The state Department of Health said Wednesday that “hundreds” of the more than 850 deaths counted in its influenza and respiratory disease surveillance report for the just-ended 2020-2021 flu season were casualties of COVID-19.

DOH officials indicated they don’t know exactly how many of the deaths were associated with COVID-19, but said “the majority” of coronavirus-­related deaths in Hawaii were also classified as pneumonia deaths.

Regardless of how many COVID-19 deaths were included in DOH’s surveillance report, officials said there was only one flu death during the 2020-2021 flu season, making the coronavirus “far deadlier” than influenza.

A Page 1 headline on a Monday Honolulu Star-Advertiser article about the influenza season incorrectly stated the flu was deadlier than COVID-19.

As of Wednesday, DOH reported a total of 81,790 coronavirus cases and 851 fatalities statewide since the start of the pandemic.

“In Hawaii and around the world, COVID-19 was far deadlier than the flu during the 2020-2021 flu season. There was one confirmed influenza death in Hawaii between Sept. 27, 2020 and Oct. 2, 2021. This is compared to 608 COVID-19 deaths in the same reporting period,” State Epidemiologist Sarah Kemble said in a statement. “While influenza deaths have been rare in the past season, the upcoming season is a big unknown. If mitigation measures are loosened as COVID cases come down, it is likely we will see some resurgence of flu and other respiratory diseases.”

Based on data in the surveillance reports, the Monday article in the Star-Advertiser said the number of influenza and pneumonia deaths during the 2020-2021 season, which totaled 859 with a week left, surpassed the number of deaths from COVID-19.

But Kemble explained in her statement Tuesday that the department’s Influenza/Respiratory Disease Surveillance Report “is an aggregate of pneumonia caused by all infectious agents, including flu and COVID-19.”

That clarification was not provided to the Star-Advertiser for Monday’s article, which compared data on flu and pneumonia deaths in the most recent surveillance report with separate COVID-19 statistics provided by the Health Department.

The DOH monitors influenza and other respiratory pathogens, relying on selected “sentinel” health care providers, the State Laboratories Division, private laboratories and the Office of Health Status Monitoring. The department reports the data to the U.S. Centers for Disease Control and Prevention and posts weekly surveillance summaries on its website.

DOH officials said COVID-19 deaths are included in the influenza and pneumonia deaths if they also involved pneumonia. Those deaths, combined with other COVID-19 fatalities not associated with influenza or pneumonia, are used to compile the Health Department’s official coronavirus death toll, which is updated daily.

Joshua Quint, an epidemiologist with the DOH Disease Outbreak Control Division, said unlike COVID-19 and influenza, two viral infections that attack the respiratory system, pneumonia is a lung disease caused by infectious pathogens that may include flu, coronavirus, rhinovirus, otherwise known as the common cold, and a number of other agents.

“The 859 includes people who died and had pneumonia, and a large number of that 859 did also test positive for pneumonia and their pneumonia was caused by COVID,” Quint said.

DOH spokesman Brooks Baehr said in an email the department has “not gone through the death certificates to determine the exact number of COVID-19 deaths classified as pneumonia deaths.”

Combined flu and pneumonia death totals mentioned in DOH surveillance reports have been cited when previously discussing the annual flu season, but Quint said officials are pointing out “nuances” in the data now that COVID-19 has emerged as a major respiratory disease and a primary public health concern.

COVID-19 also was included in the flu and pneumonia mortality data for the 2019-2020 season, when DOH reported 29 deaths from influenza.

And Baehr noted, “COVID-19 can cause deaths in others ways too. For example, COVID-19 can cause fatal blood clots. And because not all COVID-19 deaths during the specified time period were the result of respiratory infection (pneumonia), not all of the 608 COVID-19 deaths during the specified time period are classified as pneumonia deaths.”

Although COVID-19 restrictions such as mask wearing, social distancing and limiting gatherings, have greatly reduced flu spread and deaths in Hawaii, health officials are urging the public to get an annual flu shot, which in most cases can be administered at the same time as the COVID-19 vaccine.

The CDC recommends annual flu shots starting with 6-month-old infants and especially for people at high risk of flu complications, including young children, older people, pregnant women and people with certain chronic health conditions.

“DOH strongly recommends that all eligible individuals get vaccinated against both flu and COVID-19. It is safe to receive both vaccinations at the same time,” Kemble said in the statement. “Getting the flu shot will help to ensure that Hawaii’s flu rates remain low to protect our hospital capacity and keep our communities healthy.”