How Colorado is tracking COVID-19 deaths

For months, confusion – and in many cases misinformation – has swirled about how deaths from the novel coronavirus are counted.

Deaths from COVID-19 have become a political tipping point as people, including politicians, questioned whether the numbers were exaggerated – much to the frustration of those responding to the crisis.

“Somehow you’ve trusted me for over a decade to bring you the truth about why people die and now all of a sudden me, hospitals, doctors , nurses, public health officials, are we all in cahoots and lies with you on this? said Dr. Leon Kelly, El Paso County coroner.

The coronavirus pandemic is a mass event. More than 260,000 Americans, including more than 3,000 people in Colorado, have died from COVID-19 in less than a year.

Now, the Colorado Department of Public Health and Environment estimates that the number of people dying from COVID-19 in Colorado could vary between 4,900 deaths and 7,400 deaths by the end of December, depending on the level of disease transmission.

Not only does this mean deaths are increasing at a rapid rate, but the state’s third wave of infections is poised to become deadlier than the spring push. Colorado recorded 2,000 deaths among people with COVID-19 in September and over the weekend – just two months later – that number topped 3,000 deaths. In the spring, it took the state two months to register 1,000 deaths.

“The level of disease transmission that we have seen in Colorado over the past few days is truly the highest since the start of the pandemic,” said Dr. Rachel Herlihy, the state epidemiologist at an update. press release last week. “At this high rate of disease transmission, we are unfortunately going to see an increasing number of deaths occur.”

Understanding the toll of the pandemic is complex and can be confusing. That’s because when we talk about COVID-19 deaths, it’s not just about who died of disease against those who have died with disease. It is also about examining the deaths indirectly caused by the pandemic.

“It’s always a bit politically charged because different people have different motivations,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado. “But it played out with the COVID pandemic because there’s so much political motivation to say, ‘Oh, it’s not that many people. It’s not that dangerous. ”

How do we know a death is due to the novel coronavirus?

The first thing to understand with COVID-19 data is that there is a lag in information about hospitalizations and deaths due to the progression of the disease. When a person becomes ill with the novel coronavirus, it can take up to two weeks before symptoms become severe enough to be hospitalized.

That’s why, after a spike in new coronavirus cases statewide, there is no immediate increase in hospitalizations.

It also takes time for a death from COVID-19 to be recorded by the state’s health department, which creates a lag between new cases and deaths that varies from about three weeks to one month.

It is also important to know that the process of investigating, determining and reporting a death has not changed during the pandemic. State and local officials said they were recording deaths from COVID-19 as they would any other deaths.

The cause of death listed on a death certificate is determined by one of three people: a coroner, forensic pathologist or physician.

When one of those three people fills out a death certificate, they’re making a medical judgment as to why they think someone is dead, Kelly said.

Many people who die from COVID-19 do so in a hospital. Autopsies are not often performed on patients after they die because at the time of death they have already been diagnosed with the new coronavirus. And not all autopsied people are tested for the disease.

“(Doctors) have a really good idea based on their experience and expertise in primary diagnostics on why patients died and the comorbidities that play a role,” said Dr. Vernon Naake, physician- chief of North Suburban Medical Center.

To determine the cause of death, health professionals use what they call the “without for” principle: if “without (a certain event)”, a person would not have died at that time and place. specific.

There are a number of ways this can happen when someone dies from COVID-19. Consider a case where the cause of death listed is septic shock, but the death certificate also states that the septic shock was caused by another condition that originated from Acute Respiratory Distress Syndrome, or ARDS. And in this case, the acute respiratory distress syndrome was caused by the novel coronavirus.

All of these conditions are listed on a death certificate. But the reason a death is considered a death from COVID-19 in such a scenario is that “without COVID-19, none of these other things happen,” Kelly said.

Other conditions the person may have had, such as obesity or diabetes, are not direct complications of COVID-19. However, they put a person at increased risk for serious symptoms, he said.

How the state’s health department reports deaths from COVID-19

Earlier this year, questions were raised about the accuracy of how the state’s health department tracks deaths when the novel coronavirus is not linked to the cause of death. That review led the State Department of Public Health and Environment to change the way it publicly reported deaths from COVID-19 in May.

The department now reports both the total number of deaths from the novel coronavirus and the number of deaths among people with COVID-19 at the time of their death, including when the disease was not the main cause.

Although they are divided into two categories, most of the deaths in this latest tally are deaths caused directly by the disease. This is why there is often a narrow gap between the count of those who died with COVID-19 and those who have died of disease.

On Monday, the state’s health department recorded 3,037 deaths among people with COVID-19 and 2,656 deaths from the disease.

The reason for the discrepancy between the two numbers is due to the way the data is collected by the state health department. The category “COVID-19 deaths” comes only from death certificate data, which has a lag of several weeks, so the number is expected to increase.

The “deaths among cases” category is more of a real-time tally of deaths from hospitals or through contact tracing, case investigations and other methods. Sometimes this data is collected before a death certificate is saved and processed.

This category of death data helps the state’s health department “really understand the severity of the disease and whether it is changing over time,” said Herlihy, the state epidemiologist. “At the end of the day, these two different systems of counting deaths align very closely.”

Kelly, the coroner, said he was reviewing a spreadsheet created by public health officials on people who have reportedly died from COVID-19 in his area. He goes through each death certificate and checks that it matches the cause of death and any other contributing factors listed on the spreadsheet. If it does not match, the death is removed from the spreadsheet.

“We do all of this in real time,” Kelly said. “And so, what often happens, we try to balance out the release of as much information as quickly as possible, because it’s relevant to people, but also to make sure what is happening is correct information,” clear, concise and usable. “

There are various reasons why the deaths were initially reported as due to the novel coronavirus and then deleted. For example, if a person dies in a nursing home where there is an outbreak of the disease, health department officials might classify them as probable death from COVID-19 during their investigation into the outbreak.

But the death certificate may not list COVID-19 when it goes to the county coroner. Instead, it lists similar symptoms, such as shortness of breath or respiratory failure, both of which can be from another illness.

One of the challenges of the new coronavirus is that it affects people differently. Although the lungs are often the first organs affected by COVID-19, it can also damage the kidneys and cause blood clots.

“Much more often I end up with cases that are not on the list,” Kelly said. “It works both ways.”

Calculation of the true balance sheet of the pandemic

Many medical and public health experts believe the death toll from COVID-19 is underestimated because it is likely that limited testing at the start of the pandemic led to missed diagnoses. This is often the case with other illnesses, including the flu, because not everyone is tested or diagnosed before they die, Herlihy said.