SAN LUIS OBISPO — San Luis Obispo County Public Health Officer Dr. Penny Borenstein spent most of this week’s COVID-19 briefing explaining ‘“the mischaracterization” of new CDC data.

The Centers for Disease Control and Prevention released new data that shows how many Americans have died from COVID-19 — specifically how many had coronavirus on their death certificates. However, this information has caused quite a bit of confusion.

“With national news around the issue of what counts as a death, I wanted to spend some more time addressing that particular issue,” Borenstein said Wednesday afternoon. “It has gotten a fair bit of national attention in the last one to two days, in that there is the appearance that the CDC has indicated that the vast majority of the deaths that have occurred from COVID-19 are in fact incidental from COVID-19 and that only a small percent actually died from the disease, COVID-19.

“I want to clarify that because that is absolutely a mischaracterization of what is being said nationally and what the facts are,” Borenstein added.


According to the CDC, over 180,000 people in the United States have died from COVID-19. The report shows that COVID-19 was the only cause of death listed in 6% of those deaths. Many people online have commented that they thought this meant that only about 10,000 people died from COVID-19, but that is incorrect.

“It is true that 94 percent of all 182,000-plus COVID-19 deaths in the United States have an underlying medical condition,” Borenstein said. “But let me talk a little bit further about what that means because it doesn’t mean that these individuals did not die from becoming infected and getting sick with COVID.”

Borenstein explained that on a death certificate, there could be four or more causes of death, which move in time to the ultimate cause of death listed on the first line.

For instance, she said, take someone who gets sick from COVID-19, then develop pneumonia, then have acute respiratory disease and die. COVID-19 will likely not be noted as the primary cause of death, but it is what led to pneumonia and respiratory disease.

“COVID-19 may be listed as an underlying cause further down that led to pneumonia that led to the acute respiratory disease failure and all of those are considered part of the underlying cause of death,” Borenstein said. “In this county, that is what we are counting is that cause of death regardless of whatever else was going on with the individual.”

The same goes for a person with a pre-existing condition who contracts COVID-19 and dies.

In many cases, in fact, in 94%, she said, there is a pre-existing condition, which could be anything from high blood pressure to diabetes to asthma to obesity and a host of other medical conditions that may be significant contributors to the death that happened from COVID-19. 

“The fact that you had high blood pressure and went on to have COVID may have made the disease (COVID-19) more serious and may have been a contributing factor to your demise, but it is not the high blood pressure that caused the death,” Borenstein said.

Conversely, she used the example of a young and healthy person with COVID-19, who dies in a car accident. Even if the doctor who reports this death knows the person had COVID-19, it “is not a contributing factor to that death and would not be counted.”

The CDC information backs up what Borenstein and other medical professionals have been saying for months now, that the vast majority of the deaths from COVID-19 have happened in people who have an underlying or a pre-existing medical condition.

To put that into context, nearly half of everyone from birth to 100-plus has at least one underlying medical condition, Borenstein said.

“It is not at all unusual that a majority of people in their elder years who are getting this disease and dying from it also have one underlying or more medical condition,” she said.

CMC Death

Borenstein said the County was aware of the death of an inmate-patient who tested positive for COVID-19 at the California Men’s Colony on Sept. 1 but was waiting for the death certificate before adding it to the County’s death total.

The California Department of Corrections and Rehabilitation indicated the person died due to complications from COVID-19. It would be the first COVID-19 death at CMC.

According to the CDCR, 271 inmates at CMC have tested positive for the virus since the start of the pandemic. Of those cases, 38 are within the past 14 days.

New Tier Plan

Borenstein also talked about the state’s new four-tier, color-coded plan — the Blueprint for a Safer Economy. San Luis Obispo County is in the most restrictive tier, purple, and needs to average less than 20 new cases per day to move to the next level. 

This week, the County is averaging 30 new cases per day.

Another condition of the new tier system is that counties have to remain in a tier for three weeks. From Wednesday, if everything went perfectly for SLO, the soonest it could get into the next tier would be Sept. 22.

SLO County needs to get into the next tier for local schools that do not have waivers to move to in-person instruction.

Borenstein welcomed the Blueprint because it clearly states what the County needs to do to move through the tiers and what will happen as a result. She added that it would take everyone working together for the County to move to the next tier.

“I continue to believe, I really do believe that if people would heed the guidance that we can drive our numbers down,” she said.

Grand Reopening Email

Borenstein said she had seen a “Grand Reopening of the County” email. It is asking businesses to stop adhering to the COVID-19 guidelines and fully open. 

“There are repercussions for the county. There are repercussions for the businesses,” Borenstein said. “I would very much ask that businesses who do get a request to participate really think long and hard about their willingness to do so.”

Labor Day

Borenstein wrapped up her comments by asking people to celebrate the Labor Day weekend safely and to stick to the COVID-19 guidelines.

“We want very much to honor all of our workers, but please, please do so safely in small numbers, sticking with your household, one or two other friends that you move about with over a period of weeks. Please do it as safely as you can,” she said.

Latest County Numbers

SLO County reported 29 new COVID-19 cases on Wednesday, bringing the overall total to 3,035 with 2,593 having recovered. There are 418 active cases with 11 in the hospital, including four in intensive care. Six of the new cases were in North County communities — two each in Paso Robles and Atascadero and one each in Templeton and San Miguel.