Over the past month, the most alarming coronavirus numbers coming out of the Bay Area have been in Alameda County, where double-digit death totals reported on multiple days propelled the region as a whole to break several death records.
The onslaught of reported deaths made for frightening statistics. Since the start of September, nearly half of all Bay Area recorded deaths were reported in Alameda County, according to data compiled by this news organization, which tracks deaths by the date they were reported.
It turns out the county’s reports on its public dashboard have been misleading, if not wrong. Despite reporting double-digit deaths on multiple days, Alameda County has not had a single day with more than eight deaths, and it averages no more than two deaths a day. But for reasons that aren’t entirely clear, this month the county has been reporting older deaths along with its current total.
The numbers snafu illuminates one of the most challenging — and for the public, maddening — parts of the coronavirus crisis: The struggle to track data accurately, so leaders and residents understand the gravity of the situation and can gauge the appropriate response.
“I think it’s important especially in terms of messaging so the public understands there is a risk,” said Dr. Noha Aboelata, who runs Roots Community Health Center in East Oakland, which serves an area of the city with the highest rate of cases in Alameda County.
The nearly 100 deaths reported in Alameda County since Sept. 1 — an influx that made for two of the deadliest COVID-19 weeks in the Bay Area — actually date back as far as Aug. 7, though Alameda County has done nothing to explain that publicly. On Tuesday, for example, it added 24 deaths to its count — 16 percent of the total for the entire state — without an alert or explanation.
The county is now backdating the deaths to make its site more accurate and includes this notation next to its charts: “Data from last five days especially subject to change.”
Health and coroner officials were unable to explain exactly why this is happening. This week they said variously that the influx of deaths is either due to the county catching up, snafus with the statewide reporting system, or a flood of cases of Alameda County residents who died elsewhere and whose county of residence has only recently been determined.
But it is also clear that some of the confusion stems from the three different agencies that collect death data for Alameda County — the health department; the sheriff’s office, which oversees the county coroner, and the state. This three-headed collection process exists in other counties too, but for some reason — perhaps better communication elsewhere — it has not wreaked such havoc with the numbers.
Alameda County Sheriff Greg Ahern suspects about 50 of the newly reported cases originate with other counties.
In a pre-pandemic world, when someone died in Alameda County, the death was recorded in Alameda County. A San Francisco resident shot and killed in San Leandro, for example, would be counted as a San Leandro homicide. Motorists crushed to death on the Cypress Freeway in the Loma Prieta Earthquake of 1989 similarly were added to Alameda County’s death toll.
Reporting coronavirus deaths is a more complicated and never-before-used process. Under federal Center for Disease Control and Prevention guidance, it matters not where a coronavirus victim dies but rather where they lived and most likely contracted the virus. It is up to county health officials to determine a victim’s last known address, then notify the state, which assigns the death to the county of residency.
With 14,812 deaths as of Friday and 58 counties in the state, log jams and human error can account for misleading numbers. On Sept. 15, when Alameda County’s dashboard reported 24 new deaths, Sheriff/Coroner Ahern knew that number was much higher than his office’s figure and alarmingly higher than the county’s average of 1.5 to 2 deaths a day since the start of the pandemic.
“We believe some of the counties are not reporting the deaths in a timely fashion,” the sheriff/coroner said. “When those counties are late in reporting, they are calculated at the same time; it comes as a surge.”
Ahern said officials are already reclassifying some of these newly reported deaths to bring the numbers down. For instance, six San Quentin State Prison inmates who died at local hospitals were recently counted in Alameda’s numbers. Now they’re being put in Marin County where they belong.
Neetu Balram, the public information manager for the Alameda County Public Health Department, pointed to another part of the problem Friday: delays in testing to see if a deceased person has the virus.
She said that issue is compounded by the way batches of cases are routed through the statewide reporting system, CalREDIE.
Once a laboratory has processed a test, it reports that result to CalREDIE, and then the test result is sorted into the county dashboards. If a person associated with that case dies, it’s immediately logged as a COVID-19 death in the state system and sent on to the county where that person lived.
However, for a person who may not have access to medical care — someone who didn’t test positive for the virus prior to passing — their death wouldn’t be associated with the virus until it was later uncovered by the coroner.That test must then be logged in CalREDIE before it’s processed into the county dashboard, officials said. What isn’t clear is why that process would result in delays of more than a month to report Alameda County deaths, as Balram suggested.
Aboelata of the Roots clinic said frontline workers rely on timely data to inform the residents they see on a daily basis. Any delay causes her concern.
“Everything needs to be more timely,” she said. “We have to respond in a way that we know this is an emergency.”