Health care and public health experts predict the disease caused by the novel coronavirus may end up being a cause of death for Oklahomans long after whatever marks the official end of the COVID-19 pandemic.
"There's a lot of people who didn't die who have a lot of chronic health conditions that are going to be going on forever," said Dr. David Chansolme, medical director of infection prevention at INTEGRIS Health, at a Tuesday virtual press briefing held by the Healthier Oklahoma Coalition.
"People with pulmonary fibrosis, people that might have had a heart attack, people that had a stroke -- that could lead to further things, too," Chansolme said. "It'll be interesting to see how those are read out, because they may not have had these problems had they not been six weeks in an ICU with COVID. So it'll continue to be a challenge."
Dr. David Kendrick, chair of medical informatics at the University of Oklahoma School of Community Medicine and CEO of nonprofit MyHealth Access Network, agreed.
"There are lots of downstream sequelae from having had COVID-19, many of which may have yet to present themselves, and so the involvement of the COVID-19 diagnosis may get further and further in the past, raising the complexity of making the decision about whether COVID-19 was involved or not," Kendrick said. "So just be aware that as we get, hopefully, further removed from this pandemic, there may be some more complexity in adjudicating these deaths, causes of death, moving forward."
Dr. George Monks, president of the Oklahoma State Medical Association, noted that permanent circulatory and respiratory system damage has been observed in some COVID-19 patients classified as "recovered."
"That will certainly be interesting, and will require a multidisciplinary approach, multispecialty approach, to really care for these patients going forward," Monks said.
The discussion was prompted by the recent change by the Oklahoma State Department of Health in death reporting. As of earlier this week, the state was reporting roughly 4,500 deaths at the same time the federal Centers for Disease Control and Prevention, or CDC, was reporting around 7,000.
OSDH said Monday they will begin releasing the CDC death count, which is based on what physicians write in the "cause of death" fields on death certificates. The state health department was conducting individual investigations into each death, which is more time-consuming and a process that may yield a total less representative of actual death toll caused by the pandemic at a point in time. The department said they will continue those investigations but use the CDC figure as the published death count.
"It's important that they get it right, too, and they're trying to look at all the documents, all the information," said Monks, who said he didn't believe the undercount had "nefarious" origins, but: "The process seems really slow. If you look at all the border states surrounding Oklahoma, which I looked at last night, there's not that sort of COVID death discrepancy in those border states that we're seeing in Oklahoma. Their numbers line up very closely with what the CDC death certificate information is."
"We only list causes of death on the death certificate that caused the death. We don't list other medical conditions," Monks said, dismissing a conspiracy theory that COVID-19 may be frequently listed on death certificates in cases where it played no role, such as a murder or a car crash. "I think the person that's in the best position to determine if somebody dies from COVID is probably the physician that was caring for them when they died."
Chansolme agreed and presented a hypothetical example to illustrate the point.
"COVID may not be the primary cause of death, but it causes overwhelming pneumonia, which is the primary cause. So COVID is the reason that the death happened," he said.
Dr. Aaron Wendelboe, OU College of Public Health professor and former state epidemiologist at OSDH, agreed with Monks' assessment that the state's undercount was not at all "nefarious," and said the investigative approach is, in fact, critical.
"Information about who died, when they died, the conditions under which they died -- they can really vary," Wendelboe said. "That's why it's important, again, to have some of these investigations and just really standardize the process and really know our data."
"We're just going through what I think is a very normal process" of reconciling the totals, Wendelboe said.
As of Thursday morning, the CDC death toll for Oklahoma was 7,122, while the total reported from the state's method was 4,534.