Policy decisions amid the pandemic often rely on data that can appear confusing or inconsistent – so it may not be surprising some Orange County officials are questioning whether local coronavirus numbers are accurate and what they really mean.
Orange County supervisors Michelle Steel and Don Wagner have both publicly suggested the number of reported COVID-19 hospitalizations could be artificially high because people are counted when they seek care for an unrelated reason and then happen to test positive for the virus.
At a Board of Supervisors meeting last week, Steel wondered whether, among the roughly 600 people with COVID-19 in local hospitals at the time, could as many as half of them have come to the hospital for an unconnected emergency or condition. (Experts say the number is nowhere close to that high and is likely not more than 10%.)
In an interview Monday, Aug. 3, Steel said she’s heard of such cases from several patients or their families.
It’s important for policymakers to have accurate data on the outbreak in Orange County, she said, because “then we know how serious it is.”
While county officials don’t have data showing the reasons COVID-positive patients initially sought care, hospitals do – and several health and epidemiology experts said the vast majority of people with COVID-19 who get admitted to hospitals are there because of virus-related conditions.
Why it matters
Hospitals are required to report how many patients they treat who have COVID-19, and the numbers matter for a few reasons: the state uses the change in a county’s average number of hospitalized patients to help gauge whether businesses, schools and other establishments should open or close; the data tells local health care officials when they may need to boost hospital capacity; and the number can be a snapshot of how a county and its residents are doing at controlling spread of the virus.
In Orange County, COVID hospitalizations hit a peak of 722 in mid-July and in the past week and a half have dropped daily or had only single-digit increases, according to OC Health Care Agency data.
So who are the patients that make up those numbers?
They’re mostly people who have symptoms consistent with COVID-19, with shortness of breath, fever/chills and cough being the most common, Dr. Jooby Babu said.
Babu, a pulmonologist and critical care doctor at St. Joseph Hospital in Orange, has admitted or consulted on nearly 200 coronavirus patients since March.
Some people have already tested positive, and others ask to be tested. They may be sent home to take anti-inflammatory drugs, or if their case is more severe, they’ll be admitted to the hospital for more tests and treatment.
Babu said when someone comes in needing surgery for appendicitis or a kidney stone, they’ll get a COVID test even with no symptoms “just to make sure they don’t end up infecting a large number of personnel.”
If any patient tests positive, they’ll be housed separately from uninfected patients, and hospital workers must take extra precautions with personal protective equipment.
Daniel Chow, a UC Irvine radiology professor and researcher, has studied data from more than 500 COVID-positive patients who were treated at the university’s medical center. While he found that some of them sought care for non-COVID issues, an estimated 90% were hospitalized for coronavirus-related symptoms. (While Babu didn’t have statistics, he said Chow’s findings track with what he’s seen at St. Joseph.)
Among that other 10% were people who had suffered trauma, women about to give birth and patients determined to need some kind of surgery, Chow said. But it’s possible that even some of the cases listed as asymptomatic stemmed from the virus, he said – some had strokes, and scientists have found COVID-19 can harm blood vessels and cause clotting.
“I think the assertion that there are many COVID-positive hospitalized patients there for non-COVID reasons is factually incorrect,” he said. “It minimizes the disease, it minimizes the impact and it may give a false sense of security that if you get it, it’s not a big deal.”
Officials at Providence Southern California, which has more than a dozen medical centers in the region, bristled at the suggestion that they would misstate or manipulate patient data.
“We screen all patients for symptoms, but only test those who have signs of exposure in order to ensure proper safety precautions are taken to keep staff and other patients safe. Patients with COVID-19 symptoms are admitted only if they are acutely ill,” the company said in a statement.
So why would people think hospitals might inflate their coronavirus case numbers? Some have suggested it’s about money – Steel said at the July 30 county meeting that asymptomatic COVID-positive patients might get counted in hospitalization numbers because the hospitals can get federal reimbursement for treating them.
It’s true federal funds are available to healthcare providers to help them respond to the pandemic, but California Hospital Association spokeswoman Jan Emerson-Shea said the aid falls far short of covering hospitals’ costs.
Hospitals have had to buy more protective gear, add extra beds, create new triage facilities in outdoor tents, and even add negative pressure rooms that keep sick patients’ virus particles from spreading around the facility, she said.
Two recent studies found California hospitals have lost billions since the local outbreak began in March, Emerson-Shea said. One projected a net loss of $14.6 billion through the end of 2020, only partially offset by an estimated $3.6 billion in federal aid.
“Hospitals are providing care to everyone including COVID and non-COVID patients. We’re losing money significantly because of this, but we’re doing the right thing,” Emerson-Shea said.
“There’s some notion that hospitals are improperly inflating the reports because somehow we’re making money – it’s completely untrue,” she said.
After raising questions about the numbers in recent months, Wagner said he now knows the number of hospitalized patients with asymptomatic COVID-19 is “not a huge part of our count, but it is definitely there.”
He said he’s spoken with officials at two area hospital chains who shared numbers that line up with Chow’s research. Wagner added that more precise figures for hospitalizations could be on the way, with the state expected to modify its data collection so asymptomatic cases can be separated out.
While COVID statistics aren’t perfect, no epidemiological tool is, said Shruti Gohil, an infectious disease professor at UCI.
When hospital beds are taken up by COVID-19 patients, whether they have symptoms of not, it means fewer beds are available for people who need care for a heart attack, stroke, diabetes or other serious conditions, Gohil said.
“You have the choice to focus on the perfect, versus what do we know now and what can we do to fix” the situation, she said.
“We have to operationally deal with this thing that can spread and how can we stop it.”
Source: Orange County Register