Tennessee nears 21,000 COVID-19 deaths after state review finds 2,700 additional fatalities

Staff photo by C.B. Schmelter / Physician's assistant Mia Malin checks in on occupational therapist Cori Cohen as she works with a patient inside the COVID intensive care unit at Erlanger on Monday, Feb. 22, 2021, in Chattanooga.

More than 20,000 Tennesseans have died because of COVID-19 since the pandemic began, but almost 2,700 of those lives lost are just now coming to light as the state shores up data and reporting lags through the end of the year.

Tennessee Department of Health staff performed a "year-end data reconciliation" that revealed a 20,644 COVID-19 fatalities spanning spring 2020 through December 2021, according to a news release from the department issued Wednesday.

Tennessee Health Commissioner Dr. Lisa Piercey said during a Wednesday news briefing that reporting COVID-19 data is unique in that data are updated daily, whereas most disease data is reported on a weekly, monthly or annual basis. The fast-paced nature of the reporting will inevitably result in lags, particularly in terms of COVID-19 deaths, which require a more complicated reporting process as the U.S. Centers for Disease Control and Prevention tracks the pandemic, she said.

"So this is not out of the ordinary. In fact, CDC recognizes that death certificate or death reporting can sometimes take eight weeks or more and has actually mentioned that they expect about 75% of data to be complete at the eight-week mark," Piercey said.

Most of these newly reported deaths occurred as a result of the summer and early fall delta surge and are not attributable to the recent spike in cases fueled by the new omicron variant, according to Piercey.

Several factors contribute to reporting lags, she said, including the tedious manual reporting process most providers and facilities undertake, a rise in at-home deaths and the large volume of data associated with case surges, which strains the public health system.

"The delta surge was about 10 or 12 weeks ago, with the peak of deaths in the delta surge in mid-September. So a lot of these, 70 plus percent of these, are just the normal run out of all of that reporting that is just now getting caught up," she said.

In early December, the Hamilton County Health Department updated its website to include 21 new deaths that occurred between August and October, noting that "due to a reporting issue with an area hospital, there has been a delay in reporting COVID deaths ... The reporting issue has been resolved, but we may continue to receive reports of deaths."

The U.S. Centers for Disease Control and Prevention also notes on its website that "there is significant variation between states" in the timeliness of death reports, and it takes extra time to code COVID-19 deaths.

"Counts from previous weeks are continually revised as more records are received and processed," according to the CDC.

Piercey said providers are encouraged to use faster, electronic reporting methods to prevent additional reporting lags going forward.

New national guidelines for COVID-19 death reporting are another factor contributing to the influx of new death reports, as is an increase in at-home deaths.

Piercey said the growing number of at-home deaths isn't unique to COVID-19, and the state is looking into the trend across all illnesses.

At-home deaths often require additional investigation compared to deaths that occur at health care facilities, which also slows reporting, and the entire reporting process can be delayed further when the systems are strained during surges.

As of Wednesday, the department's website listed 18,145 COVID-19 deaths since the pandemic began. Piercey said the updated deaths will be added in the first week of the new year, after staff return from the holidays on Jan. 4.

"The year is obviously not completely over, and it's going to take some time after the year is over for every data point to be finalized," she said.

Only a limited number of the newly reported deaths are a result of death certificate revisions after a death was mislabeled, according to Piercey. She estimates that may account for roughly 100 additional deaths.

Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.