Santa Cruz County implements new guidelines for COVID death counts

SANTA CRUZ — Those still monitoring COVID-19 metrics in Santa Cruz County even after the local health emergency entered the rear-view mirror earlier this year may have recently noticed a dramatic jump in one of county’s most crucial data points.

An additional 44 COVID-19-related deaths were added July 27 to the county’s dashboard now hosted on the California Department of Public Health’s website after more than seven months of no changes in the category. That brings the county’s total to 320 COVID-related deaths since the onset of the virus in 2020.

But Santa Cruz County Deputy Health Officer David Ghilarducci explained that the sharp increase came as part of an effort by state authorities to create alignment around a standard definition created by a national group of epidemiologists.

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“It boils down to an accounting issue, if you will,” said Ghilarducci. “We have not seen a dramatic burden from COVID causing additional deaths. It’s just a way that existing deaths were sort of recategorized is what caused this.”

According to Ghilarducci, the state has asked Santa Cruz and other counties to implement a new definition of a COVID-19 death where any death certificate record that indicates COVID-19 or an equivalent term as an immediate, underlying, or contributing cause of death will be counted.

State officials went through the county’s record of death certificates dating back to Jan. 1 of this year and found that 44 additional deaths met this new criteria.

Ghilarducci said county officials shared feedback that “we don’t really agree with that methodology,” noting that “a lot of them were deaths that we felt they probably died with COVID but not from it, but admittedly it’s almost impossible to know to what extent COVID might have contributed to their death.”

The state confirmed the reasoning shared by Ghilarducci.

“In December 2022, the Council of State and Territorial Epidemiologists (CSTE) issued an updated COVID-19-associated death classification recommending that COVID-19 coded deaths in death certificates be the source of death surveillance for COVID-19,” said the California Department of Public Health (CDPH) in a statement emailed to the Sentinel. “Because this updated recommendation was made in December 2022, CDPH implemented this change for all deaths occurring on or after January 1, 2023. CDPH implemented this change to align with CDC practices.”

Much like other counties in the state, until the recent change Santa Cruz’s methodology was closer to a case-by-case assessment. For any individual whose death certificate had mention of COVID-19, Ghilarducci explained, local officials would complete a comprehensive investigation. If during that investigation it was found that COVID was not the primary cause of death, the county excluded that record from the overall death count.

According to Ghilarducci the average age of those added to the county’s total since Jan. 1 were individuals in their mid-80s, all of whom had other significant underlying conditions, such as end-stage cancer, that contributed to their death.

About 75% were white/Caucasian and approximately 25% were Latinx, according to Ghilarducci.

Recent uptick

The methodological change comes amid an uptick in COVID-19 cases and hospitalizations at the national level, but only in a few regions in Santa Cruz County.

Ghilarducci said national wastewater observations, now considered the best method of measuring virus prevalence, are showing potential for a late-summer surge. But so far the city of Santa Cruz is the only region in the county exhibiting “a little bit of an upward trend” in COVID numbers.

“It kind of started around July Fourth. Seems to be steadily rising, but not quickly,” said Ghilarducci. He noted that county officials are currently helping with a response to a couple of outbreaks in local nursing homes, but unlike the early years of the pandemic, so far these outbreaks have not resulted in a large number of hospitalizations.

“That is a vulnerable group of people – typically elderly, typically underlying health conditions,” said Ghilarducci. “They certainly get sicker when they get COVID, but not to the same degree or same numbers that we saw earlier on in the pandemic.”

For the general public, he said, there appears to be “an increasing disconnect between severe illness and infection,” which Ghilarducci attributed to most of the population having a layer of protection through vaccination or infection and access to oral treatments such as Paxlovid that reduce the severity of the disease.

According to a state dashboard as of Thursday, the county didn’t have any COVID-positive hospitalized patients after five had been listed the day before. The county hit a recent peak of 28 hospitalizations in late April but quickly dropped to levels of 10 or less since approximately the beginning of May.

Things look a little different nationwide, as hospitalizations have gone up about 12% compared to the previous seven-day period, according to a tracker from the Centers for Disease Control and Prevention.

Though a new wave has not yet washed over Santa Cruz County, Ghilarducci said masking in crowded settings is “very reasonable.” Additionally, regardless of the impact this summer, COVID-19 and other respiratory viruses are expected to surge in the fall and winter, though he’s cautiously optimistic the virus is “running out of new tricks.”

He also said those who are behind on their vaccinations should get the bivalent booster now, but noted that a new vaccine formula is expected to be released this fall and for the first time, it won’t have the original strain of the virus in it.

“That COVID is long gone,” said Ghilarducci. “We’re dealing with almost a different virus at this point; sort of a distant relative, if you will.”

State of COVID

Deaths: 320.

Hospitalizations: 0.

Wastewater data: numbers rising in the city of Santa Cruz. Relatively low and steady throughout rest of county.

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