True COVID-19 Death Toll May Surpass Official Counts, Especially In San Joaquin Valley

Oct 6, 2020

Since the beginning of the pandemic, more than 1,300 people have died of COVID-19 in the seven counties of the southern San Joaquin Valley and foothills, according to official counts by county health departments and the state. The tallies aggregated in those health department dashboards, which represent between one and two percent of all who’ve tested positive for the virus, capture those who were confirmed to have contracted COVID-19 and whose death certificates listed the virus as a primary cause of death.

 

But an FM89 analysis of death data spanning many years in California paints an even more grim picture: That far more Californians have died so far this year than on average, even after accounting for COVID-19, and that those excess deaths are occurring at a higher rate in the Valley than in the state as a whole.

 

According to death data from the California Department of Public Health, 2,094 more Valley residents died from March through August of this year than during the average of that same time period for the years 2017-2019. The sum represents a rise in fatalities of more than 20 percent above the average.

 

The majority of those excess deaths occurred in the Hispanic population, which tracks with the fact that Hispanics make up an estimated 57 percent of the Valley. In some counties, however, including Fresno and Kings, Hispanics were far overrepresented among those excess deaths, while in other counties, like Kern and Tulare, excess deaths disproportionately affected whites.

 

Across the Valley as a whole, African-Americans were overrepresented among those excess deaths, while those of Asian descent were generally underrepresented.

 

Data note: These data are likely an undercount, especially in smaller counties or among less populous race and ethnic groups, because the state suppresses death counts less than 11 in any given month or group.

It might be tempting to blame COVID-19 infections for driving these excess deaths. But as of the end of August, 1,026 Valley residents had officially died of the virus, leaving 1,068 fatalities unaccounted for in the pandemic’s toll. The same calculation at a statewide level reveals that 7,764 excess Californians have died, even after factoring out those directly caused by the virus, meaning that more than 13 percent of the state’s excess, non-COVID-related deaths occurred this year in the Valley – even though we make up less than 8 percent of the state’s population. “Something is going on,” says UC Merced social epidemiologist Irene Yen. “We have a medical situation going on. We can see it in our numbers.”

However, Yen says the fact that Californians are dying at a faster rate in the Valley is unfortunately not all that surprising, given that the pandemic itself has hit the region particularly hard. “We have higher proportions of people on the front lines, essential workers, food service workers, agricultural workers,” she says, as well as prison workers.

What’s more, research has demonstrated that communities of color—so prevalent in the Valley that whites are now a minority here—are more at risk of severe disease. “There’s this multiplication of factors that make people in our region more likely to get sick, and when they get sick, get sicker and die,” Yen says. “It’s really sad.”

 

Although COVID-19 was not considered a direct cause of these 1,044 excess deaths, Yen thinks it’s likely that the virus was still a factor in many of them. For instance, many obstacles keep patients from ever being tested for the virus and knowing if they contracted it.

 

Then there are those who put off other essential health care, like dialysis, to avoid exposure to the virus in a hospital or clinic. “Maybe they were afraid to go, for example, and does that mean that they went less than they clinically needed to go and were compromised?” Yen asks.

 

As the pandemic has lingered, health experts have also been warning of higher rates of suicides and suicide attempts, substance abuse disorder, and domestic violence, perhaps exacerbated by the ongoing global recession triggered by the virus’s spread.

 

These excess deaths are very concerning for Tania Pacheco-Werner, co-assistant director of the Central Valley Health Policy Institute at Fresno State. “What that tells me is that we are not reaching these folks in time for them to either get the info, care, or get any sort of education or medical intervention to prevent their deaths,” she says.

 

These tragedies—and the fact that some communities appear to be more at risk than others—led Pacheco-Werner and other community groups to create the COVID-19 Equity Project. A collaboration between the Fresno County Department of Public Health and more than a dozen organizations, universities and health care centers, the project aims to encourage testing and provide outreach, social services and culturally competent contact tracing within underserved communities in the Fresno region. “That has involved really an overhaul of everything of how we do public health, from who is really driving, what tactics should be used, what messages should be used, to working together to have events,” she says.

 

Some of that work, Pacheco-Warner says, is as simple as helping non-English-speakers understand what their positive test result means, and assisting others without computers to create email addresses in order to receive their test results electronically. “I think we’re already being able to see the difference and the impact, just by the number of people that are continuing to get tested, which is what’s driving our positivity rate down,” she says.

 

Further south in the Valley, Kern County recently teamed up with community members to create a Latino COVID-19 Task Force, and other county health departments have created messaging specifically to target Latino and other community groups. Last week, the state public health department also added a health equity metric to its reopening guidelines to gauge testing and transmission rates in the state’s most disadvantaged census tracts.