On March 22, a Bexar County woman in her 80s died of COVID-19-related symptoms, becoming the first documented local death.

At the time, only 45 people had tested positive, but City and County officials asked residents to brace themselves for an “inevitable increase” in the number of positives. Two days later, a second person was dead from the disease

Fast forward five and a half months – 173 days – and the ravages of that inevitable increase are in the spotlight as Bexar County inches closer to reporting 1,000 deaths locally, with 990 reported as of Thursday. 

But data reported by the Department of State Health Services has Bexar County with 1,181 deaths with the first local death reported on March 21. 

San Antonio Metropolitan Health District Interim Director and Assistant City Manager Colleen Bridger said the discrepancy in the state versus local health department numbers is due to paperwork errors, and that she is “100 percent sure how Metro Health tracks COVID-19-related deaths is accurate.”

Death certificates can be filled out by a number of different people, including funeral home directors and medical examiners, so it’s “not unusual to see some errors in address and cause of death,” Bridger said, giving an example of a person whose permanent address was listed as Bexar County, but they lived for the last two years and died in a nursing home in Dallas. “A lot of paperwork is being requested and sent by people who aren’t used to having that much paperwork.”

Bridger said Metro Health would eventually sit down with the state health department and parse through both sets of data to “tidy it up” and ensure total accuracy, but in the meantime, Metro Health will continue to report cases that are under investigation, of which there are 182 as of Thursday. 

But the reported numbers are only accurate to an extent because at least 51 people have a missing date of death, according to numbers provided by Rita Espinoza, Metro Health’s chief epidemiologist. 

The growing pains involved in reporting the impact of the novel coronavirus on the local, state and national level can be seen as the public health community continues to write and repeatedly revise everything from recognized symptoms to when a person is considered to have recovered from the virus, leading to a lag in reporting time and inconsistencies in the data. 

And in some cases, simple reports don’t exist because of the sheer magnitude of time it takes to compile it during a moment when health departments have spent the last five months playing catch up. 

The most glaring example of the discrepancies in reporting came on July 31, when Metro Health reported 349 COVID-related deaths and the state reported 902. Bridger said the difference in reporting stems from Metro Health confirming county residency and a positive COVID-19 test on file before adding it to the local death toll. The state, which keeps a daily death count for all 254 Texas counties, doesn’t take into account the actual date of death, just when it receives the information.

The quality control piece of infectious disease surveillance is both time-consuming and complicated, a pandemic makes it even harder, and the fact that it is a novel virus increases the level of difficulty a step further, said Dr. Anita Kurian, Metro Health assistant director.

The reason why public health data is often reported one or two years later is because of the time it takes to clean up the data, Kurian said, which includes reaching out to health care providers and family members for missing information and checking medical records. “That’s one of the reasons why we don’t release any real-time information because it’s always provisional and subject to change.”

The 51 people whose date of death was not reported could be because it was not provided or it was not entered into the system, but because the numbers are being reported in the middle of a pandemic – as opposed to at the end of a year or after going through every quality control measure – discrepancies will exist, Kurian said. However, since this is a novel virus, it’s important to update what is known, even if it’s not 100 percent accurate because it is as accurate as it can be at that time.

While there are discrepancies in state versus county death data, Bridger said Metro Health’s numbers accurately reflect how the virus has taken its toll on Bexar County.

“Clearly there’s a correlation between the number of people in the hospital and the number of people who die, and as we see the number of people in the hospital decreasing, we are also going to see the number of fatalities go down,” Bridger said. 

In July, when hospitalization rates rose by 55 percent within the first week, a record 524 people died – more than double the deaths reported in August, the second most fatal month, where 214 people died. 

Regardless of whether the number of COVID-19-related deaths in Bexar County has passed the 1,000-person mark or not, the county has one of the highest fatality rates in Texas, Bridger said.

The state has reported 387 deaths in Travis County, and 1025 in Dallas County. In Harris County, 2385 deaths have been reported. 

“That is not unexpected because we also have higher rates of chronic disease than other places in Texas and we also have an older Hispanic population… which contributes to the unfortunate result of more people dying of COVID-19 than in other places.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.