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Are dying with COVID-19 and dying from COVID-19 the same thing? In Oregon, they are

A KGW investigation raises questions over how the state of Oregon tracks COVID-19 deaths.

PORTLAND, Ore. — Fred Creasy was diagnosed with stage 4 colon cancer at the end of June. Doctors gave the 81-year-old just 30 days to live. He died at the end of July while in hospice care at Avamere Rehabilitation Facility in Newport.

“They told my daughter you better come down here because it's going to be today. And within five hours he was gone,” said daughter Rhonda McCrary.

McCrary said her father tested positive for COVID-19 around the same time of his cancer diagnosis.

“He had no symptoms. He wasn't even quarantined,” said McCrary.

McCrary said her dad died from advanced cancer and Avamere considered Creasy recovered from the coronavirus. A few days after his death, Lincoln County Public Health reported Creasy as the county’s ninth COVID-19 death.

“I mean, that’s not what he died from. He died from colon cancer, not COVID and places are listing loved ones as COVID deaths. And they're labeling that and it's just not true,” said McCrary.

McCrary said Creasy died with COVID-19, not from COVID-19, and there’s obviously a difference.

Credit: Rhonda McCrary
Fred Creasy

Other families across Oregon are also questioning why their loved ones are being counted as COVID-19 deaths, including the family of a 26-year-old Oregon man who was listed as a COVID-19 death but tested negative for the virus.

RELATED: A 26-year-old Oregon man died after testing negative for COVID-19. Now his family wants answers

According to the Oregon Health Authority (OHA), there is no difference when it comes to tracking and reporting COVID deaths. OHA spokesman Jonathan Modie explained in an email how the state determines what is counted as a COVID-19 death:

We consider COVID-19 deaths to be: 

Deaths in which a patient hospitalized for any reason within 14 days of a positive COVID-19 test result dies in the hospital or within the 60 days following discharge.

Deaths in which COVID-19 is listed as a primary or contributing cause of death on a death certificate.

We count COVID-19 deaths this way because the virus can often have effects on an individual’s health that may complicate their recovery from other diseases and conditions, even injuries, and indirectly contribute to their death. Another reason is because OHA is using this data to track the spread of the disease, and to create actionable steps for stopping its spread.

So what does that policy mean in practice? We asked Modie about a hypothetical case where someone died from a motorcycle crash and also had COVID-19. Would that be counted as a COVID-19 death?

“It would be,” Modie explained. “But I must go back to the point about how we used this data, which is to help us track how COVID-19 is spread in the community.”

He added that the state follows the Centers for Disease Control and Prevention (CDC) guidelines for reporting deaths.

Epidemiologists like Dr. Carlos Crespo with the PSU/OHSU School of Medicine said, with the exception of a crash or gunshot wound, this is not a misleading way to report data because COVID-19 does exacerbate other health problems.   

“So, all of these chronic diseases that normally you might not die from, but the fact that you contracted COVID-19 put you over the edge,” said Dr. Crespo.

Dr. Payal Kohli, KGW’s medical expert, agrees. She explained a principle in medicine that states the simplest explanation is most likely the correct one.

“So, if you want to be very conservative, then the right thing to do is anyone who tests positive for COVID and died, gets hospitalized, or has a bad outcome, you want to say that's from COVID,” said Dr. Kohli.

Dr. Kohli also pointed out the downside of tracking and reporting deaths this way. She said ultimately you’re not counting deaths as accurately as you could be. That could bolster to the theory that hospitals and facilities are doing this for financial gain.  

“A lot of people are saying that hospitals may be doing this in a cynical fashion to try to get more money because they're being reimbursed according to how many COVID deaths we have. But I think in totality, we are underestimating the number of COVID deaths,” Dr. Kohli said. “The CDC has said that for every one case that we've diagnosed, there's likely ten out there that we haven't diagnosed,” said Dr. Kohli.

The Oregon Health Authority does not receive federal funds based on COVID-19 deaths.

Some facilities may receive some money based on Medicare reimbursement but it’s important to note Oregon has had less than 400 deaths since March. That’s far less than the hundreds of deaths per day reported by states like Florida, so the financial incentive theory isn’t as relevant in Oregon.

Colorado previously reported deaths the same way Oregon does. State health officials were counting people who died from COVID-19 and with COVID-19 as the same thing. But after public outcry, the state changed how they reported coronavirus deaths to differentiate between people who died from COVID-19 and people who died with COVID-19.

“As a clinician and as a physician, that kind of classification makes a lot more sense to me because then we've got more granularity on the data and we know exactly who is directly related to COVID, whereas who may have just died while being infected with COVID,” said Dr. Kohli.

Dr. Kohli said with less the 400 deaths in Oregon, it wouldn’t be difficult for health officials to separate the deaths into two categories.

“Yes, this becomes more challenging when the number of cases go goes up. But if you have 386 deaths, it is much more straightforward to try to classify who died with COVID and who died as a direct result,” said Dr. Kohli. 

Oregon has reported 348 deaths so far during the pandemic. The Oregon Health Authority has no plans to change their system or separate deaths into two different categories.

“I just think if somebody goes; you get hit, you're in a motorcycle accident. You died from injuries from a motorcycle accident, not COVID,” said McCrary.

Do you have a story you want us to investigate? Email us at callcristin@kgw.com

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