The pandemic has killed hundreds of Idahoans, beyond deaths reported from COVID-19
Since the coronavirus arrived in early 2020, hundreds more Idahoans have died than in a normal year — anywhere from a few hundred to nearly 1,000.
The state estimates that 861 more Idahoans died between January and September this year than died on average during those months in the past three years. Only some deaths — 447 — in that time were attributed directly to COVID-19.
The federal Centers for Disease Control and Prevention estimates that Idaho has had between 345 and 931 “excess deaths” since Feb. 1. Anywhere from 10% to more than half of those deaths were not attributed to COVID-19, the CDC says.
“I would love to have zero fatalities, zero cases,” Idaho Gov. Brad Little said at a press conference Oct. 1.
Instead, Idahoans have ignored the governor’s guidelines and protested other measures to curb the spread of disease. And systemic failures, like uneven access to COVID-19 testing at long-term care facilities, made it harder to catch and isolate the virus.
This month, the number of Idaho deaths officially related to COVID-19 blew past 500. The coronavirus disease is now one of the top causes of death in the state — overtaking diabetes, suicide, chronic liver disease and cirrhosis. For now, it has pushed influenza off the Top 10 list.
It’s possible that some of the additional deaths can be explained by Idaho’s population boom. The state has gained about 2% more people each year, and deaths increased between 1% and 2% the past few years. But the number of newcomers to Idaho over the summer would have had to be astronomical to fully explain that surge in deaths.
What we do know is that official COVID-19 death toll doesn’t tell the whole story of the pandemic in Idaho.
State and federal data are gathered and analyzed differently, but they all suggest the same thing: The state lost significantly more lives than usual this year, and only some of those additional deaths were attributed to COVID-19.
How do we know Idaho’s true death toll from the COVID-19 pandemic?
Analysts at the state and federal level monitor how many people die, and from what.
Idaho’s analyst for death data — yes, there’s just one person doing that job — stresses that all numbers are preliminary and can change, because of delays in death certificates and other factors.
She says the pandemic has taken an unprecedented amount of attention for the past several months, as she works to crunch numbers and collaborates with the state’s disease surveillance team.
“This is not a typical year for us,” said Pam Harder, research analyst supervisor at the Bureau of Vital Records and Health Statistics, which is part of the Department of Health and Welfare.
The only other time she’s been asked to run a daily analysis of deaths, in her 25 years doing this work, was during the H1N1 swine flu pandemic, she said. Idaho had 22 flu-related deaths that flu season — including H1N1 and other strains of flu — according to Health and Welfare’s records.
Meanwhile, the CDC tracks the number of deaths in Idaho, and their causes, from week to week, as it has for years. The CDC uses statistical methods, and mortality data from recent years, to estimate Idaho’s weekly “excess deaths” — providing a lower and upper estimate of how many more deaths Idaho had that week than it normally would.
In recent years, Idaho rarely had excess deaths. They would spike once or twice a year, usually during the flu season.
This year, Idaho has been stuck in a wave of excess deaths since mid-July. The U.S. has been stuck there since late March. (The most recent two weeks of CDC data show no excess deaths for Idaho, but the CDC says death counts are still being tallied.)
The Idaho Department of Health and Welfare provided the Statesman a monthly breakdown of deaths this year, compared with prior years. Those numbers show an uptick in mortality since July. They also show above-average deaths for every month this year except January and April. January was the only month with no confirmed evidence of COVID-19 among Idahoans; one person with a confirmed case had symptoms on Feb. 23. And for April, Idaho was under a stay-home order.
Excess deaths are one indicator of the true death toll of a pandemic. They can illuminate COVID-19 deaths that went unrecognized or unreported. They also can help quantify deaths that “could be indirectly related to the COVID-19 pandemic (e.g., deaths from other causes occurring in the context of health care shortages or overburdened health care systems),” the CDC says.
The CDC shows the highest number of excess deaths in Idaho during the week of Aug. 16 to Aug. 22. The CDC data show that Idaho had between 67 and 100 excess deaths that week. The death count was about 23% to 38% higher than usual.
Idaho also had excess deaths in the last week of March, following the state’s first spike in cases that prompted Gov. Brad Little to force a statewide shutdown. The CDC estimated between seven and 41 excess deaths for Idaho that week.
Some deaths ‘undoubtedly’ were unidentified cases of COVID-19
The state and CDC rely on death certificates to identify a person’s cause of death — and contributing factors. Usually, the person documenting the cause of death in Idaho is a physician. Sometimes it is a county coroner, who isn’t required to be a licensed medical professional.
“In deaths that occur outside of the hospital, the physician or coroner will often have no idea whether or not a patient may have had COVID,” said Dr. Frank Johnson, vice president of medical affairs for St. Luke’s Health System in Boise, Elmore County and McCall. “Post-mortem COVID testing is rarely done and only under unique circumstances. Undoubtedly, some deaths in our state have occurred as a result of COVID that went un-diagnosed prior to death.”
Johnson noted that COVID-19 is known to cause heart inflammation and blood clots — two life-threatening cardiovascular problems linked to the disease.
