Change in DHSS database sows residency confusion

Count for Homer cases dropped to five

A change in how the Alaska Department of Health and Social Services identifies patients with positive cases of COVID-19 has thrown the accounting of Homer cases awry. A shift in state reporting bumped the number of cases of Homer residents with the disease up to six on Sunday and then back down to four by Tuesday.

Over the weekend, the DHSS reported two new positive COVID-19 cases the department identified as being Homer residents, one on Saturday, May 16, and another on Sunday, May 17. That brought the number of Homer cases up to six.

On Monday, that case count dropped to five when DHSS moved one case on its COVID-19 dashboard to the “other” column for the Kenai Peninsula Borough. On Tuesday, DHSS moved another Homer case to the “other” column, bringing the Homer count back down to four. The “other” category is used for areas that have populations smaller than 1,000 people.

The change in how DHSS identifies the cases caused confusion about the patients’ residencies. One of those cases didn’t show up in South Peninsula Hospital’s accounting of tests done at the local hospital. It’s unknown where that one case was tested. The other case at issue was tested locally at SPH.

On Monday, South Peninsula Hospital Public Information Officer Derotha Ferraro wrote in an email that the case reported on Sunday was the recent test done at the hospital. Ferraro wrote that this case was not of a resident within Homer city limits, but a resident of the greater Homer area. As of Monday, South Peninsula Hospital has had five total COVID-19 tests come back positive, Ferraro wrote.

One of those five positive tests was for an Anchor Point man identified as being 80 or older who died on May 5. DHSS said the man had underlying health conditions. Under state and Centers for Disease Control and Prevention death certificate guidelines, a person is listed as having died “of” or “from” COVID-19 if the disease was put on the death certificate as a primary or contributing cause of death. However, the CDC considers a death a COVID-19 death if the illness is listed anywhere on the death certificate as a contributing factor.

Three of the five positive cases that have been tested at South Peninsula Hospital are actually from the City of Homer. A fourth Homer case, and the city’s first official positive COVID-19 patient, was a Homer resident who had been traveling, arrived in Anchorage, and was tested in Anchorage and self-isolated there after testing positive.

On Monday, DHSS spokesperson Clinton Bennett provided partial explanation of the change in how the state identifies residency.

“When the state was working on cleaning up information on the COVID-19 dashboard, a case that was previously labeled as ‘Homer’ was no longer Homer when the person’s residency was added,” wrote Bennett in an email. “That case was removed from the Homer case count and placed in the ‘other’ section for the Kenai Peninsula.”

In a follow-up email, Bennett clarified that a case DHSS identified on May 16 as being a Homer resident was actually from another Kenai Peninsula Borough community — the case now labeled as “other” on the COVID-19 dashboard. In a later email on Wednesday, Bennett said both the May 16 and May 17 cases identified as Homer cases were for residents from a lower Kenai Peninsula community.

At a press conference on Tuesday when asked about the change in identifying residency, Zink confirmed there had been some changes in the database. She also was asked how under this system Alaskans in small communities can track possible regional spikes in COVID-19 cases as the state moves into a major reopening of businesses and facilities starting Friday.

“We want to get as much transparent data to Alaskans as we possibly can, but we also have to protect people’s identity,” Zink said. “So in smaller communities we have to make sure the individual person can’t be identified unless they have identified themselves.”

In an email on Wednesday, Bennett said that when Public Health does case and contact investigations, that process ensures people who have had close contact with COVID-19 patients receive information directly from Public Health. “Close contact” is defined as being within 6-feet of an infected person for more than 10 to 15 minutes.

Homer Public Health Nurse Lorne Carroll provided some more background on how DHSS now identifies residents of smaller communities. Even though a resident might have a Homer mailing address that’s used on a driver’s license, Permanent Fund Dividend application, U.S. passport, property tax assessment and other official forms, that’s not what DHSS uses. The department classifies residents by Census Designated Place, or CDP — part of its attempt to be specific about location, Carroll said.

That’s also the system that has been used for some cases listed as “other” already, such as residents of the Yukon-Koyukuk and Bethel Census Areas. Carroll said the changes of some Homer cases to being listed as “other” is to be consistent with how other areas were reported.

Carroll said a resident of the City of Homer would be listed as “Homer” because that’s a Census Designated Place. Any Census Designated Place with more than 1,000 people is listed by the Census Designated Place name, such as Anchor Point or Fritz Creek. But if a resident lives in a Census Designated Place with less than 1,000 people, despite what their official resident address might say, they’re classified as “other.”

Bennett wrote that this residency identification process has been the guideline since the start of the pandemic. He said that as DHSS does interviews of patients and gets more accurate demographics or history, it updates the COVID-19 database. Thus, the listed residency of a person with COVID-19 can change if better or more accurate information about where they live is gathered after the case is initially reported.

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