staff in full safety gear stand under a sign that says "emergency"
Frontline workers at Highland Hospital will be among the first to receive COVID-19 vaccinations in Oakland. Credit: Pete Rosos

A quarter of all deaths previously attributed to COVID-19 in Alameda County weren’t actually caused by the coronavirus, the Alameda County Public Health Department announced today.  

That puts the county’s new official COVID-19 death toll at 1,223, down from 1,634.

The 25% decrease—or 411 cases—is due to the fact that COVID “wasn’t a direct cause” of death in these cases, according to county health officials. 

County officials decided to revise the numbers after they reviewed guidance from the California Department of Public Health about how to classify deaths as being caused by COVID-19. The new count more accurately reflects how many people died as a direct result of, or complications from, a COVID-19 infection. 

“There are definitely people who died from reasons that were clearly not caused by COVID,”

said Neetu Balram, a spokesperson for the Alameda County Public Health Department. 

Balram couldn’t give specifics about the true cause of death for the 411 people removed from the COVID-19 data, but she said the cases were identified after reviewing codes entered by county coroners into CalREDIE, the state’s database for disease reporting and surveillance. Alameda County uses CalREDIE data to populate its COVID dashboard.

Dr. Amesh Adalja, an infectious disease expert and senior scholar at Johns Hopkins Center for Health Security, told The Oaklandside that although some adjustments are to be expected, 25% “seems high.” Adalja said he has never seen this big of an adjustment in a death count with other infectious diseases. 

Nicholas Moss, Alameda County’s health officer, said the deaths removed from the COVID rolls occurred throughout the pandemic. He hopes the county’s decision to adjust the numbers will show people that the county is dedicated to accurately reporting the impact of the virus. 

“We knew any change like this would have raised some eyebrows,” Moss told The Oaklandside. “Nothing about this changes our policy decisions now or during the height of the pandemic.”

The county’s original method was to attribute a death to COVID-19 if the coroner or medical provider (like a hospital) listed someone as being positive for the coronavirus at the time of their death. 

Balram said the state’s definition was different: A death can only be attributed to COVID-19 if the coroner or medical provider can show that the person died “as a direct result of COVID-19, with COVID-19 as a contributing cause of death, or in whom death caused by COVID-19 could not be ruled out.” The state came up with this definition late last year in the middle of the pandemic, after Alameda County was already using its method. 

“Obviously our definition was broader than the state’s,” Balram said, adding the 411 deaths being removed were “clearly not COVID.”

In announcing the changes to the data, the county used the example of a resident who tested positive for COVID-19 but died in a car accident. Under the original definition, that person’s death would have been included in the total number of COVID-19 deaths. Balram said she couldn’t say if that actual scenario played out in Alameda County. 

“When the state implemented these guidelines, Alameda County became aware of the conflicting definitions and made a plan to conduct the update when cases and deaths stabilized,” the Alameda County Public Health Department said in a statement Friday. 

Prior to the update Friday, the Alameda County COVID dashboard showed 1,687 deaths, a tally that reflects not only the county’s old definition of a COVID-related death, but also any new deaths added to rolls since May 23. Deaths are often reported at different intervals and rarely on the day they actually occur. 

Throughout the pandemic, the county’s data on COVID-19 deaths has shown much smaller fluctuations caused by a variety of factors, such as if a person died in Alameda County but didn’t live there. 

Alameda County’s COVID dashboard contains several disclaimers, including that recent numbers, including infections and deaths, could change. That includes cases that move from “suspected” to “confirmed,” and dates of when a death has been reported to the day it actually occurred. 

“Death data may be corrected from time to time as information about the cause of death or the County of residence of the deceased person are finalized,” a warning on the COVID dashboard reads.   

Alameda County’s recounting of its COVID cases are yet another example of potential flaws in real-time data reporting involving several agencies during a global public health crisis. 

Moss, who has more experience with the HIV/AIDS epidemic, said that data isn’t computed until six months after the previous year. COVID-19 data, he said, is entered daily, giving number-crunchers less time to ensure the data being reported meets universal standards. 

“It’s not an excuse. It’s a reality,” Moss said. “Unfortunately it took us longer to get to this point than we would have liked.”