One month after the Freedom Foundation reported that Washington state’s method for tallying COVID-19 fatalities could result in an inflated count, the Department of Health (DOH) has announced it will start removing deaths improperly attributed to the virus.
In a new fact sheet, DOH explains,
“Until now, we counted all people who died that tested positive for COVID-19. This method identifies people who had the virus, but fails to tell us whether COVID-19 caused their death… We will change the way we report COVID-19 deaths in two phases. Phase 1 will take place on June 17, and Phase 2 will roll out over the next few weeks.
Phase 1: Remove deaths where COVID-19 did not contribute to death from our death count. For Phase 1, this will result in seven deaths being removed from our current death count, including two suicides, three homicides, and two overdose deaths… Additional non-COVID-19 deaths may be removed throughout the course of the COVID-19 outbreak.
Phase 2: Expand how we report deaths to identify whether we can confirm or rule-out COVID-19 as a contributing cause of death, including identifying probable and suspected deaths. As part of Phase two, future COVID-19 death classifications will include whether:
1. COVID-19 contributed to the death (death certificate, testing, and other case information available to confirm);
2. COVID-19 probably contributed to the death (death certificate information available but testing information not available);
3. COVID-19 is suspected to have contributed to death (follow-up being conducted prior to ruling out or confirming death);
4. COVID-19 did not contribute to the death (examples include homicide, overdose, suicide, car accident, or disease with clear exclusion of COVID-19 illness).”
These changes are both welcome and overdue, especially given Gov. Jay Inslee’s oft-repeated claim that the state’s response to the COVID-19 virus is guided by the best available “science and data.”
After the Freedom Foundation released its original report on May 18, based on written statements from DOH officials, Gov. Jay Inslee dismissed it as “disgusting” and “malarkey.” He further accused the Freedom Foundation of “fanning these conspiracy claims from the planet Pluto” and not caring about the lives lost to COVID-19.
However, in a subsequent telephonic press briefing held by DOH on May 21, officials confirmed that DOH “…dashboard numbers do include any deaths to a person that has tested positive to COVID-19” and that “(w)e currently do have some deaths that are being reported that are clearly from other causes” including some “…from gunshot wounds.”
While DOH claims its method of counting all deaths of persons who had previously tested positive for COVID-19 was necessary to get information to the public as quickly as possible, it was never the best or even the only way to tally virus fatalities.
In fact, after researching and contacting the 26 counties with at least one COVID-19 fatality (prior to DOH’s press release), the Freedom Foundation found that 15 have been counting only fatalities in which the virus played a confirmed role.
Six of these counties report notably fewer COVID-19 deaths than DOH — including King, Pierce, Yakima, Benton, Franklin and Thurston — suggesting the seven deaths removed from the DOH count in Phase 1 are just the start.
The remaining counties either used the original DOH process for counting COVID-19 deaths (anyone who tested positive for the virus and subsequently died, regardless of cause), didn’t respond the Freedom Foundation’s inquiries or provided responses that were unclear.
In response to a Freedom Foundation inquiry, Asotin County Public Health (ACPH) responded that, “the decedent’s death certificate notes their cause of death and we report the information,” suggesting that, unlike DOH’s original method, Asotin County requires that COVID-19 be reflected on the decedent’s death certificate before the county will attribute the death to the virus.
Benton and Franklin counties
The Benton-Franklin Health District (BFHD) informed the Freedom Foundation that, “An individual is counted as a COVID-19 death if they were lab confirmed positive for COVID-19 and died due to health complications related to the illness.”
BFHD’s website attributes the discrepancy to the different methods of counting the deaths:
“Benton-Franklin Health District has been reporting fewer deaths than Washington State Department of Health (DOH) because we have different definitions of what a COVID-19 death is. We’ve defined a COVID-19 death as someone who died with COVID-19 as their primary cause of death, meaning they died because of COVID-19. DOH includes people who tested positive for COVID-19 and died, but may not have died of COVID-19. That’s why the (DOH) dashboard may show a higher number of deaths than we have reported.”
Chelan and Douglas counties
According to an emailed statement from the Chelan-Douglas Health District (CDHD), “Deaths are counted as a COVID death in Chelan-Douglas if they have a positive COVID PCR (polymerase chain reaction) test result and have COVID listed on their death certificate…”
However, in this case the difference in CHDH and DOH’s methods for counting COVID-19 deaths has not yet led to a discrepancy. Both DOH and CHDH presently report nine combined COVID-19 deaths in Chelan and Douglas counties.
Clark County’s public health department informed the Freedom Foundation that it, “…uses the state Department of Health definition of a COVID-associated death: a person who dies following a positive COVID-19 test.”
Ferry, Stevens and Pend Oreille counties
The Northeast Tri County Health District confirmed to the Freedom Foundation that it only counts deaths of persons who are both “diagnosed with COVID-19 and died due to health complications related to the illness.”
The Grant County Health District (GCHD) was not particularly clear in responding to the Freedom Foundation’s inquiries, stating only that,
“Four of our deaths have been among those who tested positive and subsequently passed away due to complications. We have not reviewed any final death certificates, except in the most recent death who was a resident of a long term care facility. The first 4 deaths all tested positive, had worsening COVID symptoms which led to hospitalization (with the exception of death #4) and passed away.”
In a request for clarification, the Freedom Foundation pointed out that GCHD was reporting five COVID-19 deaths, not four, and asked whether “…the fifth death involved a person who tested positive for the virus at some point but died/may have died from some other cause.”
