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How COVID-19 Deaths Are Counted In Iowa

Science in HD
Iowa is leaving it up to local medical examiners to determine if they want to test post-mortem for COVID-19.

It’s known that there’s a shortage of COVID-19 testing in Iowa, but how does that factor into the state’s death count? Here's what to know about how Iowa is counting deaths from COVID-19.

How is Iowa classifying COVID-19 deaths?

Iowa officials are following CDC guidance that to have an official COVID-19 related death, you have to have a positive test. This means Iowa’s death count is for people who have a lab-confirmed case of COVID-19. They’re leaving it up to local medical examiners and doctors at hospitals to determine if they test post-mortem, but there are still testing restrictions in place that apply even to those who have passed.

What does post-mortem testing look like across the state now? Are local medical examiners doing this?

Medical examiners in Polk and Johnson counties told me they have not performed any post-mortem testing but they are screening all reported deaths for possible COVID-19 cases. They said most of their deaths have been in hospitals, where doctors perform the post-mortem exam and where testing is common under the state’s current rules, which allow testing of any hospitalized patient with fever and respiratory illness.

In Washington County, a rural area that has one of the highest number of cases in the state, the health department said they have tested one person post-mortem but that sample got accidently destroyed in transit, so the medical examiner classified that death as presumed COVID-19, but without that official confirmation that means it’s not included in the state’s count.

Can deaths can be classified as “presumed COVID-19”? How does that work?

According to guidance issued last week by the National Vital Statistics System, which is part of the CDC, coronavirus should be listed on a death certificate if it was assumed to cause or contribute to a death. That means medical examiners and doctors should list COVID-19 on death certificates, even without a test confirmation, but these presumed COVID-19 cases don’t count into the state’s statistics. The CDC says it has issued this guidance so that it can ensure the effects of this pandemic are more accurately recorded -- even with a testing shortage.

Does this mean Iowa could be undercounting its COVID-19 deaths right now?

At the moment, probably not. Christy Petersen, an epidemiologist at the University of Iowa, said while there are likely some cases like the one in Washington County that might miss the official tally, currently the death count is probably pretty accurate and definitely a lot more accurate than the state’s COVID-19 case count. Petersen said because Iowa’s hospitals are not at surge capacity so people who are really sick can and do still go to a hospital -- and there they’re prioritized for testing, and so are people who live in congregate settings -- like long term care facilities. She said if case numbers continue to climb to where the state’s hospitals are overwhelmed -- like in New York City -- then we could start to get more cases that are associated with COVID-19 that are not officially confirmed.

Clay Masters is the senior politics reporter for MPR News.