Dissecting the COVID-19 Death Statistics

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.