Who gets counted as a COVID-19 death has been questioned for months, with no formal definition in place nationwide as officials adapt to a new disease’s destructive impact.
Conspiracy theories have swirled around the idea that coronavirus mortality totals are being inflated.
Now, Nevada has released an official definition of what it considers a confirmed COVID-19 death.
As of Oct. 19, the state’s official tally includes anyone who dies from natural causes within 30 days of testing positive for the respiratory disease. As long as there is a recent positive result, the person’s death certificate is not required to specifically list a COVID-19-related term as an underlying cause of death.
“This (definition) is really in order for public health to have a way in Nevada, to make sure that we’re counting these consistently across our counties,” state epidemiologist Melissa Peek-Bullock said.
Nevada officials have attributed more than 1,850 deaths to COVID-19 since the state’s outbreak began in March. The vast majority have been among people age 60 or older, according to statewide data. In Clark County, about 73 percent had underlying health conditions, making them more susceptible to severe outcomes, local data released Oct. 6 shows.
A recent positive COVID-19 test result has always been required for a death to be included in the tally, Peek-Bullock said. A natural cause of death has not, but the state’s largest county recently removed a small number of non-natural deaths from its count.
Nevada began working on its COVID-19 death definition in July, after it became apparent the Centers for Disease Control and Prevention would not release one, Peek-Bullock said. In lieu of a nationwide definition, states have had to create their own.
In addition to setting criteria for confirmed COVID-19 deaths, Nevada’s definition includes how to count “probable deaths” from COVID-19. Probable deaths cover situations in which someone is believed to have died from COVID-19, but did not receive a laboratory test.
However, Peek-Bullock said the state has not tracked probable deaths since the local outbreak began, and officials do not have the resources to begin now.
Following the release of the statewide definition, Clark County removed six deaths it had already recorded. Southern Nevada Health District officials said it was determined those people died of “non-natural causes” but declined to elaborate on the causes of death.
State officials said they do not plan to conduct a statewide review.
“These were the ones that were like blatantly against the death definition, because they were things like suicide or overdose, whereas we didn’t have those in the other counties,” said Lindsey Kinsinger, manager of the state’s Office of Public Health Informatics and Epidemiology.
COVID or flu death
The arrival of flu season introduces another complicating factor in determining COVID-19 deaths.
Nevada has received “combo” tests for COVID-19 and influenza, but state officials said they do not have a plan about how to attribute a person’s death when they have tested positive for both respiratory diseases.
“I would assume that would be a very small number of folks that we might have to do a more thorough review (for),” Peek-Bullock said. “So we’ll deal with those as they come up on an individualized basis.”
Doctors at Las Vegas hospitals aren’t so sure.
“There are going to be a lot of cases where you see both going forward, and it will be difficult to determine whether it was one or the other, or it was both combined,” said Dr. Robert Smith, associate chief medical officer at Sunrise Hospital & Medical Center. “I don’t envy the people at the state who are going to have to sort out all the death certificates when the dust settles.”
Dr. Luis Medina-Garcia, an infectious disease physician at University Medical Center in Las Vegas, said it would take a lab study of tissues from “ a large university medical center” to determine which disease caused a person’s death.
“For mainstream America, that’s not just in reach,” he said.
Last season, Nevada reported 1,641 flu hospitalizations and 61 deaths, the majority in Clark County.
Conspiracies on social media
Disinformation about COVID-19 deaths has circulated in the U.S. for months.
This summer, social media accounts widely shared a claim that only 6 percent of COVID-19 deaths in the U.S. were actually caused by the disease, based on data from the CDC. It was a misinterpretation of the CDC analysis, experts have said.
Many COVID-19 patients’ death certificates include their underlying medical conditions, like heart disease or diabetes, and all certificates capture the sequence of events that led to their death, said Dr. Sally Aiken, president of the National Association of Medical Examiners.
That doesn’t mean COVID-19 isn’t to blame for their death.
“Just because you have a risk factor, it’s still the COVID that sets in motion the chain of events that causes your death,” Aiken said. “You are dying of COVID, because COVID pushes you over the edge, more or less.”
Last month, President Donald Trump told his audience at a political rally in Michigan that “our doctors get more money if somebody dies from COVID.” Experts say that is also false.
While hospitals receive more federal funding for treating Medicare patients who have COVID-19, the facilities and their doctors receive no additional dollars if any COVID-19 patient dies in their care, University Medical Center CEO Mason Van Houweling said.
“There is no financial incentive to have a death attributed to COVID,” he said.
Nevada officials said the state’s federal CARES Act funding is also not tied to the COVID-19 death toll.
“Our data quality is extremely important to us,” Peek-Bullock said. “We have no benefit in wanting any numbers to be inflated. We would like nothing more to see our numbers going down.”