Alameda County has changed the way it calculates deaths from the COVID-19 pandemic, resulting in a 25% drop this weekend.
The official total fell from 1,634 to 1,223 on Friday after the county changed its methodology to align with narrower guidelines used by California and U.S. health agencies. According to a news release from the Alameda County Health Care Services Agency, the new number includes only people who "died as a direct result of COVID-19, or had the virus as a contributing cause of death as well as people for whom COVID-19 could not be ruled out as a cause of death."
Previously, the county included any fatality in which the individual was infected with the virus, whether or not COVID-19 was a direct cause or contributing factor.
According to the Alameda County health agency, the county implemented its methodology early in the pandemic, before the state established guidelines for reporting COVID-19 deaths in its reporting and surveillance system, CalREDIE.
"The state guidelines are consistent with national death reporting practices," the agency said in its news release. "When the state implemented these guidelines, Alameda County became aware of the conflicting definitions and made a plan to conduct the update when cases and deaths stabilized."
County health officer Dr. Nicholas Moss told the Mercury News his agency was aware of the discrepancy between county and state data earlier, but officials didn't want to make the change during the winter surge because they didn't want to appear to be "manipulating the data" when the situation was so unstable.
He said the county saw such a large drop in deaths under the new criteria because people seeking medical care for a wide range of medical reasons had tested positive for the coronavirus.
In its news release, the county gave a hypothetical example: Under its old method, someone who tested positive for the coronavirus and then died in a car accident would be included in the death toll. But that death would not be counted in the state's methodology now used by Alameda County because COVID-19 was not a contributing factor.
George Rutherford, an infectious disease expert for UCSF, said hospitals "screen heavily" for the virus and pick up asymptomatic infections in patients who are admitted specifically for COVID-19. He said he was not sure how many counties collected data this way, but that the state's methodology is standard. Regardless, Rutherford said it's "good practice to get it straight."
John Swartzberg, an infectious disease expert at UC Berkeley, said correcting the data is the right move. The decision to delay the change during the winter surge made sense, he said, because most public health departments have been understaffed throughout the pandemic, so to "devote scarce resources" to fixing the data during that time when resources were severely stretched thin "would not make a lot of sense."
The county's news release noted that the methodology change would not have affected the course of the pandemic or the measures that guided the public health response, including the state's tiered reopening blueprint. The key metrics for that system have included case rate, positive test rate, hospitalizations and an equity metric.
The Alameda County health agency said in a statement to The Chronicle that the abrupt change in methodology does not indicate the pandemic has been any less severe:
"We hope the County's decision to update these numbers will demonstrate that we are dedicated to accurately reporting the impact of this deadly virus. Nothing about this update changes Alameda County's policy decisions now or during the height of the pandemic. The severity of this pandemic is clearly evident in the number of cases and deaths reported locally, statewide, and globally."
Swartzberg said the change in reporting methodology is "not real significant in terms of policy or the magnitude of pandemic" and that nationwide, the death toll of nearly 600,000 underrepresents the actual number of COVID-19 deaths.
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