Oklahoma public health officials are hoping to close a widening gap when it comes to recording deaths related to COVID-19.

The late-2020 surge in coronavirus cases, hospitalizations and deaths left many of the state’s tracking systems behind as providers responsible for updating reports concentrated on providing patient care ahead of filling out reports. It was further exacerbated as epidemiologists and other public health officials got behind in fatality case investigations, which is the total the state has been publishing for COVID-19 deaths. 

That has led to a stark difference in the state’s death toll from COVID-19 and one kept by a division of the Centers for Disease Control and Prevention. The state said its tally of reported deaths reached 4,478 on Monday. That’s an undercount of about 2,500 from the totals reported by the CDC’s National Center for Health Statistics, which reported 6,970 deaths. 

The Oklahoma State Department of Health said on Monday it was working on a system to better reflect COVID-19 deaths in Oklahoma in a more timely manner. 

“At this point, we want to just get that number out in front of people to where they understand that we’ve never been seeking to minimize. We’ve always been striving to be as timely and accurate as we can,” said Dr. Jared Taylor, state epidemiologist for the health department. 

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Taylor and interim Health Commissioner Dr. Lance Frye said the state has epidemiologists review death certificates and other case information to see if a death can be attributed to COVID-19. They said their investigations can’t and don’t change the legal status of any death certificate, but they are helpful to better understand the extent of any pandemic or infectious disease. Vital records, like death certificates, are built mostly for the legal system, not necessarily for infectious disease investigations. 

“This is not anything unique to Oklahoma, but we feel like now is an appropriate time for us to make this transition in our reporting system so that there’s no perception that we’re minimizing these deaths,” Taylor said. “We recognize that each one of these deaths is a tragedy and is a great cost to the family and friends of the individual, the state of Oklahoma and the world.” 

Oklahoma’s death toll from COVID-19 has been released daily since last spring on the state’s data dashboard. But nuances around the reporting of deaths from care providers, medical examiners and physicians has meant there’s never been a true accounting on a daily basis. The expectation that the virus was killing a certain number of people each day was a false one, based on how death certificates are reported. 

For example, of the 50 deaths reported on Monday by the state health department, 47 of the deaths happened in January. From the public’s perspective, that appears hard to understand. After all, how can authorities not know about a reported death? 

Taylor said it comes down to speed versus accuracy. At some point, both systems will align, but there are nuances in the way they collect and report data. The CDC system captures deaths by place of death, not residency of the person who died. That could mean out-of-state residents treated in an Oklahoma hospital who succumbed to the disease would be on the CDC report. The same could be true for Oklahoma residents who died in hospitals out of state. The state records deaths by county of residence, while the CDC doesn’t offer that level of detail until full records are available in later months or years. 

“At the current time, that data is going to reflect the most timely estimate of what we have,” Taylor said of the CDC’s tally. “We’re going to continue to do our very thorough investigations, but that process has been very complicated because throughout the preceding three months, many parts of our healthcare system have been strained. And along with that strain, we’ve seen a decreased maintenance of our public health reporting system by our partners.” 

Generally, physicians or medical examiners in Oklahoma fill out death certificates, which are then filed with the state and sent to the CDC’s vital records division for processing. The CDC will then send back a preliminary report to the state with the chief causes of any death. It’s then up to the health department’s Acute Disease Service to check those reports and use any information to better inform the state’s infectious disease response. 

The state may already have information in its disease-tracking system that a person tested positive, was admitted to hospital and then had care in an intensive care unit bed before dying from COVID-19. That may not be readily available information from a death certificate, Taylor said. The state is hoping to integrate its disease-tracking systems so it could track a disease’s progression at each step. 

“We’ve always strived to make sure it was thorough and appropriate, and we’re going to continue to do so,” Taylor said. “But if you can check enough boxes, I think we can automate that and it will serve the purpose of expediting this process.”  

On social media, some have accused state health officials of underplaying the extent of the death toll from COVID-19. Taylor said some of the discrepancies may be as simple as using a generic code of a contributing factor on a death certificate compared to a more specific one. 

“They have access to different sets of data than we do,” he said. “Sometimes, and it’s relatively rare, they may reach a different determination than we do. We may conclude that COVID was a driver of it when they may code things a little more generically that may end up not getting picked up by the CDC and classified as a COVID death.”  

Dr. George Monks, president of the Oklahoma State Medical Association, has questioned the difference between the state’s death toll and the one kept by the CDC. In a statement, he said he was pleased to see the health department take steps to improve its reporting.

“Normally, when a physician indicates a cause of death on a death certificate, such as cardiac arrest or stroke, that is accepted as fact in our state’s reported vital statistics,” Monks said. “Deaths related to coronavirus shouldn’t be treated any differently. It is crucial for Oklahoma’s physicians and public health leaders to get the most timely and factual data.”

In the coming weeks, Taylor said the state will likely use its weekly epidemiology report to discuss the differences in death reporting from the health department’s internal systems and those collected by the CDC’s vital records division. 

Paul Monies has been a reporter with Oklahoma Watch since 2017. He covers state agencies and public health. Call or text him at (571) 319-3289 or email pmonies@oklahomawatch.org. Follow him on Twitter at @pmonies. 

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