What toll will virus take on the state?

Deaths were already higher in 2020 prior to pandemic hitting

Colorado recorded a nearly 20% increase in deaths in March and April as the novel coronavirus swept the state, according to state data that provides an early glimpse of the broader impact of the pandemic.

The data from the state health department show deaths in Colorado are on the rise from 2019 levels, largely because of the impact of the COVID-19 respiratory disease. However, medical and public health experts cautioned it’s still too early to measure the pandemic’s full toll.

“That’s something that will be argued and debated undoubtedly for a generation,” said Dr. Leon Kelly, El Paso County’s coroner, who also has served as deputy medical director for the county’s public health department during the coronavirus crisis. “What price did we truly pay as a society for the pandemic?”

Overall, deaths are on the rise in 2020, as January and February also saw slight jumps. There were 7,102 deaths statewide during those two months, up from 6,725 in January and February of 2019, according to provisional death certificate data provided to The Denver Post by the state.

But the increases in March and April were more significant. In 2019, 6,761 people died in Colorado during those two months, but this year the number of deaths in that same time frame increased by 1,341 to an estimated 8,102 deaths. But there’s a lag in death certifi

cate data, meaning the number of deaths in April could still rise further.

Kirk Bol, manager of the state health department’s vital statistics program, said the increase in deaths this year can be attributed largely to the coronavirus, as well as Colorado’s growing and aging population.

The most recent death certificate data shows there were 644 COVID-19 deaths in Colorado in March and April. That’s more than the 461 individuals who died in Colorado from influenza or pneumonia in all of 2019, according to the death certificate data.

Unlike that breakdown of coronavirus fatalities in the death certificate data, the Department of Public Health and Environment’s tally includes more recent information, and shows the number of deaths reported into May.

As of Wednesday, 1,091 people had died from COVID-19 in Colorado since the virus was first confirmed in the state in early March, according to the agency.

Pandemic altering mortality rates

The additional numbers also could include those who died indirectly from the outbreak, such as people who didn’t seek needed medical treatment.

The pandemic is affecting every part of society, meaning it could alter mortality rates in multiple ways, said Dr. Lisa Miller, professor of epidemiology at the Colorado School of Public Health.

For example, she said, has there been an increase in domestic violence as more people stay home? Or are there fewer heart attacks or severe asthma attacks because the air is cleaner from fewer cars on the road?

“I certainly think it’s something to investigate,” Miller said. “The list of things to investigate is long.”

Tracking the number of people who died either directly or indirectly as a result of the outbreak is complex, and therefore, the numbers from public health officials are more of an estimate, according to the experts.

Even with influenza, a disease that has been around for decades, the number of deaths each year is estimated — not calculated precisely — because public health officials know that they can’t capture them all as not everyone is tested for the flu, Miller said.

With COVID-19, testing has been limited since the start of the outbreak and there are far more cases of COVID-19 in Colorado than have been confirmed. It’s also widely believed the novel coronavirus likely was in Colorado as early as January.

As a result, it’s possible there are COVID-19 deaths that were missed and classified as something else. Likewise, there are deaths that could be counted as COVID-19 that were caused by another illness, according to medical experts.

“You’ve got a brand new disease and to think that this is a straightforward issue would be naive,” Miller said. “It’s not straightforward.”

Counting direct COVID-19 deaths

The death count from the new coronavirus provides government officials and the public with an understanding of the severity of the disease and the response to the outbreak.

But the tally has become a political flashpoint as some individuals claim the numbers are inflated, saying people with underlying health conditions died from those illnesses rather that the coronavirus.

People with underlying health conditions, such as heart and lung disease or diabetes, are among those at a high risk of complications from COVID-19. Such complications include pneumonia, hypoxemic respiratory failure and sepsis, according to the U.S. Centers for Disease Control and Prevention.

If somebody with diabetes tests positive for the new coronavirus and dies after developing pneumonia and respiratory failure, a physician will record it as a COVID-19 death, said Dr. Stephen Cobb, chief medical officer of Centura Health’s Denver metro group.

The reason that the cause of death is attributed to COVID-19 is because that person would not have died at that time or place unless they had the new coronavirus, said Kelly, who added that it would be the same for anyone with a lung or heart illness.

Cobb said it’s harder to make the cause of death determination when someone has COVID-19 and an illness such as congestive heart failure because the symptoms and signs of the two are the same.

“Where we have a risk of not having correct COVID numbers, it’s not because we’ve over-contributed the deaths,” Kelly said. “It’s undoubtedly, in some places, undercounted deaths.”

Overall toll of the pandemic

There are concerns about the indirect impact of the pandemic. If there was a surge in coronavirus cases, more police and firefighters could become sick and that could lead to more deaths if they aren’t able to respond to potentially life-threatening situations. Or if sanitation workers become sick, then it makes it more difficult for cities to manage their waste.

Physicians increasingly are worried that patients are not seeking care when they become sick because they are afraid of contracting the new coronavirus.

So far, the medical examiner’s office in El Paso County, which also serves 20 other counties, has not yet seen a large increase in individuals dying from heart attacks, other preventable deaths or suicides, Kelly said.

In fact, he said, there was an initial drop in homicides and car-crash deaths as social-distancing policies first rolled out earlier this year. It’s in the last three to four weeks that those deaths have started to increase, he said.

There were no big changes in the number of homicides in the state until April, when the number of such deaths dropped from 17 in March to eight in April. That is down from 24 homicides in April 2019, according to the death certificate data.

“Everyone was staying home,” Kelly said. “Our total cases kind of topped off.”

Likewise, Centura Health has experienced a decrease in trauma cases across its health system.

Since March 1, the system’s doctors have treated about 99 patients for injuries from car crashes, down from 169 patients during the same period last year. Another 91 patients were treated for injuries from skiing and other winter activities, a decrease from 289 patients last year, according to data provided by Centura Health.

“It truly is premature to draw any conclusions about what we know of the true mortality rate,” Cobb said.