Four new deaths related to COVID-19 were reported by Alaska’s Department of Health and Social Services Tuesday — the highest number of deaths reported by the state in a single day. Of the four deaths, two occurred recently, while one is from early August and the fourth is from mid-July.

All four of the Alaskans who died were residents of Anchorage. The two most recent deaths were of a man in his 70s and a woman in her 60s. The other two were identified after a review of their death certificates, which found that an Anchorage resident in his 80s died in mid-July and an Anchorage woman in her 80s died in early August.

DHSS created a webpage and made an announcement Tuesday to explain how COVID-19 deaths are being reported and why there were four deaths reported Tuesday that all occurred at different times.

Methods of reporting COVID-19 deaths

COVID-19 deaths in Alaska are reported in one of two ways: either directly by the hospital that treated the deceased patient, or indirectly after the patient’s death certificate is reviewed by the U.S. Centers for Disease Control and Prevention.

Hospitals report cases of COVID-19 among patients directly to the Division of Public Health’s Section of Epidemiology after receiving a positive test result. If that patient then dies while hospitalized, that facility will then report it as a COVID-19 death. This first method provides more real-time information, but can potentially miss COVID-19 deaths and is not reviewed by the CDC, according to the information released by DHSS.

“This method may not capture deaths because of the time lag associated with COVID patients who may remain hospitalized for a longer period of time, have a more complex disease and death process, or died outside of Alaska. Further, this more real-time method means that deaths have not yet undergone review by CDC,” according to the DHSS webpage.

The second method of reporting happens during the CDC’s processing of death certificates. After a person dies, their death certificate is registered by the state’s section of Health Analytics and Vital Records, and that information is forwarded to the CDC’s National Center for Health Statistics. CDC nosologists, who are professionals trained to classify diseases, then assign a code to the cause-of-death language using the International Statistical Classification of Diseases and Related Health Problems and send that data back to the state, which serves as the final cause-of-death description.

COVID-19 deaths reported in this way are generally more accurate, but can take up to three weeks to be reflected in the state’s death counts.

The state’s death count can also change as data is corrected. The example given by DHSS is if a death record initially had an incorrect state of residence for the deceased. Upon discovery of the data, corrections are addressed by the state’s vital records office and the updated data is sent to the CDC.

The death certificate process

Every death of an Alaska resident, both in state and out of state, is required to have a record that includes a “cause of death” section. The cause of death is determined by a medical professional and the CDC considers cause of death as a best medical opinion, not a definitive fact.

Because people can die from more than one cause, CDC reporting allows for all of the conditions that may have contributed to the death, and the top line of the report is reserved for the “immediate cause,” which is the final disease or condition that resulted in death. The report can also list the conditions that led to the immediate cause of death and any underlying conditions that may have initiated the sequence of events. The example given by DHSS is of someone whose immediate cause of death was a stroke, which was triggered by blunt force trauma to the head, which was caused by a car crash. It would be accurate to say that that person died from a stroke, a head injury or a car crash, according to CDC reporting guidelines.

In the case of a person dying from a car crash that happened to test positive for COVID-19, COVID-19 would not be listed on the death certificate and the death would not be considered related to COVID-19. The death certificate would only list the sequence of conditions that were tied to the car crash.

All Alaska resident COVID-19 deaths have the virus listed as either an immediate or underlying cause of death, and most have listed COVID-19 “somewhere in the lethal chain of conditions.”

“Whether COVID-19 shortened a life by 15 years or 15 minutes; whether COVID-19 is an underlying or contributing condition, the virus was in circulation, infected an Alaskan, and hastened their death. This must be reported,” according to the DHSS webpage.

To learn more about the process by which COVID-19 deaths are reported by the state, visit dhss.alaska.gov.

COVID-19 by the numbers

There were a relatively low number of new COVID-19 cases reported on Tuesday — 34 among residents and three among nonresidents.

The state also reported three new hospitalizations associated with COVID-19. Currently there are 40 COVID-19 patients hospitalized with another six patients under investigation for COVID-19. Six of the hospitalized COVID-19 patients are being treated on ventilators.

The state has recorded 1,779 residents as “recovered” from the disease. For the past two days of reporting recoveries have outpaced new cases.

A total of 333,831 tests have been conducted across the state as of Tuesday. The positivity rate of tests processed in the last seven days is 1.74%.

On the Kenai Peninsula, 15,434 tests have been conducted. At 2.3%, the seven-day positivity rate for tests in this region is slightly higher than the statewide average. Two new cases were reported on the Kenai Peninsula on Tuesday — one in Kenai and one in Soldotna. In the last 14 days, 64 cases have been reported on the peninsula.

Locally, Central Peninsula Hospital has conducted 4,349 tests, with 4,163 negative, 109 positive and 73 pending results. South Peninsula Hospital has conducted 7,473 tests, with 7,243 negative, 113 positive and 117 pending results. The Seldovia Village Tribe Health and Wellness Center has conducted 641 tests, with 630 negative, 11 positive and zero pending.

Testing on the Kenai Peninsula

On the central peninsula, testing is available at Capstone Family Clinic, K-Beach Medical, Soldotna Professional Pharmacy, Central Peninsula Urgent Care, Peninsula Community Health Services, Urgent Care of Soldotna, the Kenai Public Health Center and Odyssey Family Practice. Call Kenai Public Health at 907-335-3400 for information on testing criteria for each location.

In Homer, testing continues to be available from 10 a.m. to 8 p.m. daily at South Peninsula Hospital’s main entrance as well as through SVT Health & Wellness clinics in Homer, Seldovia and Anchor Point. Call ahead at the hospital at 907-235-0235 and at the SVT clinics at 907-226-2228.

In Ninilchik, NTC Community Clinic is providing testing on Monday, Wednesday and Friday. The testing is only for those traveling, symptomatic, needing testing for medical procedures, or with a known exposure after seven days. Only 20 tests will be offered per day. To make an appointment to be tested at the NTC Community Clinic, call 907-567-3970.

In Seward, testing is available at Providence Seward, Seward Community Health Center, Glacier Family Medicine and North Star Health Clinic.

Reach reporter Brian Mazurek at bmazurek@peninsulaclarion.com.