The number of COVID-19-related deaths in the U.S. is greater than the 214,000 recorded by the Centers for Disease Control and Prevention, according to a study.

A new clinical study shows 75,000 more Americans in five states had "indirectly" died from COVID-19 between March 1 and Aug. 1 compared with the numbers made public. The true COVID-19 death toll in the U.S. might be more than 300,000, if the study is to be believed.

The study was published this week in the Journal of the American Medical Association. It was conducted by the Virginia Commonwealth University at Richmond.

It estimates that for every two deaths attributed to COVID-19 in the U.S., one more American died from the disease. "Contrary to skeptics who claim that COVID-19 deaths are fake or that the numbers are much smaller than we hear on the news, our research and many other studies on the same subject show quite the opposite," said lead author Dr. Steven Woolf, director emeritus of VCU's Center on Society and Health.

The study shows deaths between March 1 and Aug. 1 increased 20% compared with previous years.

This means some 75,000 more people in the five states covered by the study died from COVID-19 between March 1 and Aug. 1. New York, New Jersey, Texas, Florida and Arizona, account for 40% of all U.S. deaths as of Oct. 12.

In analyzing death certificates in these five states, VCU researchers found more than 150,000 deaths were officially attributed to COVID-19 from March 1 to Aug. 1. On closer inspection, however, they determined nearly 75,000 additional deaths were indirectly caused by the pandemic. This revision brought the total number of deaths for those four months to more than 225,000.

The revised toll in the five states covered by the study includes inaccurate death certificates that might have misidentified a COVID-19 death, and deaths indirectly caused by the disease. These indirect deaths were caused by illnesses such as diabetes, obesity, Alzheimer's and heart disease.

Woolf said delayed care, fear of seeking care or emotional crises stemming from the pandemic might have also contributed to these deaths. He also said inaccurate death certificates might have misidentified COVID-19 deaths.

Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security, said the VCU study confirmed what doctors saw every day and underscored how badly federal officials had performed during the pandemic.