New analysis of COVID-19-associated deaths in King County

Deaths due to COVID-19 illness in King County have slowed dramatically since the early peak of the outbreak in April. However, COVID-19 still ranks overall as the 6th leading cause of deaths in 2020 in King County.

These are among the findings in a new report from Public Health—Seattle & King County, “Summary Report on Deaths Associated with COVID-19.”

The report provides information about the overall count of deaths associated with COVID-19 and the toll that the virus is taking on particular segments of our community, including older adults and some communities of color.

As previously reported, members of the Hispanic/Latinx and Native Hawaiian/Pacific Islander communities continue to die at disproportionate rates compared to Whites. And older adults still account for the vast majority of the deaths.

The analysis did not find an increase that would suggest unrecognized COVID-19 deaths in the weeks leading up to identification of the first COVID-19 case in King County in late February.

Also, based on an analysis of the total number of deaths this year, Public Health did not find evidence suggesting that large numbers of COVID-19 deaths are going unrecognized in the official death counts.

“This report gives us confidence that our official death counts are not missing large numbers of people who have died from COVID-19,” said Dr. Jeff Duchin, Health Officer for Public Health. “And it highlights that although the COVID-19 outbreaks in long-term care facilities that led to many deaths among older residents have decreased in response to effective COVID-19 prevention measures, the threat remains. This summer’s increases in COVID-19 cases in the community remind us that we cannot let our guard down.”

Additional key findings in the report

Through September 1, there have been 724 deaths attributed to COVID-19, with 680 of those confirmed and another 44 that are suspected or pending. In March, the report finds COVID-19 ranked as the third most documented contributing cause of death in the county, but in recent weeks, it has fallen to the number eight cause. 

  • More than 90% of those who have died from COVID-19 were over age 60 (and the median age of death over the past six months has remained around 81 years).
  • More than 80% of those who have died from COVID-19 had an underlying medical condition.
  • Among racial/ethnic groups, more White people have died from COVID-19 than from any other race. But the age-adjusted rate of death shows a dramatic impact among Hispanic/Latinx residents, at 84 per 100,000 residents – three times higher than for Whites, at 28 per 100,000. And for Native Hawaiians/Pacific Islanders, the death rate is more than four times higher than for Whites, at 121 per 100,000. 

Understanding unrecognized COVID-19 deaths

Nationally, there’s been discussion of under-reported COVID-19 deaths. To check for this possibility locally, Public Health calculated “excess deaths,” using a methodology from the federal Centers for Disease Control & Prevention. This estimate shows that in King County between January 1 and August 18, 2020, there were 817 more deaths than would be expected in a typical recent year before the COVID-19 outbreak. Because the number of excess deaths varies from year to year, Public Health also estimated statistically significant excess deaths above and beyond what would be expected due to typical yearly variation in weekly deaths. This estimate found there were 264 excess deaths. By comparison, using the same time period, the total count of confirmed, suspected and positive COVID-19 deaths was 692.

Based on this analysis, there do not appear to be large numbers of potential COVID-19 deaths that are unrecognized in the official death counts.

Why deaths are decreasing

The falling number of deaths since April reflects the impact of our early community-wide COVID-19 prevention measures, particularly the stay-at-home orders, in decreasing the spread of the virus in the community. COVID-19 prevention measures – put in place in nursing homes and other long-term care facilities – have led to fewer and smaller outbreaks over time. More than 60% of those who died from COVID-19 have been residents of long-term care facilities.

Public Health has focused on protecting older people and those with underlying health conditions, who are more susceptible to severe illness from COVID-19. In addition to working to improve infection control and COVID-19 response capacity at long-term care facilities, teams of infection prevention specialists also have been working with homeless shelters and service sites.  

Efforts to limit illness and death in communities of color remain central to the pandemic response at Public Health. King County has hired a team of Community Navigators who serve as liaisons with particularly impacted communities, including the Hispanic/Latinx community. They share resources and information that has been designed and translated for these communities. Community leaders are appearing regularly on Spanish radio and TV, and in other ethnic media, to spread the word about how to protect yourself and your family from COVID-19.

Working with healthcare partners, Public Health is also increasing access to COVID-19 testing in south Seattle and south King County, where rates of COVID-19 have been higher, so that infections can be identified earlier. Additional supports, including groceries or other essential supplies, or temporary housing, are helping people isolate and quarantine.

What counts as a COVID-19 death

Over the course of the COVID-19 pandemic, public health officials locally and nationally and others have been concerned about how to most accurately count the number of deaths due to COVID-19. Unfortunately, there is not yet a national standard methodology for COVID-19 death reporting, although approaches are under development. It might seem simple, but determining and classifying the actual cause of death can be complicated.

Initial counts of deaths in many localities included everyone who died and had tested positive for COVID-19. But that approach can miss cases – for example, there are people who die with COVID-19 symptoms but were never tested. There are also people who test positive, but die for unrelated reasons, such as a fall or a car crash. Those cases are not counted in King County, where deaths due to reasons other than COVID are removed, but some jurisdictions include them in official counts.

To improve clarity, accuracy and consistency, epidemiologists at Public Health completed a thorough review of all available data about local deaths in King County. They reviewed death certificate data to interpret medical information about causes of death, and also reviewed information about illness gathered through case investigations. After assigning classifications based on this information, they then examined trends over time among people who died from January 1 through September 1, 2020. 

New categories help clarify how we count deaths, show total of 724

In July, Public Health, along with the Washington State Department of Health, classified deaths associated with COVID-19 into three main categories. A total of 724 deaths fall into these categories:

  • 94% (680) are confirmed (the deceased person tested positive and had a death certificate noting infection with the virus contributed to death)
  • 5% (37) are suspected (the deceased person tested positive for the virus, died of a natural disease that may have been exacerbated by COVID-19, but did not have it listed on their death certificate)
  • 1% (7) are pending (deaths where Public Health is awaiting death certificates or the cause of death is missing, but the deceased person did have confirmatory testing for COVID-19) 

Not included in the total are 17 additional deaths classified as probable, meaning that COVID-19 was listed on the death certificate but the deceased person did not have confirmatory testing. 

Over the course of the pandemic, the King County Medical Examiners Office (MEO) has increased testing of deaths that come under its jurisdiction. In recent months, approximately 90% of people who died and came under the jurisdiction of the MEO have been tested for COVID-19. By testing the vast majority those who died, this ensures that more deaths are classified correctly.

For additional details, including a description of the methodologies, please see the full report, “Summary Report on Deaths Associated with COVID-19 in King County, Washington

For current data about COVID-19 deaths, hospitalizations and cases, please see the Daily Outbreak Summary dashboard

For current data (updated weekly) about COVID-19 impacts by race and ethnicity, please see the Race and Ethnicity data dashboard

(Originally published September 3, 2020)

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I'm part of the communications team at Public Health - Seattle & King County and work closely with all of the programs in the Community Health Services Division.