States find more deaths from unreported covid-19

Ohio, in February, announced more than 4,000 additional deaths while reconciling its data, and Indiana added about 1,500. Minor revisions have also recently arrived from Virginia, Minnesota and Rhode Island. On Thursday, West Virginia authorities said medical providers had not properly reported 168 deaths to the state’s public health department.

“No one likes surprises and no one likes the wrong data because that’s what drives decisions,” said Ayne Amjad, West Virginia’s state health official.

These issues underscore the ways in which Covid-19 can still challenge data information systems in the United States. Like many countries, the United States is trying to track pandemic events almost as they happen, and much of that effort has required accelerating the way reported deaths occur.

In West Virginia, reporting deaths would typically require waiting many weeks for death certificates to be completed, Dr. Amjad said. But last year the state asked medical providers to fill out a one-page report on deaths from Covid-19 to create a faster record. The state discovered the recent count of all December and January deaths by using death certificates to determine that the 168 death reports were not filled out properly, Dr. Amjad said.

He said the reporting problems were in about 70 places, mostly hospitals and long-term care centers. A Covid-19 hike like the one that hit the U.S. this winter may slow down notification, she said, but she and Gov. Jim Justice described the reporting errors as unacceptable. According to data collected by Johns Hopkins University, the United States has recorded more than 530,000 deaths from Covid-19, about half of them since Thanksgiving.

On Tuesday, Minnesota health officials said an audit found that four private labs were unable to report lab results, and that it resulted in the finding of 138 more deaths. These had been recorded on death certificates, a health department spokesman said.

An audit in Indiana found 1,507 historic deaths, most by 2020, state authorities reported in early February. Death certificates were used to verify these fatalities, a state health department spokeswoman said. Shortly afterwards, a problem with unreconciled mortality data led the Ohio Department of Health to find 4,000 deaths not reported by Covid-19.

In Virginia, it was a system problem that recently led the state to add about 900 deaths. Officials there realized the number of deaths they reported did not appear to track an increase in cases, and death certificates helped correct the mistake, said Lilian Peake, a Virginia state epidemiologist. “We realized something was wrong,” he said.

These state solutions are not filling the most important gaps in what researchers believe is a lower death toll from Covid-19. This is highlighted in a wide gap between the known deaths of Covid-19 and deaths from excess, or deaths above average levels in recent years.

According to public health experts, Covid-19’s death was particularly likely at the start of the pandemic, when evidence was scarce and doctors filling out death certificates were less familiar with the disease. They have also explained some excess deaths from other problems, such as people avoiding hospitals during health emergencies.

“We’re a little stuck with this misinformation, especially at the beginning of the pandemic,” said Robert Anderson, head of the mortality statistics branch at the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention . .

Matching front-line surveillance data with death certificates can improve the data on both systems and can sometimes lead to rewritten certificates, Anderson said. But changing death certificates is not easy, he said. The person who has filled out the death certificate — often a doctor — must agree to modify the record.

“We’re seeing some deaths that weren’t Covid before they were attributed to Covid when it was modified, but it’s a relatively small number,” Anderson said.

Big changes at the state level can create, at the very least, artificial and temporary in the data that Johns Hopkins and others make to show daily trends.

This happened briefly with the backlog of Indiana and Ohio mortality data, before it backed down, which Johns Hopkins tracks and reflects on in his records when possible. By contrast, there is still an artificial bulge of 469 deaths in Iowa on Dec. 11, when that state changed the way it reported deaths from Covid-19.

“This is the challenge and that’s why we need to work to improve our national surveillance,” said Jennifer Nuzzo, an epidemiologist and scholar at the Johns Hopkins Center for Health Security.

Write to Jon Kamp at [email protected]