Michigan’s coronavirus death toll much higher than reported as state readies release of new data – The Detroit News

Michigans death toll from the coronavirus is expected to grow substantially when the state health department publishes itscount of probable deaths the number ofpeople suspected to have died from the virus without testing positive.

Public health experts say the governments official death tally of 5,595 in Michigan is likely an undercountand that adding thepresumptive deaths would be a more accurate representation of the toll of the virus.

This is in part because testing for the disease COVID-19 has been limited, and the official count in Michigan hasso far only included deaths where the individual tested positive for the virus. At least a dozen other states are already disclosing probable coronavirus deaths and cases.

"Reporting these probable deaths is very important, and it will improve that data quality," said Nilanjan Chatterjee, a professor at Johns Hopkins University'sDepartment of Biostatistics. "It's a step in the right direction."

The count of probable deaths "provides a more complete picture about how COVID-19 has impacted the state," said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services.

A timeline for the release of dataremains unclear, butSutfin reaffirmed Wednesday the department's plan to release counts of both probable deaths and cases "soon."

An employee for C.W. Morris Funeral Homes in Highland Park rolls out a body from Sinai-Grace on Thursday. The worker said it was a COVID-19 patient, but the funeral home denied it.(Photo: Clarence Tabb Jr., The Detroit News)

Michigan is overdue to start reporting presumptive COVID deaths, as well as probable cases of the virus, said Dr. Teena Chopra, an infectious disease specialist in Detroit.

She noted the federal Centers for Disease Control and Prevention expanded its reporting to include the "probable"classifications almost a month ago on May 6.

"There is a huge number of patients who are clinically clear-cut COVID cases, but havent been reported," said Chopra, a professor at Wayne State University.

"Theres no reason why they should not be counted with the total deaths. Becausewhen we are seeing these patients, clinically there isclearly no alternative explanation for them dying or even being admitted to the ICU," she added.

"Why would the state not want to report the probable cases? I don't understand that."

Dr. Teena Chopra is a professor of infectious diseases at Wayne State University.(Photo: Wayne State University)

At least 12 states are already reporting probable COVID deaths and cases to the Centers for Disease Control and Prevention, including hardest-hit New York, which began reporting presumptive cases in April. New York City had nearly 17,000confirmed deaths and another 4,760 probable deaths, through Thursday.

Probable deaths include individuals without a COVID-positive test who were presumed to be infected due to their symptoms and an epidemiological link, Sutfin said. The definition alsocovers those whosedeath certificate listedCOVID-19 disease as a cause of death or a significant condition contributing to death, she said.

An example would be a symptomatic household member of a COVID-positive person where the household member ended up dying, said Brian Hartl, an epidemiologist in the Kent County Health Department.

"That person never got tested, but we'd call that a probable death," Hartl said.

Other examples would be sudden deaths at home attributed to COVID,deaths at the hospital before the individual could testpositive, and patients whofalsely tested negative but who were "clearly" a COVID case, Chopra said.

"This test, as you know, has a 30% false-negative rate," she said.

The state's definition of "probable" death due to COVID-19is based on a national standard established by the Council of State and Territorial Epidemiologists on April 6.

Michigans local health departments have been reporting both confirmed and probable COVID deaths to the state for weeks. Each local health departmentreceived guidance, along with recommendations to evaluate cases based on the council's standard, Sutfin said.

Additional information is necessary to define a probable death, requiring a report and then a public health investigation, so establishingthis class of deaths takes longer, she said. Most would be found during contact monitoring of people potentially exposed to infection, Sutfinadded.

Kent County hasnot gotten many reports of probable COVID deaths, Hartl said.

"The majority of reports we've had have had a positive test," he said. "I don't know if it might be because ofa lack of awareness in the community to report those (probable deaths)."

Counting the probable cases is critical to understanding the "true burden" of the new coronavirus,Chopra said, including the impact it could have on patients' long-term health.

"When we talk about reopening, we need to know how close we are to herd immunity," Chopra said. "If we are not counting the (probable) cases, we are under-reporting so we are also under-counting our herd immunity."

It is possible that a small fraction of the probable deaths are not from COVID-19, but an influenza-like illness instead, Johns Hopkins' Chatterjee said.

Adding probable deaths to the state's official COVID toll is still likely to be an undercount, hesaid.

A more reliable estimate of the total deaths due to the coronaviruswould be to examine the so-called "excess"deaths statewide those above and beyondthe deaths that would typically have been expected in Michigan during the same season in an ordinary year, the biostatisticiansaid.

"That will give us an idea of how many deaths we still have missed, even after adding the probable deaths,"Chatterjee said.

Provisional data on deaths from COVID-19 and other causes,updated weekly by the Michigan Vital Records Office, showthat more people died from cancer, heart disease, COPD (chronicobstructive pulmonary disease), pneumonia and flu during March and April than during the same months last year.

The numbers aren't yet complete due to lags in the reporting of death certificates by funeral directors across the state, saidJeff Duncan, Michigan's registrar of vital records.

"There have been increases in other causes of death, particularly early in the crisis when testing wasnt widespread," Duncan told The Detroit News.

"A lot of that may have been COVID-related, but it wasnt recognized by the doctors who completed the death certificate."

March deaths attributed topneumonia and flu were more than 50% higher year over year, with 197 reported last March, compared with 299 this spring. For April, pneumonia andflu deaths jumped about 36% from 203 in 2019to276 this spring.

April heart disease deaths were up 20% over last year, from 1,984 in 2019, to 2,379 this year.Stroke deaths were up about 19% for April, from 421 that month last yearto 499 this spring.

And septicemia, a serious blood infection, was blamed for 124 deaths thisMarch compared with 88 such deaths during March last year, an increase of 41%.

"It may be that those deaths were from COVID, but it may indicate a strain on the health care system," Duncan said.

"Maybe its people not seeking care, not going to the emergency room because they had symptoms of the heart attack (and) because they were afraid.

"Ive also read speculation that response times are up for emergencies because they have to put on all the PPE (personal protective equipment) and they have to decontaminate their vehicles after every call," he said.

"We have to have a lot more data and a lot of real analysis to come to any conclusions."

CDC data shows a sharp jump in excess deathssince early this year. The CDC predictedanestimated 5,922 to 7,208 excess deaths in Michigansince Feb. 1, when compared withhistorical averages for the state.

The CDC says the excess deaths could represent misclassifiedCOVID and other deaths that could be indirectly related to the virus that is, deaths attributed to other causes but that would not have occurred without health care shortages or overburdened health care systems caused by the pandemic.

The excess deaths in Michigan this year that are not directly attributed to COVID-19 could also be because ofthe virus, but it's unclear, said Samiran Ghosh, an associate professor of biostatistics at Wayne State University.

"Why is this going up? Because theres no other big epidemic going on. Is it related to COVID? Thats the big question," Ghosh said. "The answer is it could be the case, but we dont know."

mburke@detroitnews.com

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Michigan's coronavirus death toll much higher than reported as state readies release of new data - The Detroit News