As of Thursday, nearly 2,500 North Carolinians have died from COVID-19 since the pandemic began. More than 150 of those deaths were of Guilford County residents. A listener asked Carolina Curious how the county tallies those COVID-19 deaths, and why Guilford's mortality rate is higher than other North Carolina counties. We spoke with experts from Cone Health and the Guilford County Public Health Department to find the answers.
How exactly does Guilford County count COVID-19 deaths?
It first depends on whether a person dies at home or in a hospital. If the death occurs in a medical facility, a doctor will determine the cause of death. If it happens at home, a medical examiner will step in. Under the state's guidance (which is followed by Guilford County), a death is included in the official COVID-19 total if a person:
- Tests positive for COVID-19
- Died without fully recovering from COVID-19
- Had no other alternative cause of death
The positive test piece is critically important. If a person was never tested for COVID-19, their death won't be included in the official count, even if their doctor suspected coronavirus played a role. Post-mortem tests can be done. If the case meets all the criteria, doctors and medical examiners are required to fill out a form and send it to the health department within 24 hours.
Is it a straightforward call in most cases?
Yes, in a vast majority of cases, it's an easy determination for a doctor to make. If someone enters a hospital with shortness of breath, tests positive for COVID-19, declines, and eventually passes away – the situation is pretty cut and dry. But it gets more complicated in other cases because even experts don't have a comprehensive understanding of all the ways COVID-19 affects the body quite yet.
Dr. Bruce Swords, the Chief Executive Physician for Cone Health, said, for example, someone could come into the ER with a heart attack, test positive for COVID-19 one hour later, and then pass away.
“So what is that physician going to list as the cause of death? That physician would be in somewhat of a conundrum,” said Swords. “They know that the patient had a heart attack, and that's for sure. But is it possible that being infected with the coronavirus actually caused the heart attack? Very hard to figure out.”
These cases are relatively rare though, Dr. Swords said.
Could this lead to an undercount of deaths?
It's definitely possible.
“There are almost certainly patients who have died with coronavirus outside of the hospital who have not been captured as a coronavirus death,” said Swords. “And there are almost certainly patients who died of a heart attack or a stroke or something else that were also infected with coronavirus.”
Dr. Iulia Vann, the director of the Guilford County Public Health Department, said they have a series of checks and balances in place to make sure their data is as accurate as possible. She says the county has a team that can flag death certificates if they suspect a death was related to COVID-19 but was not reported as such. But she says there's still room for improvement.
“We're still learning,” said Vann. “The process might have some areas in which it might not be 100 percent perfect. So we're trying the best that we can to have the best numbers that are reported. But sometimes we know that there might be some more information that we will have to learn from the virus in order to make that the best classification that we can.”
Why does Guilford County have a higher mortality rate than other counties in North Carolina?
Dr. Vann says the answer isn't quite clear cut, but several factors may be contributing to the higher rate. For example, Guilford's life expectancy was already lower than peer counties before the pandemic even hit.
“So that leads you to understand the fact that we have some stronger and some more serious underlying social determinants of health and medical situations in our community that puts members at a higher risk of negative medical outcomes," she said.
Vann also noted that the county has a significant number of long-term care facilities, and outbreaks in them have led to more deaths because those residents are more vulnerable.