“Both of those problems can cause sudden death in previously healthy people due to heart attacks, heart arrhythmias, and blood clots in the lungs,” Johnson said in an email. “Those people would not likely have COVID listed as a cause of death, unless they made it to a hospital before death and were tested.”
One review of COVID-19 cases found that some younger patients showed up at the hospital with a stroke.
“One of the most eye-opening findings of this study is that for patients under 50 years old, many were totally asymptomatic when they had a stroke related to COVID-19,” study leader Dr. Luciano Sposato, of Western University in Toronto, Canada, said in a news release about the findings. “This means that for these patients, the stroke was their first symptom of the disease.”
The study was published online last month in Neurology, the medical journal of the American Academy of Neurology.
A growing body of evidence suggests that even mild or moderate cases of COVID-19 may cause heart damage.
“I’m familiar with at least one case that a young healthy person died suddenly ... while out exercising,” Johnson said. “Could that person have had COVID with minimal symptoms? ... I have to think yes, but we don’t know.”
The Idaho Department of Health and Welfare and CDC rely on death certificates to determine how many Idaho deaths are related to COVID-19.
Sometimes, a physician doesn’t put COVID-19 on a person’s death certificate when a person dies after testing positive, Harder said.
“And the only reason we know that (is that) we are keeping track of people who test positive and people who die,” said Harder, who works with the state’s disease surveillance team to do that.
Were those unreported COVID deaths or not? Harder can’t say for sure.
“If someone has Alzheimer’s and COVID, the physician might put that (Alzheimer’s) on the death certificate ... if the physician doesn’t feel that COVID warrants” being recorded as the cause of death, she said.
“I’m not getting the information of when they tested positive, either,” she said. So the diagnosis could have been earlier that day or long before.
Sometimes, the death certificate even says a COVID-19 test is still pending, so the state waits for an update to come through.
But simply testing positive for the coronavirus doesn’t mean a person’s death will, or should, be attributed to the disease. The department doesn’t make that decision; it’s up to the medical provider or coroner who fills out the death certificate. They are asked to identify what triggered the chain of events that ultimately ended a person’s life. They’re also asked to say what conditions might have contributed to the death.
The department explained in a blog post in September.
“For example, if someone has a managed condition (such as diabetes) and is diagnosed with COVID-19, and the combination of diabetes and COVID-19 complications causes the person to die, this would be counted as a COVID-related death; diabetes would also be listed on the death certificate as contributing to the death. Why? Because both conditions contributed to the person’s death,” it said. “In contrast, if a person with COVID-19 dies from trauma received in a motor vehicle accident, this would not be counted as a COVID-related death if the coroner determines that the victim’s illness had nothing to do with their death.”
Niki Forbing-Orr, spokesperson for the department, said the number of coronavirus cases and deaths is “probably under-reported,” as opposed to the numbers being inflated.
“If there’s one thing I wish people would know, it’s that the data isn’t perfect, and everybody here is doing their best to compile it so that it makes sense and is accurate and has integrity,” she said. “The integrity of the data is very important.”
Some deaths may be casualties of the pandemic, but not of COVID-19
What has been killing people in Idaho, if not COVID-19?
During the spring, the Boise area’s largest hospital systems reported drops of 30% to 40% in the number of people seeking medical care for emergencies.
Patients who delayed care — possibly due to fear of coronavirus exposure in an emergency room — were showing up later, with more severe medical conditions, they said.
Cardiologists told St. Luke’s Health System Medical Director Kenny Bramwell of “a few cases” where patients had chest pain, thought they were having a heart attack but chose to stay home rather than go to the hospital, Bramwell said in May.
That has continued, Johnson said.
“There are also certainly deaths that have occurred that are indirectly related to the COVID pandemic: people avoiding care for serious problems (like heart attacks and strokes), infections that would have been prevented if people had come in for scheduled immunizations, postponing routine cancer screening and missing early detection of cancers, mental health conditions that worsen under the stress of lost jobs/lost income/isolation, injuries and homicides when families are isolated with an abuser and lose access to other support,” he wrote in an email. “These deaths are not recorded as ‘COVID related,’ but would be captured by looking at ‘excess deaths.’”
Many people have lost their social connections during the pandemic, he added. A friend or family member who used to visit may not be there now to notice their loved one’s health declining, he said.
Staying safe from COVID-19 doesn’t mean neglecting everything else
Johnson and others in health care have stressed that, while it’s important to stay vigilant about COVID-19, Idahoans should remember that the coronavirus isn’t the only thing that can make them sick.
Health care leaders have urged people to get flu vaccinations as soon as possible — before the flu season gets in full swing in Idaho. They also urge people to continue seeing their doctor for checkups, mammograms and other routine screenings.
Johnson says the important thing is not to fixate on COVID-19 but to focus on staying healthy in general.
“Myself included, I’ve gained 15 COVID pounds,” he said. “We all deal with stress in different ways, and for many of us the stress means unhealthy eating, not exercising as much, not eating as well.”
But those healthy habits are even more important now, he said. “If we do get COVID, the better our health is, the better we’ll be able to respond and recover from that ... and also those other illnesses and conditions.”
