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Four months into the Coronavirus pandemic, Orange County Health Care Agency officials are still struggling to get the public timely, accurate data about how many people are dying from Covid or how many are in the hospital with the virus.
It’s triggering tons of questions from residents and local media.
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This week, Orange County health officials acknowledged the county’s coronavirus death chart – which shows date of death – is missing some deaths in recent days because of an average week-long lag in reporting, creating an impression of a major drop that may not be accurate.
The county Health Care Agency reports the deaths differently than the state Department of Public Health by using dates the deaths occur, while the state tallies them on the days the deaths are reported.
For instance, according to the state data, 141 new deaths were reported during the two-week time period ending last Sunday. It doesn’t reflect the date of deaths, but rather the date the deaths were reported into the system.
In that same timeframe, county data shows 61 new deaths.
That’s because county officials plug the counts into dates people died on. Some of those deaths that occurred during that time frame may not be reported yet because of a lag.
“We know that the standard death case needs to be reported within eight days,” interim county health officer Dr. Clayton Chau said at a Thursday news conference.
“Now with that said, there’s [deaths] that were reported up to 14 days or so. But on average it’s eight days,” he said.
UC Irvine epidemiologist Andrew Noymer said he computes the average daily increase of deaths by using the past seven days of new deaths reported, similar to the state data.
“The deaths are kind of reported in clumps that don’t necessarily reflect when they occurred,” said UC Irvine epidemiologist Andrew Noymer in a Wednesday phone interview.
In order to further simplify his metrics, he recently switched to a benchmark — when OC could see its 1,000th death.
“The deaths are down a little bit in the [Wednesday update],” Noymer said. “We’re about 45 days from our 1,000th death and that’s up from 30 days, so that’s good. The deaths are growing more slowly in the last few days than they have been previously.”
Graphs on the state and county website also paint two different pictures: the state Department of Public Health shows deaths spiking up and down on certain days, while deaths appear to be plateauing on the OC Health Care Agency’s graph.
Chau said they add the deaths to the day people died to get a better understanding of where the county’s virus situation sits.
“Because if you just show the day when they don’t actually figure out when the death actually occurred, you will never figure out the trend. So that’s our effort,” Chau said at a Thursday news conference.
Noymer’s colleague, Dr. Daniel Chow, also said the seven-day average is the best to use because the raw numbers tell a vague story.
“The problem is you’re not going to get a real time picture in [the raw numbers], you’re just going to be seeing what’s been happening in the past,” Chow said.
State health officials didn’t respond to questions about the differences in death reporting.
Numerous residents have been reaching out to Voice of OC about the discrepancies between state and county data over the past few weeks.
Meanwhile, the virus has now killed 604 people out of 35,778 confirmed cases so far.
The county also continued to see a drop in hospitalizations, with 592 people hospitalized, including 189 in intensive care units.
Over 403,000 tests have been conducted throughout OC, which is home to roughly 3.2 million people.
There’s also rising questioning about how hospitalizations are being reported to the Health Care Agency with County Supervisors’ Chairwoman Michelle Steel raising concerns that hospitals are potentially misclassifying regular patients as Covid thus inflating numbers.
At Thursday’s press conference, Steel said county officials continued to push state public health officials for better coordination on reporting hospitalizations to the public. Earlier this week at the county supervisors’ regular meeting, Steel also pressed county health officials to engage with the state and local hospitals.
Chau said he’s looking into the concerns, but didn’t have an estimate of how many patients that could be.
“We don’t know and I’m hoping we would work together with our local hospitals to get us that information,” Chau said at Thursday’s news conference. “Once we get it we’ll obviously share it with all of you.”
CalOptima board chairman, Dr. Paul Yost, disputed Steel’s assertions Wednesday, noting that most hospitals test people for the virus before they’re admitted. If they test positive, their non-virus procedure is cancelled, he said.
There’s also increasing questioning about how Coronavirus patients are getting transferred out of hospitals and into other facilities as well as how those transfers are getting reported to the public.
County Health Care Agency officials previously said hospitals were transferring virus patients to long term care facilities and skilled nursing facilities. But specifics, like how many patients have been sent to long term care or nursing facilities, remain unknown.
“Yes, hospitalized COVID-19 positive patients are being discharged to long term care facilities. The OC Health Care Agency (HCA) does not track individual transfers. However, when a hospitalized COVID-19 positive patient is transferred to a Skilled Nursing Facility (SNF), that patient would be subtracted from the hospitalized count (by the sending hospital) and added to the SNF count via the state daily reporting,” HCA staff said in an email last week.
When asked about specifics of the transfers at last Thursday’s news conference, Chau directed reporters to follow up with Health Care Agency staff.
“As far as I know, I have not heard any surge in skilled nursing facilities,” Chau said. “I’ve not heard staff reporting that we’ve had an issue yet.”
When asked about long term care facility and skilled nursing facility capacity, how the cases originated, if patients are still able to spread the disease or if someone died after being transferred, Health Care Agency officials gave the same answer on Wednesday.
Noymer said there’s not a lot of reliable statistics lately.
“There’s not a lot of numbers that we can rely on these days. The hospitalizations are kind of funny. I’m looking at the deaths on the long term situation and I’m looking at the ICU’s on the short term situation. And the ICU’s are basically steady, hovering sort of right around 200 day after day,” he said Wednesday. “I’d say things are just kind of simmering in Orange County, it’s kind of like a low boil.”
Nick Gerda covers county government for Voice of OC. You can contact him at firstname.lastname@example.org.