Are California hospitals over-counting coronavirus patients?

Eufemia Didonato

“I can now say with 100% certainty that everything you think you know about COVID hospitalizations and deaths IS A LIE!” The bold claim comes from Kirk Uhler, the firebrand Placer County supervisor and vocal skeptic of the state’s COVID-19 response and mask orders. It was the title of his […]

“I can now say with 100% certainty that everything you think you know about COVID hospitalizations and deaths IS A LIE!”

The bold claim comes from Kirk Uhler, the firebrand Placer County supervisor and vocal skeptic of the state’s COVID-19 response and mask orders. It was the title of his Facebook rant last week that has received 316,000 views and been shared more than 6,600 times — particularly among anti-mask activists and those furious about Gov. Gavin Newsom’s shutdown orders.

Uhler’s primary contention: California hospitals count patients admitted to their facilities who have COVID-19, even though they may not have been admitted for symptoms of the disease.

Hospitals then report those positive cases to the state as part of their overall COVID-19 count. This, Uhler argues, inflates the number and prominence of the pandemic and leads to unnecessary lockdown orders because hospitalized patients in the state tallies might not actually be sick from the disease.

“Not a single county in the state… can tell you they know how people are hospitalized in the intensive care unit — or dead — because of COVID as opposed to with COVID,” Uhler says in the video. He goes on to describe a hypothetical accident involving someone being hospitalized after severing a limb while “juggling chainsaws” and later testing positive for COVID-19.

The claim is part of a national web of conspiracy theories that have taken hold throughout the coronavirus pandemic, sometimes coming from the Trump administration, repeated on social media and parroted by pundits. Vice President Mike Pence aired a version of it on a call with governors last month, The New York Times reported.

Experts say Uhler’s theory, like any widespread conspiracy, is rooted in a kernel of truth.

He’s not wrong about hospitals reporting all infections to the state.

But his argument is deeply misleading, experts say. There are good reasons why health officials rely on total hospitalized patients with COVID-19 — as opposed to those there because of it — in deciding when to issue shutdown orders like the ones Newsom called for Monday in 30 counties, including Placer. Experts say the state uses the numbers to track the prevalence of the disease and the burden it places on the medical facilities.

Where the claim arose

Uhler first attacked the numbers at last week’s Placer County Board of Supervisors meeting.

Dr. Aimee Sisson, the county’s health officer, said the state was likely going to order businesses, such as restaurants, to shut down again because the county’s COVID-19 case count was continuing to rise.

Uhler told Sisson he had spoken with a hospital administrator who mentioned to him that they’re testing everyone admitted to the hospital, including for elective procedures.

Sisson confirmed that was indeed the case.

“We have raised this issue with the state, and I’m hopeful they will begin asking hospitals to track that data separately,” she said. “Incidentally, I did have a conversation with one of our hospitals, and they indicated at the time they had 12 (COVID-positive) individuals and three of them were asymptomatic positives or hospitalized with COVID but not for COVID.”

On Sunday, 6,485 people with COVID-19 were hospitalized in California, according to state data. Of those, 1,833 were in the intensive care unit — up 65 percent from a month ago. More than 7,000 Californians with COVID-19 have died.

The daily hospital data must follow precise details spelled out by the California Hospital Association and state health department. That information is then used to feed California’s online dashboards that populate news websites, inform decisions on lockdowns and make occasional appearances in Newsom’s noon briefings.

The state for months has required hospitals to report the number of people who are hospitalized — for any reason — who also have a laboratory-confirmed case of COVID-19.

Should it matter?

The California Department of Public Health said the reason a COVID-19-positive patient was in the hospital wasn’t a factor in their reports. A spokesperson declined to address Uhler’s video.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said it’s not misleading for the state to ask hospitals to report all COVID-19 patients — even asymptomatic ones.

She said each time someone tests positive for the disease inside the hospital, they require special care and precautions because they can infect other patients and members of the staff. Plus, an asymptomatic patient could easily grow sick in the hospital’s care.

Gerald Kominski, professor of health policy and management at UCLA’s Fielding School of Public Health, agreed.

“We need to do this testing in order to protect both hospital personnel and other patients who are in the hospital,” he said.

State health officials aren’t just using the numbers to determine how many beds are free. They’re using hospitals as a barometer to help monitor COVID-19 infection rates in communities, said Arthur Caplan, director of the medical ethics program at New York University’s Langone Medical Center.

Caplan said those numbers about hospital infections, and ultimately ICU space, help if “you want to know if the outbreak is going to get worse.”

Placer County’s COVID cases

In response to Uhler’s line of questioning, Placer County Public Health said in its weekly COVID-19 update that local hospitals have agreed to share a weekly breakdown of those hospitalized due to COVID-19 compared to those hospitalized for other reasons, including trauma or maternity, but who test positive.

Only one hospital had done so as of Friday. The health department didn’t say which one, but it reported that all 16 COVID-19 patients — two of whom were in the ICU — were there because they were sick from the disease and not for other reasons.

The Sacramento Bee reached out the several hospital chains in the region. None provided their numbers. Some claimed that doing so would violate patient privacy.

As for deaths, Placer County noted the state requires all death certificates to list COVID-19 cases as either a direct cause of death or “a significant condition contributing to death.”

“The 11 COVID-19 fatalities in Placer County thus far all had COVID-19 listed as a cause or contributing factor to death,” health officials wrote.

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