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Keeping accurate COVID count is tough

T-L File Photo CINDI BRUNOm an RN, administers a COVID-19 test at an Ohio County COVID-19 testing site

For The Times Leader

CHARLESTON – Nearly two years into COVID-19, the politics of masking and vaccinating continues to play out in schools and workplaces. Wary of shutting something down, individuals who sniffle or cough continue to ponder whether confirming an infection is worth it.

And, through it all, a critical countdown continues all over the state.

Doctors at WVU Medicine Wheeling Hospital and WVU Medicine Reynolds Memorial contribute to this every time they list the virus as a factor when they’re signing death certificates. An official at a local nursing home or with Wheeling-Ohio County Health Department may file a separate form – a new, streamlined piece of paperwork developed to track the pandemic in closer to real time than the certificates allow – whenever the virus is even a suspected agent of demise.

And, each week, state epidemiologist Shannon McBee and a team from the state’s Office of Vital Statistics compare the two information sources. Case by case.

“We’re doing our best to capture the deaths,” McBee said, noting the process will be faster and more efficient when a system that will allow the electronic filing of death certificates comes online in early 2022.

Right now, the team must pair and compare each death certificate to each of the newer death report forms by hand.

McBee explained that, even if there is a death report that has already been added to the state’s COVID-19 dashboard, that death will be removed from the count if the death certificate – which is generally signed by a physician, coroner or a nursing supervisor — does not list the virus as either a primary cause of death or an underlying condition at the time of death. Conversely, if there is no death report on file, but the death certificate flags COVID-19 as a factor, that death is added to the official tally.

That weekly reckoning is why the death count goes unexpectedly up or even down over time, McBee explained. The death report forms – which are speedier – allow a quicker tracking of disease spread and severity, but they’re not as accurate.

But, without them, McBee said, the death count would be impossible to track in any timely way. A variety of reasons that include some state residents who live in border counties dying in out-of-state hospitals have contributed to death certificates coming in as long as six months after an actual death.

“This is a slow process,” McBee said of collecting the data-rich certificates, noting the federal government is not putting any time frame on linking COVID-19 to specific deaths.

Another contributor to the time lag is the sheer number of COVID-19 deaths, McBee added. Prior to the pandemic, other Class 1 diseases such as tuberculosis, rubella, hemorrhagic fever and Middle East Respiratory Syndrome (MERS) were rare to non-existent. That made them easy to track.

Each positive virus test and each COVID-19 death – the latter of which numbered more than 3,200 for the state and was approaching 100 each for Ohio and Marshall counties as of this week – now crosses McBee’s desk. Both must literally be accounted for — to the state dashboard and to the federal government, she said.

“It sometimes misleads the public — ‘Oh, we didn’t have any deaths this week,’ McBee said of the unavoidable outcome of continually reconciling the count via a public dashboard. “But, we probably did.”

TRACKING TRENDS

For all its time limitations, McBee said the dual reporting system has been critical to developing an understanding of how the virus spreads and kills since the pandemic began.

Were it not for physicians everywhere dutifully listing contributing factors, for example, she said the healthcare system would not have known so quickly that people with conditions such as diabetes, asthma and obesity were more at risk of severe infections and death.

In West Virginia, “a lot of professionals do list COVID as one of the underlying causes,” McBee said of what she sees as state physicians realizing from the beginning there was a critical need to search for trends and establish an accurate assessment of the virus’s human toll.

So, for example, a hospice patient actively dying from cancer, but who died after contracting COVID-19, would likely have the virus included as a contributing factor on a death certificate, McBee said.

She added that such thoroughness is helping the healthcare system see the big picture when it comes to deaths that are not obvious, noting some physicians are even listing the pandemic as an underlying cause in what are sometimes called “deaths of despair” (suicide and overdoses). Because this is considered a subjective judgment, McBee said those deaths are not being counted on the COVID-19 dashboard at this time.

Will statisticians of the future – who may look back on the pandemic era and search for broad “excess death” trends that may be easier to see in retrospect – find COVID-19 did more damage than this first-draft accounting identified? McBee said she doesn’t have a crystal ball to know that, but that she does feel like the system is keeping count as well as it can given how the pandemic has unrolled.

The count has already spotted mega trends, McBee noted. COVID-19 is already known to be the third leading cause of death for 2020, behind heart disease and cancer, she said.

And, while the numbers are still being crunched, she said the team has identified a “significant” increase in overdose deaths each time a round of COVID-19-driven federal stimulus checks went out. She said a full report on that link will be issued when the final tallies come in.

“It’s horrible,” McBee said of this sideways-but-trackable link between the pandemic and deaths of despair. “But, if you think about it, individuals who are entrenched in drug addiction and have access to a pot of money,” may purchase drugs rather than do the other things toward which the stimulus money was aimed.

McBee sighs at that paradox. And at the continuing reluctance of a segment of West Virginia’s population to vaccinate, especially during the spread of the delta variant to COVID-19.

“It has hit harder and faster than any of us would have expected,” she said, noting recent reports crossing her desk have her particularly concerned about children and young residents under age 21.

While only one West Virginian under age 18 had died from COVID-19 as of mid-September, she said more than 20 young West Virginians were hospitalized with a virus complication called Multisystem Inflammation Syndrome in Children (MIS-C) at the time of her interview this week.

“It’s hard to digest, knowing that we have a tool,” she said of hoping more state residents will vaccinate. “It’s horrifying from a public health standpoint and it’s not over.”

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