Bacon's Rebellion

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Dissecting the COVID-19 Death Statistics

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by

James A. Bacon
in

by Carol J. Bova

If you compare the COVID-19 hospitalization statistics published by the Virginia Department of Health (VDH) and the Virginia Hospital and Healthcare Association (VHHA), you’ll quickly see they don’t add up.

On May 30, the VDH COVID-19 dashboard showed a total of 4,601 hospitalizations. The same day, the VHHA showed that 5,745 patients had been discharged from hospitals, while 1,471 still were being treated in hospitals — a total of 7,216.

The discrepancy, more than 2,600 hospitalizations, is huge. It’s big enough to sway the way Virginians perceive the severity of the epidemic.

The explanation is simple, but hard to understand. VDH says, “The data we share is an underrepresentation of COVID-19 in Virginia….Our data are intended to answer questions about the epidemiology of COVID-19.” VDH is interested only in the severity at the time they learn of a case, not if it later requires hospitalization.

In April, the Virginia Hospital and Healthcare Association stepped up to answer critical questions about the utilization and availability of hospital beds and ventilators. The Association collected the daily numbers from the hospitals and published it along with the number of discharges and the number of hospitals with supply shortages

VDH and VHHA numbers are  cumulative from the beginning of the pandemic in Virginia. The VDH and VHHA systems cannot be synchronized, so when looking at data to track or understand virus impacts on our hospital system, we need to use VHHA data. For insight into the overall death rate, we must rely on VDH.

However, VDH does not identify how many of the 1,370 deaths occurred in hospitals. Deaths are an unspecified part of the revolving door of total COVID-19 patients in and out of hospitals.

The daily VHHA COVID-19 hospital discharges exceed the VDH daily COVID-19 deaths. In the last ten days, daily discharges ranged from 43 to 255 a day, while deaths ranged from 12 to 57, so the cumulative total of COVID-19 discharges is sharply mounting, far faster than total deaths.

We don’t have any data on the length of hospital stays for COVID-19 in Virginia, which may affect the continuing number of patients in the hospital at any given time, and we don’t know how many of those discharged go to a rehabilitation center or nursing home to complete their recovery, which may become another area of concern.

We do have some information on the general length of hospitalization and the proportions of disease severity from the Centers for Disease Control, “Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19).” “The median length of hospitalization among survivors was 10 to 13 days.” Among U.S. COVID-19 patients, 19% were hospitalized, and 6% were admitted to ICUs.

In Virginia, with a population of 8.5 million, a rough average for total daily hospitalizations has been 1,450. The average number of ICU patients has ranged from 349 to 461 a day; those on ventilators, 182 to 307. Of the 1,370 deaths, 778 (56.8%) have been in nursing homes with outbreaks.

The takeaway from all this is we need to take a long view of the numbers and not get caught up in weekly fluctuations.

Carol J. Bova is a writer who lives in Mathews County.

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8 responses to “Dissecting the COVID-19 Death Statistics”

  1. LarrytheG Avatar
    LarrytheG

    Moral of this story. It’s easy to SLING data to feed those that want it.

    It’s much harder to validate it… and few want to do that so it gets
    left to those in higher ed who need a good project!

    don’t mean to be flip… but we are all learning that data out the wazoo
    is NOT necessarily “information” much less “good” information.

    Clearly VDH has never considered itself to be a purveyor of vetted information… they just got forced to release data.. and they did…

    I’m not sure what the exact motivations of VHHA is. In normal times with enough support from the Fed, I would expect and trust CDC data but these are not normal times and CDC is no longer allowed to do what they normally do.

  2. cjbova Avatar
    cjbova

    VHHA is an advocate for its members: 110 hospitals and 27 health systems. Downplaying the number of hospitalizations does not help the hospitals where the true numbers will.

    VHHA is using Twitter to say hospitals are facing a $3.6 Billion revenue loss because patient volume is down 50%, surgeries were cancelled, ER visits were down, the growth in charity and uncompensated care increased, their costs are up due to COVID-19–and they want people to contact the governor and say hospitals need $1 Billion of the fed money Virginia received to get ready for the next surge in cases.
    https://twitter.com/VirginiaHHA/status/1266356800938545164?s=20

    CDC does not receive uniform data from all states regarding hospitalizations, so they use cases and deaths in their state by state reports.

  3. COVID-19 DEATHS AND HOSPITAL DISCHARGES APRIL 14 TO MAY 30

    […] For discussion, see Bacon’s Rebellion Blog May 31, 2020. […]

  4. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Thanks, Carol, for this explanation. There are other lessons here, ones that I learned from hard experience. One has to look at the sources of data. Both VDH and VHHA are relying on voluntary reports from hospitals. Hospitals may have more incentive to provide data to VHHA, or it may be easier to do. A second lesson, implied by your comments, is that data is collected by different agencies for different purposes and, therefore, the results will often not be the same. In summary, anyone using data needs to understand its sources and its limitations. Included in that is understanding why some data may differ from similar data. Many times I indignantly confronted an agency for providing bad or wrong data because it conflicted with some other data I had found, only to have it explained, patiently, to me that there were legitimate differences between the sets of data and that both sets were legitimate.

    1. cjbova Avatar
      cjbova

      VHHA started a dashboard May 18: COVID-19 in Virginia Licensed Nursing Homes. This also relies on voluntary reports and has its own agenda.

      The VHHA nursing homes report says today 1618 residents have positive or pending COVID-19 tests, and 965 have recovered. They don’t report deaths and don’t say how many facilities responded or what the total number of patients in those facilities is.

      We can see it’s only a fraction of the nursing homes in the Commonwealth because the VDH Outbreaks tab has 4920 cases in 214 long term care facilities and 785 deaths compared to the 2583 cases in the VHHA dashboard.

      The VHHA report does highlight the continuing shortages of supplies in Virginia’s licensed nursing homes. Fourteen facilities report difficulties in obtaining one or more of these types of PPE: N-95 masks, surgical masks, gloves, face shields and isolation gowns.

      That would be an indicator why VDH shows 31 new nursing home outbreaks with about 700 more cases since May 18.

      At some point, VHHA will likely start (or increase) lobbying the Commonwealth for funds and/or supplies for nursing homes.

      1. LarrytheG Avatar
        LarrytheG

        dumb question and you may have said this but are long term care facilities members of VHHA?

        1. cjbova Avatar
          cjbova

          Some are part of hospitals and health systems. VHHA says, “The Virginia Hospital & Healthcare Association (VHHA) formed in 1926 as a trade association of Virginia hospitals.

          “In 1995, members voted to change the name from the Virginia Hospital Association to reflect changing membership, which includes not only rural and urban hospitals, but integrated health care delivery systems and their long-term care facilities and services, ambulatory care sites, home health services, insurance subsidiaries, and other health system-related entities.”

          They also say:
          “VHHA and the Virginia Department of Health (VDH) recently announced a collaborative effort to support long-term care facilities during COVID-19.”

  5. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    “They don’t report deaths and don’t say how many facilities responded or what the total number of patients in those facilities is.”

    We can see it’s only a fraction of the nursing homes in the Commonwealth

    Thank you Carol. It would appear that the State officials of Virginia and their crony allies who pay them off with large amounts of cash, continue their pattern of half truths, misinformation, and elaborate cover ups of relevant facts that public citizens of Virginia and their elderly parents are entitled to know for their own safety, and so as be able to hold those involved accountable.

    Meanwhile, be advised that the governor can put you in jail for failing to follow his mask and operating your own businesss rules which he has used to shut down your livelihood for months, while rioters run free in your streets.

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