The data shows that deaths from causes the CDC and physicians routinely link to COVID – including heart disease, respiratory illnesses, diabetes and hypertension –have soared and remained high for certain racial and ethnic groups.
Betsy Ladyzhets, MuckRock’s Documenting COVID-19 project; Shaena Montanari, Arizona Center for Investigative Reporting; and Rachel Monahan, Willamette WeekIt’s not always easy to identify a COVID-19 death.
Incorrect death certificates add to the racial and ethnic health disparities exacerbated by the pandemic, which stem from long-entrenched barriers to medical care, employment, education, housing and other factors.
Such barriers to accurate death reporting add on to existing health disparities that made non-white Americans more susceptible to COVID in 2021, despite widespread vaccination campaigns and health equity efforts. Coroners and medical examiners serving Black communities, in particular, have fewer resources for death investigations, according to an analysis by the Boston University School of Public Health, relying on survey data of death investigations by the Department of Justice. Counties with the highest shares of Black residents had the fewest full-time personnel to investigate each death, the researchers found.
These inaccurate codes “compromise our ability to say something definitive about a person’s cause of death,” Dwyer-Lindgren said. Garbage code deaths among non-Hispanic white people increased only 1% during the pandemic, compared to the prior two years; among Hispanic, Native, and Asian Americans, they increased by more than 20%.
Timian Godfrey, a Navajo assistant clinical professor of nursing at the University of Arizona, traveled to the Navajo Nation in early 2021 to help with its mass vaccination campaign. But neighboring white communities were more “hostile to masking” and vaccination, said Will Humble, executive director of the Arizona Public Health Association. As a result, white death rates in Navajo County rose by 3.5 times from 2020 to 2021, while white death rates in neighboring Apache County rose by more than five times.
The Window Rock formation is illuminated on March 17 in Window Rock, Ariz. during an event to remember members of the Navajo Nation who died of COVID-19.In Portland, Black residents are disproportionately affected Some of those excess deaths resulted directly from COVID. While the overall number of official deaths in Portland did not change significantly from 2020 to 2021, the distribution shifted: The rate of Black deaths more than doubled from 2020 to 2021. Death rates among other groups remained constant or dropped.
Russell Barlow, an epidemiologist at the agency, pushed back against potential undercounting of COVID deaths. In later stages of the pandemic, he has seen more “incidental” cases in which a patient tested positive for COVID – but it’s unclear whether the virus actually contributed to their hospitalization or death, he said.
During the pandemic, these investigators saw more cases but did not receive a corresponding increase in resources. The state medical examiner’s office had 17 full-time staff as of summer 2022, with 8.5 positions “vacant pending recruitment.” While the office received a funding increase in Oregon’s latest legislative session, goals such as accreditation by the National Association of Medical Examiners are still far off.
This is far from the comprehensive education that should be required to fill out death certificates, said Rebecca Fischer, an epidemiologist at Texas A&M University. “It’s unfair to put this burden onto somebody without proper training,” she said. Sometimes, JPs may want to perform a COVID test or full autopsy to determine how someone died, but may feel constrained by the high costs of these tests, said Thea Whalen, the executive director of the Texas Justice Court Training Center, who organizes training for JPs.
Fischer also pointed to political polarization around COVID as a potential driver of inaccurate death reporting in the state. Inaccurate reporting can further contribute to community perceptions of COVID risk, as part of what Stokes calls a “negative behavioral feedback loop.” If someone does not know people are dying from COVID in their community, they may be less likely to follow public safety measures – thus contributing to more spread of the virus.