COVID-19 Death Reporting – Global Implications

Ever since Florida switched its COVID-19 death reporting from as-reported date every day to as-of-actual date reporting aperiodically, death reporting has continued to confuse reporters, scientists, and database managers.  Now other states are reporting a mix of these methods so it is very difficult to get an accurate measure of total deaths in the US.  Furthermore, other countries have had similar issues with death reporting including not reporting or underreporting deaths totally compared to alternative methods which rely on excess deaths - current year compared to previous years’ averages.

We discuss 4 different ways that COVID-19 deaths can be tracked for Florida. 

1.     Health and Human Services (HHS) ask hospitals around the country to report deaths every day (red curve).  It is the most accurate and timely way to track deaths but it does not count all deaths since many occur outside the hospital system. 

2.     Florida’s Department of Health (FL-DOH) reports deaths to the Center for Disease Control (CDC) every Monday and Thursday and they also generate a death count total on Fridays for public consumption.  These reports allow us to reconstruct the as-reported death curve (green) which is complete and timely but not very accurate since it is not given daily and lags cases significantly.

3.     The FL-DOH report also allows us to reconstruct the as-of-actual date death curve (blue) which is very accurate and complete.  Its drawback is that this curve is continually revised and updated so the curve takes 8 or more weeks to be complete.  So it is not timely.

4.     Excess death reporting is perhaps the most complete but it takes even longer to generate so it is not very useful for tracking outbreaks like the current Omicron.

Why is it important to understand this for Florida and other reporting entities such as South African provinces?  The reason is that the current Omicron outbreak method 3 (blue) is showing a declining death count suggesting that Omicron is extremely mild since no deaths are measured even after Omicron cases began their exponential growth 4 weeks ago on 12/7 in Florida.  This creates a false sense of complacency among healthcare professionals and government officials.  The red curve reflects the real fact that for the last 2 weeks COVID-19 hospital deaths have already begun to rise due to the Omicron variant.  Omicron death rate appears lower than the Delta due to more vaccinations, boosters, and the younger average age of infectees.  As we track this over the next few weeks we should be able to determine how much milder the Omicron might be intrinsically after adjusting for all these other factors.  Almost surely it will not be the mild infection that many commentators are guessing and hoping for now based on South African (SA) data.

The same problem in death reporting has plagued SA reporting and for the first 4 weeks, after Omicron was discovered in SA in November, there were few deaths.  This led everyone to conclude that Omicron is super mild.  Over the last 2 weeks, deaths have been edging up even as cases are continuing to fall.  The 2-8 week lag in death reporting is responsible for this lagged response.

It is important not to underestimate the virulence of SARS-CoV-2 even in the potentially milder Omicron version.  As the WHO chief reminded everyone today, Omicron may be milder but it is not a mild infection.  For countries such as Australia, India, Brazil, Canada, Mexico, etc. to not heed this warning is a major mistake that could cost millions their lives and livelihoods this year.