COVID deaths, outbreaks and resolved cases: How is the Hamilton data reported?

It's tough to keep up.

Tough to keep up with changing COVID numbers, with changing reporting mechanisms, with new metrics, with lockdowns, with public health guidance ... heck, even if you should or shouldn't plan a beach vacation. Note: you shouldn't.

We get it. And we want to help.

In an effort to do so, we are taking the key metrics public health reports and breaking them down, explaining what they mean, what they tell us - and what they don't. Think of it as The Spectator's attempt to share our insider knowledge with you.

Hopefully, this guide will keep you better informed - and less confused - moving forward.

COVID deaths: In May, when asked what is a COVID death," Dr. Bart Harvey, the city's associate medical officer of health, said: the simple answer is somebody has tested positive and then has died."

That doesn't necessarily mean they died of COVID-19, it doesn't even mean COVID played a role in their death, but it does mean that they tested positive," Harvey said.

Indeed, public health's website states: Deaths are included whether or not COVID-19 was determined to be a contributing or underlying cause of death."

For instance, early on in the pandemic, there was an outbreak at a Hamilton hospice. Two people who died were classified as COVID deaths. COVID may have played a role in accelerating their deaths, or it may not have.

COVID outbreak deaths: Public health's website includes a chart detailing information about active outbreaks. The chart lists the following: location of the outbreak, the dates it was declared and declared over, total cases, total resident/patient/patron/student cases, total staff cases, total visitor/other cases and deaths. The limitation with this data is that when a death is added to the death column, public health does not indicate if the death is in a staff member, a patient, a resident, etc.

For instance, one new death was linked to the Hamilton General Hospital 7 West neurosurgery unit outbreak on Jan. 6. The Spectator was unable to tell you if the death was in a staff member or a patient. Neither the hospital nor public health would clarify, citing privacy. Public health later removed that death altogether. We also don't know why and have not been provided with a clear answer.

To make matters more confusing, the new outbreak deaths do not always line up with the number of overall deaths Hamilton public health reports. Sometimes, the outbreak chart shows, for example, four new deaths but public health's overall death toll only goes up by one.

Public health says data fluctuations may be due to ongoing investigation and data collection, transfers between health units, error detection and linking/unlinking cases to outbreaks."

Ages of those who've died: When someone dies with COVID, they are listed in a chart on public health's website based on their age decade. For instance, someone who is 75 would be listed in the 70s" column. The column with the most deaths, however, is the 80-plus column. Deaths are not broken out by decade after the age of 80. Earlier in the pandemic, public health shared information with media about the exact age of the person who died. They stopped doing so in recent months.

Resolved cases: Cases are considered resolved" when a COVID case no longer has symptoms and two weeks has passed since they started showing symptoms.

Recently, public health said it is having trouble clearing" resolved cases. On Jan. 4, Hamilton's medical officer of health put part of the blame for recent high numbers of active cases on public health being stretched to the limit.

With the volume of cases that are coming through for our public health staff, we're very much working on a prioritized basis in terms of case and contact management," said Dr. Elizabeth Richardson. We may not be clearing our active case numbers as quickly as we had in the past."

To clear cases an active case, public health follows up with the person who tested positive and ensures they no longer have symptoms and are past the two-week symptom onset mark.

Community acquired case: When a case is listed as community acquired" under public health's exposure" chart, that means public health is unsure how the person acquired COVID. High numbers of community acquired cases are considered concerning because that means public health is less able to track spread. Other categories in the exposure chart are: close contact, direct travel history, outbreak associated and under investigation, meaning public health is still looking into how the person got sick.

Date and time when numbers are pulled: Hamilton public health's website uses COVID statistics considered accurate as of 3 p.m. the previous day. That means statistics are about 24 hours out of date by the time they're made public.

COVID hospitalization: The number of COVID patients in Hamilton hospitals is not always representative of how many Hamiltonians have been hospitalized. Both Hamilton Health Sciences and St. Joseph's Healthcare say that because their COVID units are regional," patients from outside Hamilton whose local hospital doesn't have a COVID unit may come to them. Outsiders may also come if their local hospital's COVID unit is full.

Declaration of outbreaks: Outbreaks are typically declared when there is evidence of transmission within one setting. That explains why outbreaks are not always declared even when there are several cases at, say, a school. Public health typically needs them to be linked to declare an outbreak. In congregate settings, such as long-term-care homes, just one case triggers an outbreak.

Katrina Clarke is a Hamilton-based reporter at The Spectator. Reach her via email: katrinaclarke@thespec.com