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How Colorado tracked the death of COVID-19

For months, confusion – and in many cases misinformation – has been swirling about how deaths from the new coronavirus are reported.

The death of COVID-19 has become a political point of experience as people, including politicians, have questioned whether the census is exaggerated – much to the disappointment of those responding to the crisis.

“Somehow you’ve trusted me for more than a decade to offer you the truth about why people are dying, and now all of a sudden I, the hospitals, the doctors, the nurses, the public health workers, are all in agreement and lying to you about it?”

; said Dr. Leon Kelly, an investigator in El Paso County.

The coronavirus pandemic is a mass victim. More than 260,000 Americans, including more than 3,000 in Colorado, have died from COVID-19 in less than a year.

The Colorado Department of Public Health and the Environment now estimates that the number of people who die from COVID-19 in Colorado could range between 4,900 deaths and 7,400 deaths by the end of December, depending on the level of disease transmission. .

This not only means that deaths are rising rapidly, but also that the third wave of infections in the country is poised to become more deadly than the spring tide. Colorado reported 2,000 deaths among people with COVID-19 in September and over the weekend – just two months later – that number exceeded 3,000 deaths. In the spring, the state took two months to report 1,000 deaths.

“The amount of disease transmission we’ve seen in Colorado over the last few days is really the highest since the pandemic began,” said Dr. Rachel Herlichy, a state epidemiologist, at a news briefing last week. “With this high rate of disease transmission, we will unfortunately see an increasing number of deaths.”

Understanding the number of victims of a pandemic is complex and confusing. This is because when we talk about COVID-19 deaths, it’s not just about who died from the disease to the deceased s the disease. It also includes consideration of deaths indirectly caused by the pandemic.

“He’s always a little politically charged because different people have different motivations,” said Dr. Matthew Wania, director of the Center for Bioethics and the Humanities at the University of Colorado. “But it played out at the peak of the COVID pandemic because there is so much political motivation to say, ‘Oh, not so many people. It’s not that dangerous. “

How do we know that death is from the new coronavirus?

The first thing to understand about COVID-19 data is that there is a delay in hospitalization and death due to disease progression. When someone becomes ill with the new coronavirus, it can take up to two weeks for the symptoms to become severe enough to be hospitalized.

Therefore, after a jump in new cases of coronavirus across the country, there is no immediate increase in hospitalizations.

It also takes time for COVID-19 deaths to be registered by the state health department, creating a delay between new cases and deaths that ranges from about three weeks to a month.

It is also important to know that the process of investigating, determining and reporting deaths did not change during the pandemic. State and local officials said they recorded COVID-19 deaths as they would any other death.

The cause of death recorded in a death certificate is determined by one of three people: a forensic doctor, a medical expert or a doctor.

When one of these three people completes a death certificate, they make a medical assessment of why they think a person has died, Kelly said.

Many people who die from COVID-19 do so in a hospital. Autopsies are not often performed on patients after their death, as they are already diagnosed with the new coronavirus at the time of death. And not everyone who undergoes an autopsy is tested for the disease.

“(Doctors) have a very good idea based on their experience and their experience of making primary diagnoses about why patients have gone through and the comorbidities that play a role in this,” said Dr. Vernon Naake, chief medical officer at the Medical School. center in the northern suburbs.

In determining the cause of death, medical professionals use the “but for” principle: if “but for (a certain event)”, a person would not die at that particular time and place.

There are several ways in which this can develop when someone dies from COVID-19. Consider a case where the cause of death is listed as septic shock, but the death certificate also says that septic shock is caused by another condition resulting from acute respiratory distress syndrome or ARDS. And in this case, the syndrome of acute respiratory distress is caused by the new coronavirus.

All these conditions are written in a death certificate. But the reason death is defined as a fatal case of COVID-19 in such a scenario is because “but for COVID-19 none of these other things happen,” Kelly said.

Other conditions that a person may have had, such as obesity or diabetes, are not direct complications of COVID-19. However, they put a person at increased risk of severe symptoms, he said.

AAron Ontiveroz, The Denver Post

Dr. Leon Kelly, a medical examiner in El Paso County, at the district investigator’s office on Monday, October 19, 2020.

How the state health department reports deaths from COVID-19

Earlier this year, questions were raised about the accuracy of how the state health department tracks deaths when the new coronavirus is not linked to the cause of death. This scrutiny led the State Department of Public Health and the Environment to change the way it publicly reported COVID-19 deaths in May.

The department now reports both the total number of deaths due to the new coronavirus and the number of deaths among people who had COVID-19 at the time of their death, including when the disease was not the main cause.

Although divided into two categories, most of the deaths in the latter number are deaths caused directly by the disease. That is why there is often a close difference between the number of deaths s COVID-19 and the dead from the disease.

As of Monday, the state health department had registered 3,037 deaths among those with COVID-19 and 2,656 deaths due to the disease.

The reason for the discrepancy in the two numbers is due to the way the data is collected by the state health department. The category of “deaths due to COVID-19” comes only from data on death certificates, which are several weeks behind, so the number is expected to increase.

The category of “deaths among cases” is rather the number of real-time deaths that come from hospitals or through contact tracking, case investigations and other methods. Sometimes this data is collected before the death certificate is registered and processed.

This category of death data helps the state health department “really understand the severity of the disease and whether it changes over time,” said Herlichy, a state epidemiologist. “After all, these two different death counting systems are very closely aligned.”

Investigator Kelly said he was reviewing a spreadsheet created by public health officials of people reported to have died from COVID-19 in his area. He goes through each death certificate and checks that it corresponds to the cause of death and all other contributing factors listed in the spreadsheet. If it does not match, the death is removed from the spreadsheet.

“We do all this in real time,” Kelly said. “So, what happens is many times, we try to balance with bringing out as much information as possible as quickly as possible, because it’s important to people, but we also make sure that what’s happening is correct, clear, concise and usable.

There are various reasons why deaths were initially reported due to the new coronavirus and then eliminated. For example, if a person dies while in a nursing home where there is an outbreak of the disease, health officials could identify it as a probable mortality from COVID-19 during their investigation of the outbreak.

But the death certificate may not contain COVID-19 when directed to the district investigator. Instead, he lists similar symptoms, such as shortness of breath or respiratory failure – both of which can result from another illness.

One of the challenges with the new coronavirus is that it affects people in different ways. While the lungs are often the first organs affected by COVID-19, it can also damage the kidneys and cause blood clots.

“I’m far more likely to come across cases that aren’t on the list,” Kelly said. “It works both ways.”

Calculate the true cost of a pandemic

Many medical and public health experts believe that the number of deaths from COVID-19 is underestimated, as limited testing at the start of a pandemic is likely to lead to missed diagnoses. It is often the case with other illnesses, including the flu, as not everyone is tested or diagnosed before they die, Herlichy said.

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