In mid-April, the Centers for Disease Control began including probable and presumed positive cases in their coronavirus death toll numbers.
But it wasn’t until nearly two weeks later, on April 27, that Kentucky started reporting probable cases in its death toll. The 213 deaths reported in the first seven weeks of Kentucky’s pandemic only include people who were tested and confirmed to have coronavirus.
Which means the accuracy of the state’s death toll is only as good as its testing.
Fewer than 1.3% of Kentuckians have been tested, and despite recent efforts to expand free testing statewide, Kentucky remains among the bottom 10 states for testing by population, according to Johns Hopkins University.
In New York City, adding in probable coronavirus cases increased the death toll at that point by more than half. States have varied in their implementation of the new guidance; some have not started including probable cases yet, while others are reviewing earlier deaths to see if they should be included as probable cases.
“States decide whether to implement and, if so, how to implement CDC proposals,” said Sebastian Kitchen, a spokesperson for the Governor, in an email. “While this adds more work for overwhelmed local health departments, the Kentucky Department for Public Health decided to move ahead with including probable cases. The change took time in order to develop guidance specific to Kentucky for public health officials.”
Kitchen said Kentucky officials will not require regional reporting authorities to look back at deaths from earlier in the pandemic to find probable coronavirus cases.
Interviews with coroners, hospitals and elected officials indicate Kentucky’s death toll numbers are likely an undercount. Experts say no state has fully captured the extent of the deaths from this virus.
“I don't think anyone would dispute the fact that there is an undercount,” said Mark Hayward, a professor of sociology at the University of Texas who serves on the Board of Scientific Counselors at the National Center for Health Statistics. “We all know there's an undercount. The question is, how much is the undercount?”
The only way to truly know the impact of coronavirus will be to look at the “excess deaths” from this time period to see how many more people died than in a typical year. Provisional data shows that Kentucky began to exceed its typical number of deaths in April, but the final numbers won’t be available for months or longer.
The measure of excess deaths will capture the deaths from the virus, but it will also shed light on an area of great concern for many — casualties of the pandemic who were never infected with coronavirus at all.
Post-Mortem Tests Not Common
As of today, Kentucky has at least 253 deaths from coronavirus. Until just a few days ago, that number only included deaths of confirmed coronavirus cases.
Those who die with COVID-19 symptoms before being tested can be tested post-mortem by hospitals or the state medical examiner. But interviews show that option is rarely used.
At University of Kentucky Chandler Hospital, spokesperson Kristi Willet said suspected coronavirus patients can be swabbed before they are transported to the morgue. She said that has only been necessary twice, and neither tested positive. The University of Louisville Hospital is now testing everyone who comes into the hospital, regardless of symptoms.
County coroners are typically called in when someone dies at home or otherwise outside of medical care. If coroners suspect coronavirus, they have been directed to consult with the state medical examiner.
As of April 27, the Office of the State Medical Examiner said they had been contacted 30 times, tested 12 of those cases, and only one came back positive.
Jimmy Pollard is the Henry County coroner and, in his role as the liaison between the Kentucky Coroners Association and the Office of the State Medical Examiner, has been talking to coroners around the state.
Pollard and several other coroners said Kentucky has been lucky because its hospitals haven’t been overrun, and those who need care are still able to get it.
“They haven't had that many to pass away at home” from coronavirus, said Pollard. “Most of the time, these people that are at that point, they are so ill they are in a medical facility.”
Pollard says he’s been watching what’s happening in New York City and Detroit and has “never been so grateful to live in Kentucky.” His county has had eight cases and no deaths.
But still, when it comes to precautions, Pollard said coroners are treating every case like it could be coronavirus.
“In a small county like mine, when you walk in and it’s somebody you've known all your life, and you're wearing a mask and gloves, it’s difficult,” he said. “We’ve had to explain and say, you know, this is for my protection and yours.”
Fayette County Coroner Gary Ginn said county public health officials gave him a limited supply of COVID-19 tests that he can use if he suspects coronavirus as the cause of death. Fayette County has had 287 confirmed cases and nine deaths.
“You just have to ask the family questions, you know, like if they’ve had a temperature or was it flu-like symptoms?” he said. “Either way, we’re being cautious, wearing masks, wearing the gloves.”
He said he has not had to use any of the tests yet.
'Excess Deaths'
The true mortality of the global pandemic will be known only when the direct and indirect effects can be tallied.
The CDC has been putting out provisional data about the number of “excess deaths” since the start of the coronavirus pandemic, and once finalized and confirmed, these numbers will be the best guide to the real death toll.
From the period of February 1 through April 25, the CDC data indicate Kentucky has had fewer than typical deaths — only about 84 percent of the deaths you would expect from this time period.
Hayward said that’s likely a “problem with the data,” reflecting the provisional nature of these numbers. He said he couldn’t be sure what specifically would cause those numbers to be so low, but thought it might have to do with Kentucky being a rural state with so many counties, each with their own coroner and systems for reporting to the state.
He said, nationally, there were some trends resulting in fewer deaths, like fewer fatal car accidents, but nothing that he would expect would lead to a net negative number of deaths when all of this is over.
And, in fact, if you look closely at the data for just the last few weeks, Kentucky’s excess deaths have increased as the virus’s peak has grown closer.
For the first three weeks of April, Kentucky exceeded its typical number of deaths per week by between 4.7% and 9.2%. Even when you exclude deaths attributed to coronavirus, the state still reported more deaths than expected during two of those three weeks.
That could mean two things: first, Kentucky is not fully capturing the death toll from coronavirus, likely due to limited testing, and second, more people are dying from things other than coronavirus than is typical.
Experts say it’s probably a combination of both.
“In some ways, COVID may relate to deaths from other causes, not in a kind of biological sense, but in a social sense,” Hayward said, referring to people who would have sought care if not for the pandemic.
U of L Health has reported a 10% decrease in emergency room visits for patients showing signs of stroke, according to Dr. Kerry Remmel. As WFPL reported, doctors at U of L say stroke patients are waiting three hours longer than normal to seek care.
Hospitals from Morehead to Bowling Green and beyond have held press conferences and taken to social media to urge people to seek medical care for emergencies, reminding potential patients that the hospitals have safeguards in place to prevent the spread of coronavirus.
But still, public officials are reporting fewer people are seeking emergency care in many areas around the state — and that’s taking a toll.
In rural Garrard County, south of Lexington, Judge Executive John Wilson says there’s usually about 40 deaths a year that require getting the coroner involved.
The county had nine coroner’s calls in the first two weeks of April alone.
Coroner Shane Young didn’t respond to request for comment. But Wilson said only one of the nine deaths was even suspected to be caused by coronavirus in a medical sense; he said the others were things like heart attacks or chronic conditions. But in a larger sense, he feels they were all attributable to the coronavirus.
“What we're finding is that people are afraid to call 911 or afraid to ride the ambulance or afraid to go to the hospital,” he said. “Surviving family members told our coroner...that they were not seeking medical treatment because of these fears.”
Garrard County has had only two confirmed cases. But Wilson said, starting early on, he and other leaders spread the message to only call 911 or go to the hospital if you absolutely need it, in an effort to preserve capacity for the expected surge in coronavirus cases.
“I think people heeded that,” he said. “And there's been a consequence, certainly.”
Contact Eleanor Klibanoff at eklibanoff@kycir.org.