Late last month, Gov. Andy Beshear held a memorial for the Kentuckians who died of COVID-19.
He spoke on the south lawn of the state capitol in front of 3,301 miniature American flags fluttering in the breeze.
“Every flag you see out here today represents a real Kentuckian,” Beshear said. “Every single one. Every loss is heartbreaking.”
But missing were flags for at least 768 more Kentuckians that local health departments had already reported died of COVID-19. By that day, local health departments reported nearly 4,100 Kentuckians had lost their lives to the virus.
A WFPL News analysis of local and regional health department data on COVID deaths found counties reported 23% more deaths than the state had by Jan. 21, a number that was not passed on to the public as coronavirus deaths surged.
And on Sunday, local health departments continued to report at least 500 COVID-19 deaths more than the state.
A spokesperson said officials have ruled out only 79 deaths as not being caused by COVID-19 since the pandemic began, indicating most of the additional deaths will eventually be confirmed.
Kentucky’s reported COVID-19 deaths have been lower than the national average since the earliest days of the pandemic. And Beshear has repeatedly cited the low number of deaths in the commonwealth as proof of the effectiveness of the state’s response and the quality of care at the state’s hospitals.
The unreported backlog has obscured the true toll of the deadliest months of the pandemic so far, leaving Kentuckians without an accurate picture of when and where people are dying, now nearly a year into restrictions meant to curb the disease’s spread.
For much of the pandemic Beshear called daily reports “new deaths,” and “people that have passed away today,” without addressing when the deaths happened.
When deaths began mounting over the holidays, he was more clear: the number reflected deaths reported that day. But he still used descriptors such as “deadliest day” of the pandemic so far.
Cases have been on the decline for a month, but the state has continued to report record numbers of deaths. Beshear has recently acknowledged in response to reporters’ questions that it’s due, in part, to clearing the backlog.
“Well we’re certainly seeing deaths from the surge we had leading up to the holidays, from the holiday bump itself, but we are also having our committee get through more of the deaths,” Beshear said last Thursday.
Beshear said the state was counting deaths from January, December, and in some cases November due to the state’s review process.
“It’s important that we get it right,” he said.
Deaths In All 120 Counties
A state spokesperson said their backlog is lower than WFPL’s analysis found, and that additional deaths haven’t been reported by local health departments. But directors from eight local and regional health departments said in interviews that the backlog is at the state level, where staff are reviewing every death report to ensure the person died from COVID-19, and not another cause.
The discrepancies span the commonwealth with fewer than 20% of the unverified COVID deaths attributed to Jefferson County. Local public health directors say they’re juggling the data entry with the immense workload of implementing Kentucky’s COVID-19 response.
Purchase District Health Director Kent Koster said the state’s numbers have differed from his throughout the pandemic, though his staff reports them as soon as they can. The difference between state and local numbers is just one more thing left for counties to have to explain to residents in his district, which covers five counties bordering Missouri, Illinois and Tennessee.
He said sometimes it feels like his district is a low priority.
“It kind of puts us in the hot seat where people might think we are reporting more deaths than there really are, which is not true,” Koster said.
Someone has died of COVID-19 in all 120 counties, but as of Tuesday night, the state still listed zero COVID deaths for three counties: Morgan, Estill and Powell counties. All three local health departments have reported COVID deaths.
Local health departments in these counties have reported a combined total of 23 deaths that the state has so far, not included in daily reports. County data shows most of the deaths were reported in December. But Powell County Public Health Director Stacy Crase recalled at least one of the unreported deaths happening earlier than that.
“I think it was definitely close to Thanksgiving,” Crase said. “Because I remember thinking, ‘Oh, Thanksgiving is going to kind of throw a wrench in this getting reviewed.’ And then I’ve come to realize it takes a little bit longer than even that.”
The state turned down a recent interview request about the backlog with Public Health Commissioner Dr. Steven Stack, who a spokesperson described as the “sole point of contact” for answers.
A state spokesperson said in an emailed response to questions from WFPL News this week that they’ve cleared most of the backlog, and there are about 190 deaths left to be reviewed.
“The Kentucky Department for Public Health (KDPH) thanks those heroes and sheroes who are working on the frontlines of this pandemic helping to save lives and aiding the commonwealth in managing a virus that has become a leading cause of death,” said Susan Dunlap with the Kentucky Cabinet for Health and Family Services.