The award for the most confusing response goes to Island County’s Public Health Department. The county’s initial response the Freedom Foundation’s straightforward questions was simply that, “(c)riteria and guidance for counting deaths related to COVID-19 is an evolving conversation within the state and nationally…”
After a request for clarification, the county further responded by stating that, “…counties are working with the WA State Dept. of Health (DOH) in an ongoing and iterative process about how COVID-19 deaths are counted…”
Over the course of the exchange, county staff bristled at having to put its methodology “into a box,” but eventually appeared to say that local officials check COVID-19 deaths in the county reported by DOH and contact the Department if the state data “doesn’t look correct based on local knowledge… (T)here is a process by which we work with DOH to discuss and change as needed.”
Public Health – Seattle and King County informed the Freedom Foundation that it,
“…currently counts deaths as ‘COVID’ deaths if the decedent has a positive test result for COVID and the death certificate specifies COVID or similar illness. Public Health currently does not include individuals who had a positive test result but died of non-natural cause (i.e., overdose, homicide, traffic accidents, etc.).”
[Update 6/24/2020: King County further clarified its methodology: “In our confirmed death count, the data includes anyone who has tested positive and has COVID, or something related, listed on their death certificate. Those other related listings include not only other spellings or options of listing of COVID as was mentioned in the email below (sars-COV-2, coronavirus 19, etc.), but also illnesses such as acute respiratory distress syndrome and pneumonia. These ‘other’ causes are more common early in the outbreak when there was not clear guidance given to providers on certifying COVID deaths. Since mid-March, certifying correctly has improved greatly and we rarely need to include these ‘other’ causes.]
Kitsap Public Health District (KPHD) officials acknowledged the Freedom Foundation’s questions but failed to provide a response by publication time.
County officials failed to acknowledge or respond to the Freedom Foundation’s questions by time of publication.
Lewis County public health officials confirmed to the Freedom Foundation that the county is “currently using DOH’s definition” for COVID-19 deaths.
In response to the Freedom Foundation’s inquiry, Mason County public health officials stated, “Mason County Health Departments only count death(s) of persons who tested positive for COVID-19 and died for reasons related to the virus…”
County public health officials acknowledged the Freedom Foundation’s request, but directed questions to the county coroner. By publication time, the coroner had not responded to the Freedom Foundation’s questions and no further information was provided by the county.
Pacific County informed the Freedom Foundation that it counts only “those who died due to health complications related to the illness,” not merely those who died after testing positive for COVID-19.
When the Freedom Foundation asked the Tacoma-Pierce County Health Department (TPCHD) about its method for counting COVID-19 deaths, it pointed to an article on its website explaining the subject in greater detail. The article states,
“At the beginning of the outbreak, Department of Health defined COVID-19 deaths as anyone with a recent diagnosis who died. This decision allowed them to quickly capture and report information. Later, health statisticians would re-assess deaths that needed additional investigation.
In May, the state announced it would remove these unconfirmed COVID-19 deaths from mortality data. Starting this week, we no longer report those unconfirmed deaths. In those cases, a person diagnosed with COVID-19 died; however, COVID-19 was not listed on the death certificate as cause or contributor. Now we will report the number of deaths due to COVID-19 only when the health provider lists COVID-19 as a cause of death. Instead of reporting the number of people with COVID-19 who died, we will report the number of people who died from COVID-19.”
Multiple phone calls and emails to Skagit County health officials were unreturned as of publication time.
Multiple phone calls and emails to Snohomish County health officials were unreturned as of publication time.
The county’s website currently notes that, as of June 15, the county would simply link to the DOH dashboard for Snohomish County. An earlier version of the website suggested the county maintained an independent tally of deaths from the state, though it appeared to track the DOH-reported deaths closely, suggesting the county used the same methods as DOH.
DOH currently reports 159 COVID-19 deaths in the county.
[Update 6/24/2020: The Snohomish Health District replied by noting that, “All death data provided are confirmed either through COVID test results done before or after a death,” and that “only the rational cause will go on the death certificate.” However, it did not answer the Freedom Foundation’s question about whether the county would count the death of a COVID-19 positive person from other causes as a death caused by the virus.]
The Spokane Regional Health District (SRHD) informed the Freedom Foundation that it “…is following the state’s definition when counting COVID-19 related deaths. Persons who test positive for COVID-19 are counted…”
Thurston County’s website notes that, “An individual is counted as a COVID-19 death if they were diagnosed with COVID-19 and died due to health complications related to the illness.”
In a June 2 “letter to the community,” Thurston County health officer Diana Yu noted that a resident of an adult family home, who “was on hospice,” had tested positive for the virus and “passed away, not related to COVID.”
Presumably, DOH’s decision to count this death as caused by COVID-19 explains the discrepancy between its count and the county’s.
Walla Walla County
The Walla Walla Health Department informed the Freedom Foundation that, “In Walla Walla County a death is only counted as a COVID-19 death if the decedent tested positive for COVID-19 and died due to health complications from the virus.”
On June 7, the Whatcom County Health Department announced it would “…(switch) from using our internal Whatcom County Health Department (WCHD) database to the Washington Disease Reporting System for our publicly reported data” on COVID-19 cases.
The county further explained,
“Whatcom County had been reporting fewer deaths than Washington State Department of Health (DOH) because we have different definitions of what a COVID-19 death is. We’ve defined a COVID-19 death as someone who died with COVID-19 as their primary cause of death, meaning they died because of COVID-19. DOH includes people who tested positive for COVID-19 and died, but may not have died of COVID-19. That’s why the (new county) dashboard may show a higher number of deaths than we previously reported.”
The Yakima Health District (YHD) told the Freedom Foundation that,
“In Yakima County, we only count deaths of persons who tested positive for COVID-19 and died for reasons related to the virus. Every death in Yakima County is followed up on by our Director of Disease Control to make sure this is accurate.”