State reporting of deaths misleading

On April 28, the Florida of Department of Health reported 83 new deaths, the highest number of coronavirus deaths to date.

It was an eye-opening figure, especially when considering just 14 new deaths were reported the day before. But in actuality the number of deaths on April 28 were fewer than half of 83: FDOH later said there were 40 fatalities.

That’s because there’s a lag time between the date someone dies and the date it is publicly reported by the health department. Gov. Ron DeSantis said last week that in order to spot trends, people should look at the actual death date as opposed to the figures FDOH releases daily.

“Sometimes these things are held for four or five days before it’s reported to the department of health,” he told reporters.

Each day at about 10 a.m., the health department updates a dashboard on its website that keeps track of the number of cases and deaths in Florida. It also sends

out a press release saying how many cases and deaths were counted from the previous day. However, the actual daily death count can lag by as much as two weeks as state officials add more deaths to specific days.

Toward the end of last month, the FDOH began putting the actual daily death count on its dashboard that keeps track of cases and deaths within the state. The day with the most deaths was on April 17 with 53, the dashboard shows.

“Death data often has significant delays in reporting, so data within the past two weeks will be updated frequently,” a note on the dashboard says.

Fatalities between April 5 and April 30 show there were between 34 and 53 deaths daily. Then there was a dropoff: On May 1 and 2 there were 15 and 18 deaths respectively, but those numbers will likely increase as the state gets more notices of deaths from medical examiners.

“This data is provided to the public as it is reported to DOH,” said Kent Donahue, spokesman for the Florida Department of Health in Orange County. “The department utilizes the testing data received from all 67 counties in the State of Florida. It is important to note that data in these reports are provisional and subject to change based on additional information gathered in the epidemiological investigation. As more data is collected and analyzed, the reports will adjust accordingly.”

A death cannot be reported until it is certified by the Florida Medical Examiners Commission. County medical examiners certify deaths with the decedent’s positive COVID-19 test result, said Dr. Stephen Nelson, the chairman of the state Medical Examiners Commission.

The state statute says deaths must be reported “forthwith” which means immediately but that doesn’t always happen. Sometimes the lag can come from the medical examiner’s office because of a backlog or from hospitals not reporting the death right away, said Nelson, also the medical examiner for Polk, Highlands and Hardee counties. As of Tuesday, the state had more than 1,400 deaths.

Other states count COVID-19 deaths in a similar fashion. Hard-hit Michigan, which has reported more than 4,000 deaths, updates its death count daily at about 3 p.m. which includes the number of fatalities as of that morning, said Lynn Sutfin, from Michigan Department of Health and Human Services.

Three times a week, health department staff check death certificates to see if they missed any.

“Some may lag behind as they are identified via a Vital Records death certificate review and then compared to COVID-19 positive cases,” Sutfin said. “If they have a positive test and a death certificate indicating COVID-19 association for their death, they would be included in the count.”

The Florida Medical Examiners Commission began compiling fatality data during state emergencies after Hurricane Andrew in 1992, when some people questioned the official death toll of 65, Nelson said. Because of the widespread devastation from the hurricane, false rumors started flying that there was a barge off the state’s coast where government officials were hiding bodies, Nelson said.

Compiling the list gives officials and the public verified information to quell such rumors, Nelson said. For instance, the commission keeps track of all hurricane-related deaths, such as carbon monoxide poisoning from generators used in power outages or someone being swept off the road while driving in the storm, Nelson said.

The commission is keeping a spreadsheet with all the coronavirus deaths and its number can be different from the DOH count. The Tampa Bay Times reported that in the beginning of April the commission’s list was 10 percent higher than the health department’s. But on May 1, the commission had about 80 fewer deaths than DOH, Nelson said. The lists tend to ebb and flow on which is higher, he said.

One reason for the difference, Nelson said, is the way DOH and commission classify deaths. Medical examiners list the death where the person dies, while the health department classifies the death where the person lives.

So if a person from New York dies from COVID-19 symptoms in Orlando, the DOH would classify the death as New York’s while the ME’s office would put it down as a Florida death in Orange County.

Nelson doesn’t believe anything nefarious is going on with the delay. In normal times, the commission may not hear about a death until a family member begins making funeral arrangements.

“There’s no reason of why the death can’t [be reported within 24 hours] but sometimes it doesn’t,” Nelson said. “… It’s a human system.”