A WFPL News audit of local health department numbers found that individual counties are still reporting at least 526 more deaths than the state reported on Sunday.
Explaining COVID-19 Deaths
Delays in reporting are not unusual, but in most cases states report deaths in 10 days or fewer, according to the U.S. Centers for Disease Control and Prevention. Only 37% of all U.S. deaths are reported 10 days after the date of death, though there is significant variation between states. In Kentucky, that delay appears to be due to the state’s audit of each death.
Stack, the public health commissioner, explained during a recent briefing that local health departments review COVID-19 deaths before reporting them. State vital statistics employees and epidemiologists then verify each death by looking at death certificates, testing data, clinical information and other records.
“Most of these things, it’s probably more than 90% of all cases, go through routine processing,” he said.
A small subset of cases goes to the mortality review committee, an 11-member panel that reviews additional medical records to weed out unusual circumstances, such as a COVID-positive person who dies in a car accident, Stack told WFPL News in December.
That process can take days or weeks depending on how long it takes for the committee to gather additional patient records, he said. The committee has reviewed about 299 cases; of those, it determined 79 deaths were unrelated to COVID-19 or unconfirmed since the start of the pandemic, according to an email from Dunlap with the Kentucky Cabinet for Health and Family Services.
Local Health Departments Push Through
Regional and local health departments aren’t required to verify COVID was the cause of death, but they’re responsible for collecting information from local hospitals, nursing homes, coroners and doctors’ offices.
They provide a patient’s demographic information, general health, possible exposures, symptoms, testing, hospitalization and death information to the state.
Officials from 10 health departments around the state told WFPL News they’re understaffed, underfunded and overwhelmed.
They describe 14-hour days, working weekends, vaccinating during the day and contact tracing at night, all while fielding calls, texts and Facebook messages from residents and elected officials. In some cases, staff have quit or resigned.
“And everybody is just overwhelmed. We are seeing staff who have burnout. We’re seeing staff who feel guilty for taking a day off,” said Kentucky River District Public Health Director Scott Lockard. “We have staff that have not had two consecutive days off.”
But most health directors said they are still reporting all their deaths within a few days, to the state and their communities.
“The backlog is primarily at the state level,” said Louisville’s Interim Medical Director Dr. SarahBeth Hartlage. “I think it’s important that the state get through it but… like everyone else they have to prioritize decisions about what they are going to focus on.”
It’s unclear how long it takes the state to calculate and report deaths to the public on average, but Hartlage said the state’s review process can substantially delay when deaths turn up in the state count. As of Sunday, a dozen counties each reported at least 10 deaths more than the state has counted.
Jefferson County, the state’s most populous, is reporting 91 more deaths than the state.
Hartlage has heard the state can handle as many as 30 cases per day, though they often receive twice that number.
“I think each and every one of those deaths is important. I think obviously they are important to their loved ones and each of those numbers is not just a number, they are a person,” Hartlage said. “I think we try to recognize that locally.”
Over the weekend, Beshear announced we’d crossed the threshold of 4,000 deaths. As of Sunday, the state’s death toll had still not caught up with what local officials reported as of Jan. 21.
Additional reporting by Geoff Hing of APM Reports, the investigative unit of American Public Media, and Suhail Bhat of the Ohio Valley ReSource.
This story was produced as part of APM Reports’ public media accountability initiative, which supports investigative reporting at local media outlets around the country. Support also came from the Corporation for Public Broadcasting.
How We Reported This Story
WFPL News conducted two point-in-time audits comparing state-reported COVID-19 deaths to locally-reported COVID-19 deaths.
The first audit reviewed 116 counties and found local health departments reporting 768 more deaths than the state reported on Jan. 21, 2021.
A second audit reviewed 111 counties and found local health departments reporting 526 more deaths than the state reported on Feb. 7, 2021.
We collected data from county and district health department websites and Facebook pages, where many departments post regular updates. Some figures were confirmed through phone calls. When we could not find a report from a given date, we used the most recent date we could find. Several counties did not return calls for information. The Madison County Public Health Department was the only department in the state that declined to provide the total number of deaths.