The novel coronavirus was infecting and killing many more people in the outbreak’s early stages than public officials knew at the time, Los Angeles and Riverside counties have revealed through new data that gives a better picture of when people actually got sick or died.
On March 4, when California and L.A. County declared public health emergencies, officials were aware of seven confirmed cases in L.A. County and one in a Riverside County resident who had been on a cruise ship. Now they have additional testing results that show 128 L.A. County residents and 16 Riverside County residents were sick with COVID-19 by that date.
By March 28, when L.A. County health officials enacted stay-at-home orders and closed nonessential businesses, they knew of 37 deaths in the county. They now know the toll was at least 53.
While L.A. and Riverside counties are tracking that more updated date information, Orange and San Bernardino counties are not, officials said.
Not only does the information provide a truer timeline for earlier phases of the outbreak, but it also helps explain what’s happening now when officials report a spike in cases that they attribute to a large batch of backlogged test results being released.
The information also makes it clear that when each day’s numbers are announced, the story isn’t over — the actual number of confirmed cases and deaths that existed that day won’t come into focus for a week or more.
Of course, even this information is incomplete because of how many people have become infected but never been tested.
How cases, deaths add up
For each confirmed coronavirus case and death, the date that the local health department learns of it, and announces it as part of that day’s tally, becomes its “report date.” However, most of those people didn’t get sick or die in the previous 24 hours. Death information takes a few days to get to the counties, and testing results can take even longer.
So L.A. and Riverside counties are looking at the other information that may come with each report: the actual date a person died, or for confirmed cases, when their symptoms first appeared, when their specimen was collected or when they were tested or diagnosed. The earliest one of these becomes that case’s “episode date,” which the counties also log.
For example, on Tuesday, May 5, L.A. County reported its highest-yet one-day number of new confirmed cases: 1,577, not counting those in Long Beach and Pasadena, which have their own health departments.
Only 305 of those cases had an “episode date” of Monday, an analysis of that data shows. The bulk of the cases, about 1,200, were added to dates over the prior week, and others were assigned to dates as far back as March 7.
Retroactively assigning cases and deaths to the episode date, and not just tracking when they were reported, can add up.
Riverside County announced it surpassed 100 confirmed cases on March 25, but officials now know that there were at least 550 confirmed cases by that date — and even now, that number continues to tick upward. The county reported its 100th COVID-19 death on April 23, but in hindsight officials say 119 people had died from the disease by that date.
Los Angeles County knew April 16 that it had surpassed 10,000 confirmed cases (excluding Long Beach and Pasadena). Officials now know that on that date, there were close to 15,000 cases. The testing results just hadn’t come in yet.
‘Learning each day’
In an email, Riverside County public health department spokesman Jose Arballo Jr. said: “Data appears to show that, yes, the coronavirus infections were more prevalent in the community than first believed, and that as more data is received and studied, we will learn more about the extent of the spread of the illness.”
The county had been planning for the coronavirus since before Jan. 29, when a plane carrying 195 Americans from the pandemic origin spot of Wuhan, China, arrived at March Air Reserve Base outside Riverside, Arballo wrote.
“We have been responding to an unprecedented event and we are learning something new each day,” he added.
While Riverside County health officials are still tracking the episode date counts, that information is no longer displayed on the county’s coronavirus website. Instead, charts show the number of cases and deaths as they were reported each day. Arballo said that was to make it easier for the public to follow the numbers.
“Both are accurate, they’re just different ways of looking at it,” he said.
L.A. County Public Health Director Barbara Ferrer has often said that a particular day’s numbers do not necessarily represent those cases and deaths from the day before, but rather what was reported to the office the day before. Sometimes numbers are higher because of a backlog of test reports or death records from hospitals, especially after a weekend.
“You all have seen that on Monday, Tuesday and Wednesday our numbers can be higher,” Ferrer said Wednesday, April 29, as the county reported 1,541 new cases.
The data might look like a spike, but once it’s distributed by episode date, the trend appears more even.
It’s long been suspected the coronavirus arrived in Los Angeles much earlier than officials began tracking it, but just how early is not yet fully known.
Sarah Ardalani, a spokeswoman for the L.A. County Medical Examiner, said the coroner was looking into testing individuals who died in previous months, but so far has not begun the task, which has limitations depending on how long ago someone died.
“The department has yet to receive a formal order from the governor’s office to begin post-mortem testing,” Ardalani said.
The vast majority of deaths in L.A. County related to COVID-19 occurred at health care facilities where they were being handled by the treating physician.
‘Breaks in that chain’
Orange County Health Care Agency staff try to gather as much information as possible about each case, but the nature of COVID-19 and, to some extent, human behavior can make it difficult to collect and report all data in a uniform way, said Dr. Matthew Zahn, medical director for the agency’s Communicable Disease Control Division.
Like L.A. and Riverside counties, Orange County publicly reports confirmed cases and deaths as officials learn of them, but Zahn said his agency has not been adjusting the data later.
Unlike the flu, Zahn said, someone with COVID-19 may not know right away whether they’ll have a mild case or a severe one, and they might not get tested until they feel quite sick — and that could be days after they were first infected.
Add in the fact that not all tests take the same amount of time to process, and that some patients can be hard to reach or reluctant to share detailed health and personal information.
“There’s a lot of potential breaks in that chain that can lead to delays,” Zahn said.
San Bernardino County has yet to publicly update its data to reflect when county residents were infected with or died from COVID-19.
“We are working with the coroner’s office to identify if we had potential COVID-19 cases/deaths going back to January,” county public health spokeswoman Lana Culp said. “We have no findings to report yet.”
Staff writers Sandra Emerson and Alicia Robinson contributed to this report.
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