Officials disturbed by lack of correct COVID cases reported by the state

The huge discrepancy in the number of COVID-19 related deaths reported by the Boyle County Health Department over the past few months compared to what is listed on the Kentucky COVID-19 Dashboard is causing many residents to “distrust” local leaders and the severity of the virus.

“ … the information on the dashboard is considerably under the figures we are seeing locally. What is being reported to your representatives is creating a significant sense of distrust in us as local officials,” according to a letter sent to Gov. Andy Beshear from Boyle County Judge-Executive Howard Hunt and Danville Mayor Mike Perros on Jan. 6.

“Boyle County continually ranks among the worst relating to the COVID-19 infection. Our local rate, according to the Kentucky COVID-19 Dashboard is 149.7 per 100,000 (people.) … For example, Boyle County has reported at least 25 deaths from COVID-19, if not closer to 30. Your Dashboard reports five,” according to the letter sent last week.

“Citizens in Boyle County are disturbed to see inaccurate figures being reported; both Mayor Perros … and I (Hunt) are receiving severe criticism for the disparity. How can we help your office review and correct these figures?”

The letter stated, “The inaccuracies are perpetuating the sense that the virus ‘isn’t that bad’ here. We are losing our ability to encourage our citizens to take the pandemic seriously when they do not have confidence in ‘the system’ or its leadership.”

The letter ended with an offer from the two officials to work with the governor’s staff “to improve and clarify the impact COVID-19 is having on Boyle County.”

On Dec. 27, Boyle County Health Department Director Brent Blevins posted on social media there were a total of 25 deaths related to COVID-19, with the average age being 75.9 — the oldest victim was 97 and the youngest was 54.

On Thursday afternoon, Blevins said the number of COVID-related deaths in the county was closer to 35, but the state dashboard still listed only five deaths.

Blevins said the department receives daily positive COVID case reports from Ephraim McDowell Health facilities, First Care urgent treatment facility, The Little Clinic, all local senior living facilities, Harrodsburg Urgent Care, St. Joseph Lexington, UK Health Center, Lincoln, Mercer and Garrard counties’ health departments, Boyle County Detention Center, and Northpoint Training Center, along with various labs and physician offices.

“The forms come in all through the day, night, weekends and holidays. We enter positive cases information into the National Electronic Disease Surveillance System (NEDSS) and we track and trace positive cases and their close contacts in the Kentucky Contact Tracing and Tracking system,” Blevins added.

His office also informs the state’s regional epidemiologist of the people who were COVID-19 positive and died.

“If we have a death summary or any other supporting documentation, those reports will accompany the info sent to the epidemiologist who will convey the data to the mortality team. Local coroner, hospital, senior living facilities may also supply information to the mortality team,” Blevins said.

As to why the state COVID-19 Dashboard isn’t reflecting all of the number of deaths that he’s submitted, Blevins said, “I don’t have a good answer for that. I can’t change the way the state works.”

Blevins added that the state will “catch up” but, “It’s hard for them to keep up.”

Susan Dunlap, executive director of public affairs for the Kentucky Cabinet for Health and Family Services said the state Department of Public Health has a “regional team focused on disease investigation and contact tracing. Those staff members also work directly with the local health departments. These team members are epidemiologists and date managers focused on system enhancements, data analysis, etc.”

However, she couldn’t answer the question as to why Boyle County’s death numbers don’t coincide with the numbers that Blevins has submitted.

Dunlap said long-term and other healthcare facilities are required to report all COVID-related deaths to the DPH. “However, if someone has resided in a long-term care facility but is transferred to a hospital for COVID-19 treatment and dies there, the death might be reported by the hospital. Who reports this is dependent upon the hospital stay.”

“Mortality reviews are conducted by staff from Vital Statistics, a function of the Kentucky Department for Public Health, as well as from health professionals from the DPH. The work group reviews records collected by the regional epidemiologists and state staff, ensuring there are adequate and appropriate records available upon which to base a decision and reach a consensus on a determination of cause of death and the role COVID-19 did or did not play in that death,” Dunlap said.

“Most deaths do not have to come before this group. The treating physician, or in the case of a death at home, means that sometimes the coroner makes the cause of death determination and notes this on the death certificate filed with the Department of Vital Statistics,” Dunlap explained.

“However, there are times when an individual with a documented positive COVID-19 infection dies and no comment regarding COVID-19 is noted on the death certificate. These are the cases that may be reviewed.”

The committee also reviews notes from the regional epidemiologist or the local health department, she said.

If the person died in a hospital, residential facility or congregate setting, such as a jail or prison, “the notes from the period preceding death are reviewed. If those sources of information document COVID-19 related symptoms or finds, and the work group can determine a continuous progression from the positive COVID-19 test to death, the group will make a determination that it was a COVID-19 death,” she said.

“Due to the group’s efforts to confirm significant supporting evidence before declaring a death to be COVID-19-related, there is a risk of missing an occasional death that should have been labeled as COVID-19-related. The group shares an opinion that a minimal underreporting is more supportable than any over-reporting,” Dunlap said.

“The fact that individuals completing death certificates leave off critical information or opt for general terms – cardiopulmonary arrest being the favorite – to report cause of death has been a problem for as long as death certificates have been filed. The national data on cause of death involves systematic reviews of medical records of representative samplings of deaths to determine accurate rankings of cause of death, not relying solely on death certificates for the reasons noted.”

Dunlap also said not every county includes information regarding race and ages when they send reports to the DPH. “This information is not consistently provided to KDPH with regard to every Kentuckian who tests positive for COVID-19.”

Blevins said the system and process for every county to report their positive COVID cases and deaths on a daily basis “was built for a pandemic during a pandemic. Processes and tools are being refined as we go.”