By Craig Anderson

DOVER — A sea of numbers, presented in charts, bar graphs and maps shaded by ZIP codes, is updated daily on the Delaware Division of Public Health’s website.

That information has multiplied since last year, when COVID-19 first appeared in Delaware with a positive case in New Castle County on March 11. And thereafter, the tallies quickly increased.

Any public citizen can view statistics in case incidences and deaths reported by the state. The numbers have grown over the year to show testing results and vaccination distribution.

What the public doesn’t see is how a team of epidemiologists is analyzing that data and then using it to help state leaders shape policy.

The process of tracking COVID-19-related deaths to formulate solutions to combat the disease falls under the purview of State Epidemiologist Dr. Tabatha Offutt-Powell and her office staff.

“As epidemiologists, from a public health perspective, we’re always looking at mortality surveillance or looking at our deaths,” Dr. Offutt-Powell said. “It’s critical for us to be able to describe and measure the (reach) of disease among the population in our state.

“So we’re really looking at that direct impact on health, the severity of the disease and how it progresses, the potential impact of those with the greatest risks of illness or death and our interventions we’re putting in place.”

And with no time for delay, epidemiologists cull through preliminary real-time data provided by hospitals, long-term care facilities and death certificates to learn as much as possible about how COVID-19 is currently affecting Delaware. The epidemiology office has access to the Delaware Health Information Network for further analysis, as well.

“We don’t want to wait a year from now to understand what’s going on. We don’t want to wait even a couple weeks or months. We want to know at the moment,” Dr. Offutt-Powell said.

By pulling together information, health leaders can create prevention programs and develop policies aimed at mitigating the breadth of the coronavirus in Delaware.

“The data are provisional and preliminary and subject to change, but we need to know in a rapid sense what’s going on in our population and the severity of the disease,” she said.

The surveillance of deaths is coupled with monitoring positivity rates, case trends and hospitalizations “to guide the state’s response and interventions throughout the pandemic,” DPH spokeswoman Jennifer Brestel said.

All the data is used to help respond to COVID-19, not just one metric over another, she added.

An array of determinations is entered into Delaware's My Healthy Community website for anyone to review.

“For the most part, the public really wants to see what’s going on with COVID — whether it’s death or vaccination or cases (or) testing — so it’s really important that (we be as transparent as possible),” Dr. Offutt-Powell said.

While currently downward-trending hospitalizations could portend a drop in deaths, the doctor said that, overall, the office is “looking at trends over time, as there are changes in the virus and different variants.”

“We’re vaccinating people, those at the greatest risks of severe outcomes. We’re seeing a decrease in hospitalizations, which is really positive for us to see. We use that information and track it over time, and I think the trajectory is on the downward trend, but those can change given different factors that we see or things that are out of our control.”

And while some members of the public may question the reported death toll, the DPH describes the process as complicated and derived from many angles.

Case reporting from a real-time perspective can prompt revisions and updates, as more information arrives and data is accumulated, Ms. Brestel said.

“A lot of times, people either get confused, or they develop their own narratives about the deaths because it’s complex. It’s not simplistic or black-and-white,” she said.

“It has multiple layers and multiple sources, so that’s why I think the public sometimes has a hard time grappling with the numbers and how they change and when we’re adding Vital Statistics deaths that may have occurred in the past. It’s kind of hard to communicate, but again, that’s the challenge of that real-time, day-to-day reporting of the numbers.”

Noting that the state takes its lead from the Centers for Disease Control and Prevention, Delaware Healthcare Association President and CEO Wayne A. Smith said, “We have no concern with either the form or substance of reporting as we understand it is conducted.”

The DPH compiles COVID-19-related death statistics based on a combination of state data and federal guidelines and reports.

The state uses the CDC’s definition of a severe illness from COVID-19.

As of Thursday, 1,316 deaths out of 1,496 in the state involved individuals with underlying health conditions, the DPH said.

Chronic conditions that could put a person at higher risk of admission to the intensive care unit, intubation or mechanical ventilation or death often involve diabetes or heart, lung or kidney disease, as well as immunocompromising conditions, among others.

Death certificate data from the state’s Health Statistics Center could take weeks to a few months to process, since the information is forwarded to the CDC’s National Center for Health Statistics first. The data is transmitted weekly from Delaware’s electronic vital-events registration system, DelVERS.

NCHS codes the deaths based on the information registered by the certifier of the death certificate, and the coded death certificate data are then transmitted from NCHS back to DelVERS.

According to the DPH, Delaware’s count includes both lab-confirmed and probable deaths, per CDC guidelines. Probable cases and deaths are determined based on the case definition given by the CDC. Delaware is using the CDC’s updated case definition, released Aug. 5, to classify cases/deaths, the DPH said.

Demographic and health information compiled for statistical purposes comes from the information reported by the laboratory that processed the person’s COVID-19 test, the provider reporting the death and from information available in the DHIN, the DPH said.