Trump and some top aides question accuracy of virus death toll

President Trump has complained to advisers about the way coronavirus deaths are being calculated, suggesting the real numbers are actually lower — and a number of his senior aides share this view, according to sources with direct knowledge.

What's next: A senior administration official said he expects the president to begin publicly questioning the death toll as it closes in on his predictions for the final death count and damages him politically.

• The U.S. death toll has surpassed 71,000, with more than 1.2 million confirmed cases, according to the latest figures.
• Trump's engagement could amplify a partisan gulf we saw in this week's Axios-Ipsos Coronavirus Index over believing the death statistics.

Reality check: There is no evidence the death rate has been exaggerated, and experts believe coronavirus deaths in the U.S. are being undercounted — not overcounted.

Behind the scenes: The official said Trump has vented that the numbers seem inflated and has brought up New York's addition of more than 3,000 unconfirmed but suspected COVID-19 cases to its death toll.

• Some members of the president's team believe the government has created a distorting financial incentive for hospitals to identify coronavirus cases, the official also said.
• A second senior official said they shared this concern.
• Medicare is giving hospitals a 20% bonus for their treatment of coronavirus patients as a way to help them make up for the money they’re losing because they’ve had to postpone a lot of non-coronavirus care.
• Intentionally misdiagnosing patients with coronavirus would be fraud, and so far no one in the administration has publicly leveled such an accusation.

The other side: A senior White House official pushed back, saying this of the president's thinking: "Skepticism isn't the right way to frame it. The numbers have been revised up to include presumptive cases — meaning deaths that are believed to be related to COVID but not known for sure."

• "So he's expressed the need to properly convey that to American people so they're not startled by why numbers ticked up."
• Another senior administration official said this concern about the death count was not confined to Trump and was in fact shared by a number of his senior staff and has been a subject of discussion for weeks.
• "With something like this virus, where you've got this weird coagulation in the lungs ... we need more autopsies," the official said.
• "America's out of practice of how to deal with something like this and to report it accurately. ... We don't have uniform reporting standards in the United States or internationally. And we're not getting good data."

The number of people dying over the past few weeks, in many parts of the country, is a lot higher than average, suggesting that the official count of coronavirus-related deaths is still missing tens of thousands of people.

Between the lines: Until mid-April, a person was only identified as having died from the coronavirus if they had tested positive for the coronavirus and then died.

• But testing in the U.S. has been inadequate. Many people who have the virus weren’t able to get tested; those patients weren’t recorded as official coronavirus cases, and therefore weren’t counted as coronavirus deaths if they died.
• Last month, the Centers for Disease Control said it would include “probable” coronavirus deaths in the official tally — cases in which no formal diagnosis is available, but doctors believe a patient died from COVID-19.
• Some states do not report probable deaths to the CDC, but among those that do, the change did make a difference: Probable cases added roughly 3,700 people to New York’s official death toll.

What they're saying: Experts believe the formal death count is inaccurately low because:

• Testing problems persisted for so long and still persist.
• Some states don’t count probable deaths.
• There are still thousands of “excess deaths” even after accounting for probable coronavirus cases.