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Human error blamed for roughly 4,100 underreported COVID-19 deaths in Ohio

State health officials say a single person was charged with reconciling death data in the state. That person became overwhelmed.

Human error. That’s what state health officials say is to blame for roughly 4,100 underreported COVID-19 deaths in Ohio.

Ohio Dept. of Health Director Stephanie McCloud says the problem started back in October during a surge in cases.

“It was during the surge that apparently it became too much to sort through those, making sure that we have a good match without duplication, and this individual did not raise the red flag,” she said.

McCloud was questioned during a press conference on Thursday as to why just one person was charged with handling the COVID-19 death data in Ohio. But she said it had not been a problem prior to last fall.

But the system is a manual one, and she pointed to the need for ODH to be able to upgrade its technology.

McCloud says she was first notified via email on Tuesday of last week. She wanted to make sure the number she was hearing was accurate before announcing it publicly, which happened on Wednesday.

“I will tell you, initially I was uncomfortable with the 4,100 number, not thinking honestly that that was possible,” she said.

After looking into the issue, officials realized it was indeed possible, although the exact figure is still unknown.

She described for reporters during the Thursday zoom press conference how the underreporting likely happened.

It begins with the two ways ODH receives its death information to add to the online dashboard.

The first is from the Ohio Bureau of Vital Statistics via the Electronic Death Registration System (EDRS), which collects death certificates signed by physicians. Those then get sent off to the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention, to be coded – U-071 when it comes to COVID-19 deaths. Once coded, that information is sent back to ODH to be recorded as official COVID-19 deaths in the system. That process can take from one to seven months.

Meanwhile, the second way ODH receives COVID-19 death information is from the Ohio Bureau of Infectious Diseases via the Ohio Disease Reporting System (ODRS). That information comes directly from hospitals, local health districts and urgent care centers. It is considered more real-time data and is added directly to the state death counts.

McCloud says, having those two distinct pipelines of information, means double counts are incredibly likely. A coded death certificate could be returned months later for a death that is already in the system, or a death initially reported to be from COVID-19 could be coded differently later. Both cases require reconciliation, and that is what just one person was assigned to do. When deaths started piling up, that person got overwhelmed.

It was not reported by that employee but rather discovered as part of new employee training and quality assurance checks. A supervisor discovered the issue and then reported it, where it went up the chain of command.

“It is not acceptable, and we are addressing it so that the public can have confidence in this,” McCloud said.

To address the issue, McCloud says the department is being restructured, and additional resources are being brought in to help. And, in the meantime, there are more hands-on-deck to sort through the backlog.

An administrative review also is underway to determine whether more personnel changes are needed.

“We are deeply committed to sharing information that is accurate and timely to the people of Ohio,” said Dr. Bruce Vanderhoff, chief medical officer for ODH. “When we identify a problem with that reporting, we are going to act on it quickly and thoroughly.”

And Dr. Vanderhoff added that, despite the error in reporting, he does not feel Ohio should have changed the way it was tackling the pandemic. He points out that death data lags, likening it to looking in the rearview mirror, which would not be the most helpful factor in tackling current challenges.

“I feel very confident that our response is well-targeted, that it is just what we need at this time, and that we can feel confident that the measures that we need to take, we are taking and will continue to take,” he said.

The additional confirmed COVID-19 deaths will be added to the total figure in the coming days with the goal of finishing up next week. The first batch was added Thursday, bumping up the total deaths for the day to more than 700.

“From the time I get up until the time I go to bed, every single day, I think about what we can do to save more lives in the State of Ohio,” Dr. Vanderhoff said. “So learning there are even more of us that this virus has killed, of course, saddens me, but as I think about, as the governor thinks about, as the director thinks about, what we need to do to save those lives, we have never relied on a single measure to inform us about the severity of illness or the patterns of this virus’s activity.”

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