NEW YORK CITY -- As the coronavirus bore down on New York, Dr. Doug Bass' family begged him to work from home. He refused, pointing to his patients at Phoenix House, a drug and alcohol treatment center where he served as medical director.
"He said he was on the front lines and they needed him," his brother, Jonathan Bass, told The Associated Press. "Too many people relied on him."
Bass, 64, died suddenly last month after suffering symptoms commonly caused by coronavirus, including coughing, a fever and severe stomach cramping. That made him possibly the first physician still treating patients in New York City to die from the disease caused by the coronavirus.
Except he wasn't counted.
It happened so quickly he was never tested for COVID-19, but his brother believes he was among the hundreds of undiagnosed cases that, for weeks, have been excluded from the official coronavirus death toll.
Mayor Bill de Blasio said Wednesday the city would begin counting victims like Bass who weren't tested, including those dying at home whose symptoms fit certain parameters.
"It's just horrendous. The numbers speak for themselves. This used to be a very, very rare thing in New York City and suddenly it's jumped up. The only thing that's changed is COVID- 19," de Blasio told reporters.
A year ago, the New York City Fire Department was receiving an average of 64 calls for cardiac arrest per day, generally with no more than half of those patients dying, FDNY spokesman James Long said. "Now, in this pandemic, we are seeing more than 300 cardiac arrest calls each day, with well over 200 people dying each day," Long wrote in an email.
Casualties have been undercounted worldwide, experts say, due not only to limits in testing but the different ways nations count the dead - not to mention deliberate underreporting by some governments.
The Centers for Disease Control and Prevention recently issued new guidance saying it is acceptable to count undiagnosed COVID-19 cases as "probable" or "presumed" coronavirus deaths under circumstances that are "compelling within a reasonable degree of certainty."
New York Gov. Andrew Cuomo on Tuesday said he was also interested in trying to find a way to account for people who die at home without being tested.
For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with health problems, it can cause pneumonia.
Bass, the New York City doctor, believed he had been getting better in the days before his death and continued working for Phoenix House, which provides residential and outpatient treatment at multiple locations in New York City and Long Island.
He had a weakened immune system, his brother said, but "nothing life-threatening and nothing terminal." He collapsed in the elevator of his building in Manhattan's East Village neighborhood after calling for an ambulance because he could not breathe. Officials at Mount Sinai Beth Israel, the hospital where Bass was taken, declined to comment on his death.
Ann-Marie Foster, the president and chief executive officer of Phoenix House, said her organization had at least two patients who had tested positive for coronavirus, but added it was not clear whether Bass had dealings with them. She said she received an email from Bass at 6:27 p.m. on March 27, the evening before his death.
"We've lost a gem," she said.
There have been similar uncounted fatalities among health care workers.
An emergency room physician at East Orange General Hospital outside Newark, Frank Gabrin, died March 31 from what his loved ones and colleagues described as coronavirus complications. A cancer survivor who also was never tested for COVID-19, Gabrin died in his husband's arms, at home in New York City, days after developing symptoms that included a dry cough, aches and fever.
The actual coronavirus death toll will be better understood when the pandemic is finally over, based on an a review of fatalities in out-of-hospital settings, said Dr. Mitchell Katz, president and chief executive officer of NYC Health + Hospitals, the largest municipal health system in the country.
"If an older person was found dead in their home, it would not be easy to know whether they succumbed to COVID without ever having been brought to diagnosis, or whether they succumbed to cardiac arrest," Katz told reporters recently.
"I think there will be ways, when all of this horror that we're living through is done, to try to study these things," he added. "But I think, right now, everybody is in the moment trying to save as many lives as they can."