Local officials are confident that six people have died in Calhoun County after being diagnosed with COVID-19, though it's unclear why two reported deaths last week still aren't part of the state's overall count of coronavirus deaths.
"I'd like to know that as well," said Calhoun County Emergency Management Agency director Michael Barton. "All that data is collected at the state level, so it's something we don't control."
More than 30,000 people in Alabama have been diagnosed with coronavirus, according to numbers released Monday morning by the Alabama Department of Public Health. Of those, 831 have died with the disease, and 10 additional deaths are considered "probable" COVID-19 fatalities.
In Calhoun County, there have been 207 confirmed cases, according to the ADPH numbers. Those numbers show four deaths in the county from the virus with no "probable" coronavirus deaths under investigation.
That doesn't quite match with statements local health and safety officials made last week. On Wednesday, Calhoun County recorded its fourth death from the virus, and local officials said there were two more recent deaths, of people who'd been diagnosed with the virus, who would likely soon be added to the count.
Five days later, the official count still stands at four.
Why the two haven't been added isn't clear, though Barton confirmed again on Monday that they were people who'd tested positive for the virus. Asked if the potential undercount in Calhoun County indicates that the statewide death toll may also be an undercount, Barton said he didn't know.
"I can definitely say that the count in Calhoun County is too low," Barton said.
Dr. Karen Landers, an assistant state health officer, said that most deaths from the virus are added to the official count within a few days, though some additions can take longer.
"There is a reason for being very meticulous," she said.
Landers said cases listed as "probable" do often take a long time to research, because cases in the "probable" category are typically deaths of people with coronavirus symptoms who died without getting tested for the virus. Narrowing down those cases by reported symptoms before the patient's death is tricky.
"I'm just astounded at the broadness of the symptoms," Landers said. The most common symptoms of the virus — cough and fever — are now well known, but in the past few months researchers have identified many less-known symptoms such as a loss of smell and taste.
Landers said that anyone diagnosed with the virus who later dies would normally be added to the count of coronavirus fatalities. A lag in those numbers, she said, was quite possible. Hospital officials at the state's busiest hospitals may not have time to immediately send their files on those cases to the state to be counted, she said. For people who die outside a hospital, a death would likely be added to the count when a coroner declares that COVID-19 is the cause of death.
At least one of Calhoun County's suspected recent deaths happened at the victim's home. Attempts to reach Calhoun County Coroner Pat Brown for comment were not successful, but Barton said the coroner's office had recorded the recent out-of-hospital death as coronavirus.
Critics of Alabama's COVID-19 response have raised the possibility of an undercount before, though those complaints came mostly in the early weeks of the pandemic, when testing in the state was sporadic. Since May, the state has consistently done about 30,000 tests per week, with anywhere from 9 percent to 12 percent of those tests coming back positive.
Calhoun County has among the lowest per-capita rates of infection of any county in the state, but across Alabama as a whole the virus continues to surge. The state now records more than 600 new cases per day, on average. The state averaged about 200 new cases per day at the end of April, when the state began to ease its initial stay-at-home order.