States are discovering more deaths not reported by 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 come from Virginia, Minnesota and Rhode Island. On Thursday, West Virginia officials said medical service providers did not adequately report 168 deaths to the state’s public health department.

“Nobody likes surprises and nobody likes wrong data because that’s what drives decisions,” said Ayne Amjad, health officer for the state of West Virginia.

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

In West Virginia, notification of deaths typically requires waiting several weeks for death certificates to be completed, said Dr. Amjad. But the state last year asked medical providers to also complete a one-page report on Covid-19 deaths to create a faster record. The state discovered the recent under-counting of all deaths in December and January, using death certificates to determine that the 168 death reports were not properly completed, said Dr. Amjad.

She said reporting problems occurred in about 70 locations, mostly hospitals and long-term care facilities. A Covid-19 wave like the one that hit the United States this winter could delay reporting, she said, but she and Governor Jim Justice found the reporting errors unacceptable. The United States has recorded more than 530,000 deaths from Covid-19, about half of them since Thanksgiving, according to data compiled by Johns Hopkins University.

On Tuesday, Minnesota health officials said an audit found that four private laboratories did not report the results of the laboratory, which led to the discovery of another 138 deaths. That was recorded on death certificates, said a health department spokesman.

An audit in Indiana revealed 1,507 historic deaths, mostly from 2020, state officials said in early February. Death certificates were used to verify these fatalities, said a spokeswoman for the state health department. Soon after, a problem with unreconciled mortality data led the Ohio Department of Health to find 4,000 unreported deaths from Covid-19.

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

These state corrections are not filling large gaps in what researchers believe is a significant Covid-19 death count. This is underlined by a large gap between known Covid-19 deaths and excess deaths, or deaths above average levels in recent years.

The incorrect recording of Covid-19 deaths was particularly likely at the beginning of the pandemic, when tests were scarce and doctors who filled out death certificates were less familiar with the disease, according to public health experts. They also attributed some excess deaths to other issues, such as people avoiding hospitals during health emergencies.

“We are kind of stuck with this underreporting, especially in the beginning of the pandemic,” said Robert Anderson, head of mortality statistics at the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention.

Combining frontline surveillance data with death certificates can improve data on both systems and can sometimes lead to rewritten certificates, said Anderson. But changing death certificates is not easy, he said. The person who filled out the death certificate – usually a doctor – has to agree to change the record.

“We are seeing some deaths that were not from Covid before, that were attributed to Covid when corrected, but it is a relatively small number,” said Anderson.

Major changes at the state level can create at least temporary and artificial lumps in the data that Johns Hopkins and others are gathering to show daily trends.

This happened briefly with the accumulation of mortality data from Indiana and Ohio, before they were backdated, which Johns Hopkins tracks and reflects in their records when possible. There is still an artificially large lump of 469 deaths in Iowa on December 11, in contrast to when that state changed the way it reports Covid-19 deaths.

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

Write to Jon Kamp at [email protected]