Maryland officials said Thursday that there have been 517 more COVID-19 fatalities during the coronavirus pandemic that were not counted previously, increasing the death toll of the virus to more than 9,300 in the state.
The state’s Department of Health attributed the increase to deaths caused by COVID-19 that were classified improperly by doctors, nurses and others who record deaths at hospitals, nursing homes and elsewhere. The errors weren’t caught until the department’s Vital Statistics Administration reviewed the data later and compared it with other sources of data.
The health department also believes there are 21 more fatalities likely attributable to COVID-19, bringing the total of suspected virus deaths to 213, according to the department.
Dr. Jinlene Chan, deputy health secretary for public health services, said the correction speaks to the challenge of reporting data publicly in real time during the pandemic. She said it’s not unexpected that speed and changing guidance have led to reporting errors.
Normally, state officials wouldn’t release preliminary data, which is often adjusted after officials check their work. But the pandemic required “transparency” by those collecting the numbers of deaths, as well as hospitalizations and overall cases, which the state has reported daily.
“We’ve been keeping a close eye on on all metrics so we knew that increasing our numbers by this amount would catch people’s eyes, that there would be questions, and we wanted to be upfront,” she said.
“Other states have had to make similar corrections,” she said. “We update our data daily to provide as much information as we can. That’s not even being done by every state.”
Other public health experts acknowledge that reporting data has been somewhat tricky during the pandemic.
Beth Blauer, executive director of the Centers for Civic Impact at the Johns Hopkins University, is leading an effort to explore what has worked and not worked in reporting data and what should be “carried forward.”
Generally, she said, the United States has had a high rate of excess deaths, which may be directly or indirectly linked to COVID-19. That does count what happened in Maryland, with deaths reported as due to COVID but miscoded and therefore not counted.
With COVID-19 still a relatively new disease, the standards for reporting fatalities have been variable, she said. Those who certify deaths have had to learn as they go, and there’s a range of people who are licensed to do such work.
Death certificates typically are filled out by doctors, nurses or others at hospitals, nursing homes, the medical examiner’s office and elsewhere.
”We’re in uncharted water with everything pandemic related,” Blauer said. “We’re caught between needing to have critical information out quickly so people can make the most informed decisions about what’s safe for them and their families, and the kind of bureaucratic processes of certification.”
The health department’s admission raises questions about the data, Blauer said, such as when most of them took place, as well as the demographic details. How many of the newly added deaths were teachers? How many were children? The answers could help state officials rethink their vaccination outreach strategy, she said, and target populations differently.
Several states have recalculated their data, Blauer said, due to policy changes, scrutiny and other factors such as more familiarity with the disease and what it looks like. It’s important for state officials to come forward and be transparent about their reclassifications, she added.
”I want to emphasize that state and local governments have been voluntarily reporting data to the public, and it’s been such an important part of our ability to navigate through this,” Blauer said. “It is part of the trade-off.”
The health department said 332 of the deaths occurred among hospital inpatients, followed by 112 at nursing homes. Most of the rest of the deaths occurred at home or in hospice.
Representatives for hospitals, nursing homes and the medical examiner’s office either deferred to the state health department for comment or had no comment.
Chan said all of those who certify deaths were provided with reminders about the current guidance on how to code for a COVID-19 death. She said the U.S. Centers for Disease Control and Prevention lists two specific codes to use.
However, the 517 COVID deaths that weren’t counted until Thursday did not include one of those codes.
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Chan said the state will continue to check data and make corrections as needed.
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The CDC reports that Maryland has had 4,753 “excess deaths” since February 2020. These are deaths that wouldn’t normally be expected and may be directly or indirectly linked to COVID.
Chan couldn’t say when the state would review the excess deaths recorded by the CDC and other institutions.
A review by the BMJ, the medical journal published by the British Medical Association, found that the United States had 458,000 excess deaths and among the worst rates of excess deaths of 29 high-income countries examined. Together, those countries had close to a million excess deaths.
Chan said some may not be due to COVID but because of the pandemic. For example, there were a lot of people who did not go to emergency rooms when they experienced symptoms of a stroke or heart attack because they feared being infected with COVID. She said there also were a lot of people who put off routine care during the pandemic and their conditions worsened.
As for the miscoded deaths, Mike Ricci, a spokesman for Gov. Larry Hogan, said the department did what it was supposed to do in fixing the data.
“This is another example of the commitment to data integrity that our epidemiologists have demonstrated throughout the pandemic.” he said. “We would encourage all states to conduct a similar review of their medical certifiers. And while these are exercises in data maintenance, what’s most important is that we never lose sight of the human toll of COVID-19.”
Baltimore Sun reporter Pamela Wood contributed to this article.