How many Floridians really have died from COVID-19?

FORT LAUDERDALE, Fla. — Are Floridians getting an accurate picture of who is dying from COVID-19 and when?

Not likely.

Florida in August changed its rules for determining whether someone died of COVID-19, moving that responsibility from public medical examiners to the doctors who treated the patients. The change was meant to relieve medical examiners who were swamped with COVID deaths, but it also created inconsistencies in how COVID deaths are documented and raised new questions about the accuracy and timeliness of the state’s COVID-19 death counts.

Florida Surgeon General Scott Rivkees this week ordered an investigation into delayed reporting of COVID-19 deaths, noting that some are now being reported two months late. A spokesman for Gov. Ron DeSantis questioned how a death could be caused by COVID months after a positive test result. At the same time, health experts say it is more likely that Florida’s COVID deaths, now at more than 16,500, are understated.

Jill Fisch is convinced her 78-year-old mother, Marjorie Levy, died from the virus in her Palm Beach County nursing home. But the doctor listed “natural causes” as the cause of death on the death certificate. Fisch said her mother tested positive for the virus on Sept. 29 and died on Oct. 9. “There is no way it wasn’t COVID-related,” she said.

Isaiah Clark, owner of Bell & Clark Funeral Home in Riviera Beach, said several times he has been told a deceased person is COVID-positive when he arrives to pick them up at a hospital, only to find no mention of the virus on the death certificate. “It has become a mess whether they want to admit it or not.”

The shift from the medical examiner to the treating physician as the person who signs off on the death certificate has created inconsistency and questions about whether COVID-19 deaths may be going unreported.

Dr. Stephen Nelson, chairman of Florida’s Medical Examiner Commission, said medical examiners are better skilled than doctors at uncovering the true cause of death. “That is what our experience and training is all about.”

Two days ago, Florida’s health officials ordered an investigation of all pandemic fatalities. Health officials said of the 95 fatalities reported to the state Tuesday, 16 had more than a two-month separation between the time the individuals tested positive and passed away, and 11 of the deaths occurred more than a month ago. When the lag was at its worst, on Oct. 7, 86 people — or more than half of all COVID-19 deaths reported that day — were more than two months old.

These delays raise red flags that have to be examined, according to Rivkees.

“During a pandemic, the public must be able to rely on accurate public health data to make informed decisions,” Rivkees said in a statement. “To ensure the accuracy of COVID-19 related deaths, the Department will be performing additional reviews of all deaths. Timely and accurate data remains a top priority of the Department of Health.”

In a statement to the Sun Sentinel, the Florida Department of Health said the vast majority of deaths associated with COVID-19 in Florida are reported by the Department within two weeks — but said there are various challenges in making that happen.

Health officials did not respond to a request for a timeframe when the review of all coronavirus fatalities will be completed and the reporting problems will be fixed.

Nelson of Florida’s Medical Examiner Commission said the August backlog at county medical examiners has been cleared, the state’s certification process for physicians to input cause of death is electronic and there should be no lag in Florida’s data collection of COVID-19 deaths. Florida requires doctors to fill out the cause of death within 72 hours after receiving the death certificate from the funeral director.

“I can’t think of any reason for a delay unless the state is not treating death certificates with a high priority,” said Nelson, who also is chief medical examiner for Polk, Highlands and Hardee counties.

Death statistics play a key role in understanding the current spread and lethal nature of the coronavirus. Florida government officials also monitor the number of new COVID-19 cases and deaths to make decisions on reopening safely.

Palm Beach is one of the counties most affected by the chaos in reported coronavirus deaths. Palm Beach County had 50 of the COVID-19 deaths in the latest report, which shattered the previous one-day record of 27 deaths reported Aug. 7. Of those, 23 were deaths from September, including an 85-year-old Palm Beach County woman who died Sept. 27 — 3 months after she was diagnosed with COVID-19.

Palm Beach health spokesperson Alexander Shaw said, “Florida Department of Health in Palm Beach County staff quickly recognized this issue and took immediate steps to prevent its repetition.”

The rule change may also have created inconsistency and misclassification of coronavirus deaths at a time when the data has become politicized. Only a week ago, House Speaker Jose Oliva slammed the death data from medical examiners as “often lacking in rigor” and undermining “the completeness and reliability of the death records.”

House Democrats then blasted the House Republicans’ report as an insult to coronavirus victims and an attempt “to downplay the death toll.”

What one doctor may call a COVID-19 death, another may classify as something else.

Nelson said long hospital stays may be behind some of the overlooked coronavirus deaths.

“Because coronavirus patients are living longer, physicians lose track of the fact that what got the patient in the hospital and started the ball rolling was a COVID infection,” Nelson said. “They are saying the elderly person died from pneumonia or diabetes.

Jay Wolfson, a professor of public health and health law at the University of South Florida in Tampa, said inconsistency has now become inevitable. “We have learned that the coding and reporting isn’t uniform not only between counties but between individual hospitals.”

Jason Salemi, an associate professor of epidemiology at the University of South Florida’s College of Public Health, says the state is likely undercounting COVID deaths, and cites a report released Tuesday by the CDC which found that a total of 300,000 more deaths than normal had occurred in the United States since the outbreak. The report raises the likelihood that the reported 223,000 deaths nationwide from the virus is likely an undercount.

Salemi says the same dynamic almost certainly applies to Florida. “It’s just unclear to the degree,” he said. “Is it 5%, 10% more deaths?”

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(Sun Sentinel reporter Mario Ariza contributed to this report.)

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