(TNS) — Patrick Hidalgo died on the second day of March, in his apartment, at 41 years old, after complaining to his family of waking up in the middle of the night and gasping for breath.

The Miami-Dade county medical examiner attributed the death of this former Obama staffer to heart disease.

His family says it was COVID-19.

Hidalgo isn't counted as a virus death in Florida, but he illustrates that the pandemic has claimed far more people than the official death count indicates. Today, official coronavirus deaths stand at 16,505 in Florida. Yet the true number of dead from the pandemic could be up to 25 percent higher if you include people who are listed as having died of other causes brought on by the pandemic, according to a new study by the Centers for Disease Control and Prevention.

Researchers at the CDC found that up to 22,861 people more than normal may have died between Jan. 1 and Oct. 3 — 8,000 above the official COVID-19 tally at that time.

The CDC tried to measure the entire toll from the pandemic, including casualties that weren't officially caused by the virus itself, such as those who waited too long to go to the hospital for fear of the virus; who overdosed after relapsing because they lost their jobs; or who probably died from the virus but were never tested.

Scientists have employed similar methods to compare the deadliness of flu pandemics like the one in 1918 and the one in 1968. Researchers establish a baseline for the average number of deaths likely to occur in an area. Then they either count or estimate the number of deaths that exceeded that expected amount. Researchers call those extra deaths "excess deaths."

Just as Florida's legislators and health leaders are debating what counts as a virus death, the CDC is finding there's been a lot of excess deaths this year in the Sunshine State.

Hidalgo was one of them.

"He was really the light of the family, without a doubt," said Manny Hidalgo, his older brother. The family released a statement Friday announcing that doctors at Columbia University had analyzed tissue samples from Hidalgo's lungs and found evidence of damage consistent with a novel coronavirus infection.

Andrew Piascik worked side by side with his brother Chris at a Palm Beach dental clinic, until the 35-year-old Chris went to the hospital on June 15 with a stomach ache and diarrhea.

Chris Piascik, a 6-foot-10 former football player for the University of South Florida, never made it out of the hospital alive. Days after seeking medical attention, he was placed on a ventilator, never to be taken off. Records from the Palm Beach County Medical Examiner's Office list him as a fatality of COVID-19.

"We didn't know he had a positive COVID test," Andrew Piascik said. "We had an open casket funeral. They said if he had COVID we'd have to incinerate his body."

Chris Piascik left behind a wife and daughter. "It's just sad that you have a 36-year-old not with you," his brother said.

The death is among about 16,500 official coronavirus deaths in Florida so far. But the CDC estimates that excess deaths in the state probably ranged from about 16,200 to almost 23,000 between Jan. 1 and Oct. 3.

On that date, the state had only about 14,600 declared coronavirus deaths, meaning up to 8,000 people might have died as a result of the pandemic even if they weren't infected, or if their infections killed them without being detected.

And experts say the state's official tally from the virus is still probably an undercount.

"Its undoubtedly that way in Florida," said Jason Salemi, associate professor at the University of South Florida's College of Public Health, said of the extra pandemic deaths. "It's just unclear to the degree. Is it 5 percent, 10 percent more deaths? Is it the same within age groups? But undoubtedly, it's there."

"It's most likely an underestimation," agreed Dr. Tali Elfassy, assistant professor of medicine at the University of Miami and an epidemiologist by training, speaking of the state's official virus death count.

CDC data appears to support those suspicions. The data shows that the spikes in extra deaths appear to happen right as COVID-19 deaths spike. That means the excess deaths appear to be concentrated in the weeks when the pandemic was at its deadliest, indicating they may be related to the surge in infections.

Jaclyn Baker, 32, died on the first of June from a drug overdose in Palm Beach County.

"She was just a gorgeous young woman, inside and out, but very broken, as so many of our kids are," said Robin Tupper, of Stuart. Tupper is the mother of Baker's former partner, Nicholas Tupper. Nicholas Tupper died of an overdose in 2017, and Robin was something of a mother to Baker.

"I think the pandemic had a hand in it," she said of Baker's overdose death. "These kids isolate already, and now you add the pandemic in, and they can't go out, they're not able to be touched, they're not able to share, and their drugs are being taken away and changed and reduced."

Overdose deaths are up this year. So are deaths from diseases like diabetes and Alzheimer's and from other external causes like car accidents.

In fact, more Floridians have died in just the first eight months of 2020 than have died on average over the past 16 years, the South Florida Sun Sentinel found in an analysis of death statistics from the Florida Department of Health's Office of Vital Statistics.

At least some of the extra deaths can be attributed to reluctance on behalf of people to visit the hospital.

Eric Knott, a pulmonary and ICU medicine trainee on the front lines of treating coronavirus patients, said he can "count on two hands" the number of patients he sees who are putting off trips to the hospital in order to avoid exposure to the virus — despite doctors' recommendations to the contrary.

"I've had a few cases of persons putting off something as simple as chest pain evaluations that ultimately led to emergency room visits under critical circumstances," he said.

Knott said, however, that strengthened disinfection and isolation protocols at hospitals have "made them the safest place to be, ironically. It's where I personally feel safest, anyway."

"In the environment we're in now, COVID-19 is obviously a huge factor in the excess deaths," said Troy Quast, a professor of economics at the University of South Florida who studies death reporting. "But there's a possibility of a lot of indirect deaths due to COVID-19. Someone may be afraid to go to the hospital because of COVID experiences chest pains, and when they finally go their condition is so acute they can't be saved."

Earlier this month, outgoing Florida House Speaker Jose Oliva released a report written by his staff that called into question if some deaths classified by the state were actually caused by the virus. Medical Examiners and Florida House Democrats bashed its methodology.

Then on Wednesday, Scott Rivkees, Florida's surgeon general, announced that all COVID-19 deaths reported to the state so far would be reviewed for accuracy due to alleged lags and irregularities in the death reporting.

Accurate reporting on causes of deaths have long been an issue with public health systems in Florida, said Quast, the USF economist. "Death cause reporting is so haphazard and so erratic."

At the start of the pandemic, this already inconsistent system was faced with a surge of deaths from a deadly new virus for which few tests were available. A spike in the number of deaths attributed to pneumonia and flu this March likely included coronavirus deaths recorded, instead, as pneumonia, experts say.

Medical examiners were originally tasked with certifying COVID-19 deaths. Then, in August, Florida changed the rules and gave that responsibility to individual hospitals and physicians.

But the shift appears to have only gummed up the death reporting system even more, creating a lag between when deaths occurred and when they were reported in the state data. At the peak of the lag, over half the coronavirus deaths publicized by the Florida Department of Health on Oct. 7 were more than 60 days old.

The move to strip medical examiners of the coronavirus death reporting responsibility has also led to uneven reporting practices, said Jay Wolfson, a professor of public health and health law at the University of South Florida.

"In part it may be because we don't want to know," he said.

It is unclear when the state will complete its review of coronavirus death reporting or how the review will address the current issues.

But as the state's health authorities scrutinize mortalities to make sure that they are really due to COVID-19, the CDC's excess death estimate — up to 23,000 dead — measures something distinct: the total cost, in lives, of the virus' continued effects on Florida.

"It's pretty reliable at giving an estimate of the differences we are observing," Quast said of the method used by the CDC. "It's hard to argue that there isn't some change that is causing that death."

(c)2020 Sun Sentinel (Fort Lauderdale, Fla.). Distributed by Tribune Content Agency, LLC.