State re­port­ing of deaths mis­lead­ing

Orlando Sentinel - - Front Page - By David Har­ris

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.”

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