A year ago, no one would say that 149 deaths in the first three weeks of the year from a single disease in San Bernardino County could be considered a good sign.
But on its surface, this is what the number of deaths from coronavirus can look like.
Unfortunately, infectious disease experts say the number of deaths reported in recent months – and the 0.6% death rate listed on the county’s website – is likely to be far below the actual number of deaths. This is especially true for the period before Friday, January 22, and Saturday, January 23, which together account for 33 of the deaths, after seven days with a total of one counted death.
Since November 1, when the virus outbreak began in winter, San Bernardino County has had almost 200,000 new cases. Provenly accurate statistics across the country suggest that between 2,000 and 4,000 of these people will not survive the disease. But the county has reported only 516 deaths since November, meaning that hundreds or thousands of deaths are probably not yet reflected in these statistics.
Experts say insufficient counting can fuel misperceptions about how dangerous the new coronavirus is.
“I just hope that people who don’t take the virus seriously now won’t regret it later – ‘I wish you had told me how deadly it is,'” said Andrew Noymer, an epidemiologist at UC Irvine who specializes in disease mortality infectious. “Consider yourself immediately: it is quite deadly.”
County officials acknowledge that winter deaths can take months to appear in the statistics.
“We also experienced a delay when things were going bad in July, taking 6 to 8 weeks for some deaths to be reported later,” said county spokesman David Wert in an email, “and how things are going much worse, we are probably not going to get a true picture of all the November / December deaths that occurred until March. “
The county hopes to begin catching up as early as December 15 through January 7, according to a notice on its coronavirus panel. As a result, “death counts are expected to increase in large numbers in the next week as they are processed and included in the panel data,” says the notice published on Saturday, 23 January.
Overburdened hospitals and registrars are causing delays in other counties as well, but statistics suggest the situation is on a different scale now in San Bernardino County.
“These delays are normal, although they are often long,” said Noymer. “The compilation of data from death certificates is a bureaucratic process. This takes a long time.
For example, Orange County was still receiving death certificates for COVID-19 deaths that occurred in July in October, three months later, Noymer said.
Why more deaths are expected
Across the country, the number of deaths from COVID-19 is about 1.5% of the number of confirmed cases.
“But when cases increase and deaths decrease enormously, there is a period when that number is much less than 1.5%,” said Noymer. “It looks like San Bernardino County is going through that period now.”
In the summer, the Centers for Disease Control found that, across the country, the typical time between the onset of symptoms and a death by COVID-19 was about two weeks, and the average time between a death and the report of that death. death was just over a week. Others, analyzing coronavirus data, found that there was about a three-week delay between the start of the increase in cases and deaths.
If the number of people dying from COVID-19 is between 1% and 2% of the number of known cases, and the interval between cases and deaths remained at three weeks, then San Bernardino County could have reported about 825 to 1,650 deaths so far in January.
Instead, it reported 159 – less than a fifth of the expected minimum.
This formula was much more accurate in other southern California counties.
Riverside County, which does not update the numbers on weekends, reported 792 deaths from coronavirus as of Friday. This is close to the lower limit of its expected range of about 760 to 1,520 deaths by Friday.
Los Angeles County reported 4,553 deaths, almost in the middle of its expected range of about 3,025 to 6,050 deaths.
Orange County had an expected range of about 630 to 12.65 deaths and reported 672.
How a death is reported
San Bernardino County normally takes two to three weeks to report COVID-19’s death, Wert said.
“Given the huge burden on hospitals at the moment and the slowdown in the process in general, it is safe to assume that this period has increased,” he said. “… There are usually several steps involved by various parties, all of which are now inundated with COVID support duties, so things got slower.”
First, the provider who oversees the care of the deceased must complete a death certificate, he said. The provider must attest to the fact, the cause and the form of someone’s death, which can be difficult for elderly people or those with serious health problems, in addition to COVID-19.
So, depending on the circumstances, the deaths can be prosecuted by the coroner’s office, which is also backed, Wert said.
The records are then processed through County Vital Statistics, which can take up to eight weeks, Wert said. This office validates the information, often reaching out to close relatives or others for missing information.
Finally, records go to the Public Health Communicable Diseases Section. Each case must be paired with a positive test, and the county determines whether the person died of COVID-19. Someone who had the disease, but died of something else, is not counted.
“If it is still unclear, the county is conducting another medical review,” said Wert.
The process is similar in Riverside County, where each reported coronavirus death is validated by Wendy Heatherington, head of Riverside County’s public health epidemiology unit.
Validation of deaths that come from the coroner’s office or the vital records office can take up to two weeks. Even with the death toll increasing, it remained within that window, but more work is needed.
“I’m doing more on weekends than in September,” she said.
Still, she said, there are so many people dying that the system can be overwhelmed, which could explain why another county was left behind.
“Yesterday (Wednesday), the vital records team sent in more than 83 deaths, while in September and October I might receive five a day,” she said.
It is understandable that the process takes time, said Brandon Brown, an associate professor at UC Riverside with a background in epidemiology.
“Like everything else during pandemic times, many people involved in public health, including vital records, were completely overwhelmed, as most public health departments were already underfunded before COVID-19,” he said.
But the delay has a consequence, he said: “We may be underestimating the true mortality rate of COVID-19.”