While the death toll in Covid-19 is lower, raising hopes that the US will turn a corner as vaccinations continue, states across the country are steadily finding previously unreported deaths leading to confusion in the data.
The issues largely relate to systems that states use to report Covid-19 data in near real time, and not deaths that are slower to report through death certificates. These frontline numbers are the ones that feed state dashboards and data trackers, like the one closely watched by Johns Hopkins University, that help policymakers and the public keep a close eye on pandemic trends.
Ohio announced more than 4,000 additional deaths in February as the data reconciled, and Indiana added about 1,500. Recently, smaller revisions have also come from Virginia, Minnesota, and Rhode Island. On Thursday, authorities in West Virginia said medical providers had incorrectly reported 168 deaths to the state’s public health department.
“Nobody likes surprises, and nobody likes data that is wrong because it drives decisions,” said Ayne Amjad, West Virginia health officer.
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These issues underscore the ways in which Covid-19 can still challenge US data reporting systems. reported.
In West Virginia, reporting deaths typically would require many weeks to wait for death certificates to be completed, said Dr. Amjad. But the state last year asked medical providers to also fill out a one-page report for Covid-19 deaths to create a faster record. The state discovered the recent under-number of all deaths in December and January by using death certificates to determine that the 168 death reports were not filled out correctly, said Dr. Amjad.
She said the reporting problems occurred in about 70 locations, mostly hospitals and long-term care facilities. A Covid-19 wave like the one that hit the US this winter could slow reporting, she said, but she and Governor Jim Justice called the reporting errors unacceptable. According to data from Johns Hopkins University, there have been more than 530,000 deaths in the US, about half of them since Thanksgiving.
Covid-19 reported deaths in the US daily.
Notes: For all 50 states and DC, US territories and cruises. Last updated
Source: Johns Hopkins Center for Systems Science and Engineering
On Tuesday, Minnesota health officials said an audit found four private labs reported no lab results, which led to an additional 138 deaths being found. These were listed on death certificates, a health department spokesman said.
An audit in Indiana revealed 1,507 historical deaths, mostly from 2020, state authorities said in early February. Death certificates were used to verify those fatalities, a state health service spokeswoman said. Soon after, a problem with irreconcilable mortality data led the Ohio health department to discover 4,000 unreported Covid-19 deaths.
In Virginia, it was a system problem that recently led the state to add about 900 deaths. Officials there realized that the number of deaths they reported did not seem to follow a rise in the number of cases, and death certificates helped correct the error, said Lilian Peake, the Virginia state epidemiologist. “We realized something was wrong,” she said.
Monitoring of the US outbreak
Confirmed cases by state, ranked by last day count
Cases confirmed daily per 100,000 inhabitants
Note: Trend indicates whether a state has had an increase or decrease in the total number of cases in the last seven days compared to the previous seven days. Last updated
Sources: Johns Hopkins Center for Systems Science and Engineering; the Lancet; Associated Press; US census
These state fixes don’t fill major gaps in what researchers say is a significant under-figure of Covid-19 deaths. This is underscored by a wide gap between known Covid-19 deaths and excess deaths, or deaths above average in recent years.
According to public health experts, it was particularly likely in the beginning of the pandemic, when few tests were performed and doctors filling out death certificates were less familiar with the disease. They have also attributed some additional deaths to other issues, such as people avoiding hospitals during health emergencies.
“We’re a bit stuck with this under-reporting, especially at the start of the pandemic,” said Robert Anderson, chief of the mortality statistics division at the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention. .
Matching first-line surveillance data with death certificates can improve the data in both systems and can sometimes lead to rewritten certificates, said Mr. Anderson. But changing death certificates isn’t easy, he said. The person who completed the death certificate – often a doctor – must agree to change the certificate.
President Biden and Vice President Kamala Harris marked the loss of life from Covid-19 last month with a candlelit memorial and a moment of silence as the US death toll surpassed 500,000. The president called on Americans to remain vigilant. Photo: Jim Loscalzo / CNP via ZUMA
“We are seeing some deaths that were not previously Covid and were attributed to Covid when modified, but it is a relatively small number,” said Mr. Anderson.
At the very least, the major changes at the state level could cause temporary and artificial bulges in the data that Johns Hopkins and others knit together to show everyday trends.
This happened briefly with the Indiana and Ohio mortality backlog, before being dated retroactively, which Johns Hopkins maintains and reflects in his archives where possible. There’s still an artificially large bulge with 469 deaths in Iowa on Dec. 11, conversely, from when that state changed the way it reports Covid-19 deaths.
“This is the challenge, and that’s why we need to work to improve our national surveillance,” said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security.
Write to Jon Kamp at [email protected]
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