyed view of the crisis and that, in turn, should lead us to respond to the pandemic with the seriousness that it deserves. Alas, that seriousness has yet to take hold among the country’s top political leadership.