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6 dead in Hall County — and what you should know about that data
The 2019 Novel Coronavirus (2019-nCoV) is depicted in an illustration provided by the Centers for Disease Control and Prevention in January 2020. - photo by Associated Press

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Hall County’s first official COVID-19 deaths were documented Wednesday, April 15, by the state Department of Public Health. As of 7 p.m. Friday, the total confirmed by DPH was six.

Statewide there were more than 17,000 cases confirmed and 650 deaths. Nearly 20% of those testing positive for the virus have been hospitalized statewide.

A total of 605 cases of COVID-19 were reported in Hall County in the state data. The per capita rate was 292.1 per 100,000 residents, which is the highest in Northeast Georgia. 

State data has lagged behind what’s happening in real time, as state epidemiologists work to verify what’s provided on the local level. 

The Times reported the first known local death earlier this month when a local assisted living facility was notified a resident had died with COVID-19 on April 3. 

Data on COVID-19 cases and deaths is complicated by numerous circumstances, including whether to count presumptive cases, the lag created in the state verification process, when to attribute a death to COVID-19 amid numerous health factors and limited testing availability.

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Northeast Georgia Medical Center nurse manager Leah Wallace works in the hospital's new COVID-19 mobile unit Thursday, March 19, 2020. - photo by Scott Rogers

Presumptive cases

On April 14, the Centers for Disease Control and Prevention started including both confirmed and probable cases and deaths in its COVID-19 counts

State data had only included cases with positive tests. To stay aligned with the federal agency, DPH spokeswoman Nancy Nydam said the state agency recently began including the probable deaths and cases. The Times was unable to confirm when DPH started adding probable deaths and cases to its total.

Because COVID-19 was a novel virus, Nydam said there have been many unknowns. 

“Now that we have learned a great deal more about COVID-19 and have more definitive information about clinical presentation and its effects on individuals, we don’t necessarily need a lab test to confirm a death as being caused by COVID-19,” she said. 

Probable cases are people who had an illness consistent with COVID-19 or have known epidemiologic links, which may include symptoms, exposure to a known case or absence of another diagnosis, but no actual lab test, Nydam said.

Down the road, she said the DPH may implement some retroactive review, but “it would not likely make a significant change in the numbers.”

“And in some instances the numbers might actually go down if further review of a medical record indicated another possible cause of death unrelated to COVID-19, regardless of whether a lab test was done,” Nydam said. 

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The Longstreet Clinic holds COVID-19 testing Friday, April 10, 2020, at a temporary drive-thru shelter in the parking lot of the clinic. - photo by Scott Rogers
Delayed data

At Northeast Georgia Health System’s facilities, data is input in real time into Epic, the system’s electronic health record system, spokesman Sean Couch said. It is then entered daily into DPH’s system by NGHS employees.

Cases are listed in DPH data by county of residence, and the location may be listed as unknown before state epidemiologists verify it. 

“It is really important to remember, there is a lag time in reporting deaths, so the numbers you see in the updates are not real-time numbers,” Nydam said.

The hospital has declined to provide the number of deaths in its facilities, referring to the official tally from DPH. The hospital serves Hall County and the surrounding region.

Counting deaths

Though probable COVID-19 deaths are now counted by the state, not all deaths of those who tested positive will be listed in state data.

“If the person was dying for another reason — cancer, heart disease, etc. — but happened to have a positive test for COVID-19, then COVID-19 might not be listed on the death certificate,” Nydam said.

She said the decision of the virus playing a role in a person’s death would be left to a physician, medical examiner or coroner.

“Using their medical judgment, they might call the death presumed COVID or probable COVID, based on the medical history, exposure, and/or symptoms,” Nydam said.

The state’s data includes that from hospitals as well as coroners.

COVID-19 test
This undated file photo provided by U.S. Centers for Disease Control and Prevention shows CDC's laboratory test kit for the coronavirus. - photo by Associated Press

Gov. Brian Kemp and the state health agency's commissioner, Dr. Kathleen Toomey, have both openly expressed frustration at the limited availability of testing in Georgia. As of Wednesday, just over 4,000 tests for the disease had been processed by state labs, compared with nearly 60,000 Georgia tests handled by commercial labs.

Without more widespread testing, it's impossible for health officials to accurately track the spread of the virus.

DPH announced a significant expansion in testing on Wednesday.

Anyone showing symptoms of COVID-19 — which primarily includes fever, cough and shortness of breath — could now be eligible for testing.

Referrals are still required and certain groups — health care workers, first responders, law enforcement and long-term care facility residents and staff — will still be prioritized whether or not they are showing symptoms, according to an April 15 news release.

DPH is increasing the number of specimen collection sites statewide to provide for the additional testing. There is a referral-only testing site in Hall County. 

One new site expected to open Thursday will raise the total to 36 statewide, with more expected within the next week, said Nydam said.

Nydam said the agency now has about 5,000 test kits in hand and has ramped up its ability to process them.

“As much as anything that affected testing was actually having the kits to collect specimens and the capacity to process those tests,” Nydam said by email. “We are in a much better place now on both counts.”

Residents can be referred to a DPH specimen collection site by their local health department or their health care provider. The local health department can be reached at 770-535-5743.

People should not arrive unannounced or without an appointment at any collection site, hospital or other medical facility, according to DPH.

Associated Press contributed to this report.

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