State health officials spoke at length, during a Feb. 11 online conference with journalists about how Alaska reports COVID deaths, case counts and adverse reactions to the vaccine. In all instances the process can be, at times, complex.

COVID DEATHS

When determining COVID caused deaths, CDC guidelines, instruct physicians to “use their best clinical judgement to determine the cause of death.” This means looking at contributing and intermediate causes, as well as fundamental underlying conditions.

The CDC states that “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely … it is acceptable to report COVID–19 on a death certificate as ‘probable’ or ‘presumed.’ In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely.”

A CDC instructional webinar states that if COVID is listed as a “probable” cause of death, then COVID should be listed as the reason for the fatality. Alaska follows this recommendation with the state website explicitly stating: “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.”

When deaths occur among people who “have many complex medical conditions and it’s not as clear cut when that person dies how the death certificate is going to be filled out,”

In Alaska, COVID deaths are recorded and then reported to the general public in two ways – either directly from a hospital to the state after someone dies, or through individual physicians who fill out death certificates which are then sent to the state and CDC for final review and publication in Alaska’s COVID-19 Dashboard. In each instance, the opinion of the physician is the primary indicator on whether a death is ascribed to COVID or not. At times, however, this determination is not obvious, said Dr. Tessa Walker Linderman, who helps lead Alaska’s vaccination task force.

Tessa noted that deaths occur among people who “have many complex medical conditions and it’s not as clear cut when that person dies how the death certificate is going to be filled out,” she said. “Ultimately the provider who is managing that person fills out the death certificate.” From there it is filed and coded by the CDC.

These death reports are then reviewed and sometimes altered at the state level, which explains why Alaska occasionally announces a large cluster of new deaths on a single day.

VACCINE DEATHS & ADVERSE REACTIONS

Determining deaths and adverse reactions due to COVID vaccines is another tricky process.

Dr. Liz Ohlsen, a public health physician for Alaska, said this is largely the responsibility of the CDC, which tracks adverse reactions to the vaccines through two main programs called V-Safe and the Vaccine Adverse Event Reporting System (VAERS).

V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after a person receives a COVID-19 vaccine. Participants can choose to tell the CDC if they have any side effects after getting the shot. Depending on the answers, someone from CDC may call for more information. This data is saved and used to gauge the safety of the vaccine for the general public.

Alaska does not independently investigate VAERS reports of Alaskans who die following vaccination. Rather, they rely on the CDC’s final judgement.

VAERS is another CDC-run system in which physicians or patients can report adverse reactions and deaths that occur following vaccinations. After someone reports an incident to the VAERS website, the CDC investigates the report and makes a call as to whether the reaction or death should be attributed to the vaccine. While VAERS includes reports of more than 500 U.S. deaths following a vaccination, the CDC claims that none of those are due to the vaccine itself. Similarly, Alaska has five post-vaccine deaths listed on VAERS, but the CDC says none of them are vaccination induced. The state does not independently investigate VAERS reports of Alaskans who die following vaccination. Rather, they rely on the CDC’s final judgement.

Regarding adverse vaccine reactions, the VAERS website has recorded 11,249 instances with 117 reported from Alaska as of Jan. 29. After reviewing these claims, however, CDC investigators have decided that the vast majority are not “severe” based on their reading of the reported data.

“There have been some severe adverse reactions that have been reported and associated with the mRNA vaccines, both the Pfizer and Moderna vaccines, primarily anaphylaxis,” said State Epidemiologist Joe McLaughlin on Feb. 11. He claimed that the number of people who truly had anaphylaxis reactions is “very small,” – between three and 10 “severe adverse reactions” per 1 million vaccines administered, according to the CDC.

COVID CASE COUNTS

Determining whether someone has COVID is another process which is not always immediately obvious.

According to the state’s website, a COVID positive test result should be taken at face value, while negative results should be viewed with a grain of salt.

The state’s website claims that the COVID test “almost never gives a false positive,” but false negatives can occur if testing is not done properly or if a person is in the early stages of infection.

“If you have any symptoms of COVID-19, it is safest to assume you are infected and act accordingly, even if your diagnostic test comes back negative,” the state website advises.

Complicating the process are updated guidelines from the World Health Organization claiming that the standard PCR COVID test is only “an aid for diagnosis” – not the definitive answer. On Jan. 20, WHO reminded COVID testers that “careful interpretation of weak positive results is needed.” It added that healthcare workers should “consider any result in combination with timing of sampling, specimen type, assay specifics, clinical observations, patient history, confirmed status of any contacts, and epidemiological information.”

When asked about whether the revised WHO guidelines have impacted the way Alaska tests for COVID, Ohlsen’s response indicated it had not.

“There’s very few, if any, tests you wouldn’t want to make sure that you are thinking about – to some extent – but that doesn’t necessarily mean that for a COVID test that you would say, well the test says this, but the clinical scenario says something different so I’m going to go with the clinical scenario,” she said. “I think it just makes us consider everything when you’re putting it all together.”

VACCINE STATUS IN ALASKA (as of Feb. 12)

• 167,432 total vaccine doses administered.
• 116,228 persons vaccinated.
• 51,204 vaccinations complete (both doses administered)
• 28,200 females have completed both vaccine doses.
• 21,500 males have completed both vaccine doses.

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