Health Care

State mortality data may shed light on Covid-19’s toll

hospital bed with ventilator
A bed equipped with a ventilator inside a negative pressure room at the UVM Patrick Gymnasium surge hospital. Photo by Mike Dougherty/VTDigger

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As the coronavirus outbreak continues, researchers are looking at Vermont’s mortality data to learn more about the total death toll related to the illness, and whether Covid-19 deaths have not been counted.

A higher-than-average number of Vermonters died in March, according to preliminary data from the Department of Health. The higher number could potentially be linked to the Covid-19 crisis, but researchers say it’s too early to know.

According to the Department of Health, 570 people died in Vermont in March 2020, compared with 498 in January and 504 in February 2020. In March 2019, the state’s fatalities numbered 527. 

The number of people who have died of the new virus in Vermont could be higher than the Department of Health’s reported total of 52, as of Sunday. The tally counts all individuals who tested positive for Covid-19 and had the virus listed as a cause of death or contributing condition on death certificates.

“Could those deaths be caused by Covid? Cautiously, yes,” said Mark Hayward, a University of Texas-Austin researcher who works with mortality data.

Fatality numbers are increasingly being used as an indicator of the disease’s quieter toll. Experts say there are many people who may have died without ever being tested for the virus. 

The Vermont data is preliminary, and it’s only one month of a crisis that could last many months, experts say. 

Several countries have begun releasing data on how many people have died in March — and often, that total is far higher than the number of deaths in previous months.

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Mortality rates are likely to be one data point researchers consider as they try to understand the new illness. Getting a complete count of the death toll of a pandemic is difficult, and the global impact of Covid-19 may never be known. A century after the Spanish flu pandemic, researchers were still arguing whether the death total was 17 million or 50 million.

In other states, mortality data since the start of the outbreak was notably different. A New York Times analysis found seven states where the total deaths since the start of the crisis were 50% higher than a normal death total for this time of year. That would mean there were 9,000 more deaths in those states than were reported for Covid-19.

Hayward, the University of Texas-Austin researcher, said at a national level excess mortality numbers have been used to estimate the toll of a particularly widespread disease. In years prior, the Centers for Disease Control and Prevention have used the fatality rate for swine flu outbreaks. 

“You can almost guarantee there’s an undercount, it’s just a question of how much,” Hayward said.

It can be tricky to gather mortality data because of the way deaths are reported state by state. Each state and territory has its own system of investigating deaths, logging death certificates and reporting cause of death. 

“This is a shock to the system, and it’s hard for statistical agencies to keep up,” he said. “They’re committed to an accurate count, but whether they have the resources is a different issue.”

It’s hard to draw firm conclusions from the variation in Vermont’s numbers. For one thing, 570 is not a record-breaking total, as other states have had during the Covid-19 crisis. The state had more than 580 deaths in January 2018, during a bad flu season.

Timothy Sly, an epidemiologist at Ryerson University in Toronto, said he does not believe the rise to be statistically significant.

“When you take out the [known] Covid deaths and compare it to last year’s total of 527, there’s not a lot of daylight between those numbers,” he said.

Hayward said the data could become more clear in the coming months, particularly as medical examiners now are looking for Covid-19. “There are shifting sands,” he said. “What happened at the start of the crisis is not what’s going to keep happening.”

Department of Health Commissioner Mark Levine said more analysis needs to be conducted to tell if there was a true rise in deaths. 

But he said unknown Covid-19 deaths are a possibility, particularly in cases involving patients with an underlying condition “that might not have killed a person at that time if they didn’t have Covid.”

“We’re gonna have to do a lot more investigation into that to really understand and give you the   kind of answer that would be more data-driven and science-based,” he said.

Another problem is parsing out the reason for the rise, since the cause of death in each of those cases won’t be published for months or more. States submitted death numbers to the CDC for preliminary totals, but still need to submit the individual death certificates. The documents are not standardized nationally, and it can take a while to finalize the data. 

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Levine has said the state is concerned about people being reluctant to go to the hospital for fear of contracting the virus, leading to a rise in deaths not related to Covid-19.

“Health care institutions across the nation are reporting marked decreases in patients presenting with heart attacks, strokes and other serious medical illnesses,” he said.

Some experts have also worried about the stress of isolation worsening health conditions such as obesity, addiction and depression, which could lead to a rise in deaths. The state has said at least so far, the Covid-19 crisis has not led to a surge in suicides.

The state reports deaths as caused by Covid-19 if the person had Covid-19 when they died, according to the Department of Health’s website. Several death certificates have listed Covid-19 as a contributing factor, in line with CDC guidance.

Tracy Dolan, deputy commissioner of the Department of Health, said physicians across the state were the ones to make the initial determination of cause of death and file a death certificate. But the Medical Examiner’s Office reviews a large number of certificates and may flag one with Covid-like symptoms.

“If we see pneumonia, and we see some other things that might make us think it could be Covid-19, we might reach back out,” she said.

The state will soon issue recommendations for post-mortem testing to make those decisions more consistent, Dolan said. That may include anyone who died in a long-term care facility.

She said it was possible that early Covid-19 cases were missed, but the health department has become a lot more “proactive” in testing Vermonters in long-term care facilities for the virus and have expanded the list of symptoms that are potentially related to Covid-19.

“The hardest part has been the long-term care facilities and just watching it, especially early on, move through those facilities,” she said. “It was hard for all of us to feel like, ‘what else can we do?’ and that’s when we started to get a lot more proactive like, let’s reach out to all of them.”

The CDC has expanded the list of symptoms for Covid-19 to include nausea, fatigue and headaches. Recent reports indicate that the disease can cause blood clots, leading to strokes and circulation problems. The virus has also been known to cause elevated heart rates for long periods of time, and patients have subsequently died of cardiac arrest. Covid pneumonia is also a condition that has been recognized as a cause of death.

Editor Anne Galloway contributed to this report.

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