Doubts raised about official death counts
Are reporting agencies on the same page?
When the coronavirus pandemic subsides, there will be a lot of questions in need of answers.
What population was most at risk? Which communities were hit hardest? Were there steps that could have been taken to save lives?
Health experts and policymakers will have to take a look at these questions and more so they can be better prepared in the future. And to do that they will need reliable data to make informed decisions.
But will that data be accurate?
“I just don’t know how we will ever reconcile the number of deaths that are being counted and make sense of this. No matter what happens, the numbers we have and the numbers the state has are probably never going to match.”
— Edward Howell, vice president of the Pennsylvania State Coroners Association
Edward Howell, vice president of the Pennsylvania State Coroners Association, is skeptical.
“I just don’t know how we will ever reconcile the number of deaths that are being counted and make sense of this,” he said. “No matter what happens, the numbers we have and the numbers the state has are probably never going to match.”
The reality, he said, is that the true death toll will likely never be known.
A handful of county officials interviewed by the Reading Eagle said discrepancies in death totals in Pennsylvania are the result of inconsistent interpretation of the county code, a patchwork of decisions that must be made in real time and with limited resources.
Different interpretations
There’s been a disconnect between the state Department of Health and county officials.
The COVID-19 death totals recorded by the state do match the numbers being reported by county coroners who are elected to investigate unexpected or suspicious deaths like homicides or suicides that take place within their jurisdictions.
In some cases the gap is wide, and the circumstances vary.
In Berks County, Chief Deputy Coroner Jonn M. Hollenbach reports 103 people have died of COVID-19, while the state lists only 85 deaths under the county.
In Montgomery County, First Deputy Coroner Alexander Balacki reports that 164 people have died of COVID-19, while the state lists 184 deaths under the county.
And in Chester County, Coroner Christina VandePol reports that 42 people have died of COVID-19, while the state lists 44 deaths under the county.
In Berks, the county toll is disease investigations.
But Howell, who also serves as coroner of Wayne County, argues that method has created confusion among people who are comparing the numbers he reports and those being recorded by the department.
He said early on that he became frustrated with the system when a second death popped up under the county that he had no information about.
“That person could have died in another country for all I know,” he said. “I had people calling me asking me about it and I didn’t have anything to tell them. I honestly don’t know if I’ll ever know who that person was or where they died.”
Howell said that, despite those frustrations, coroners are doing their best to make sure the information they are in control of is accurate.
“We’re trying to be vigilant in collecting all of the information so that it’s here,” he said. “We’ve been elected to do a job. And I don’t really see any benefit in not doing it and running the risk that it doesn’t get done.”
‘Best we can’
The handful of county officials interviewed by the Eagle said they have to depend on their community partnerships to help them keep an accurate count of the COVID-19 deaths that occur in their counties.
Hollenbach said coroners are well suited to collect the information because they have experience in this role.
The coroners already have relationships with local hospitals, nursing home administrators and first responders, and can properly communicate with families and track community spread.
“Our goal is to give the public the best information possible based on what I have in front of me,” he said. “This pandemic is no different.”
Hollenbach said he believes most offices feel the same way. And, he added, most offices are collecting data pretty much the same way.
The hospitals are responsible for testing and reporting deaths that occur there, long-term care facilities are responsible for testing and reporting deaths that happen there and the coroners are responsible for testing and reporting deaths that take place at home.
But Balacki said that there’s no doubt in his mind that some COVID-19 deaths are going to slip through the cracks in part because patients can be asymptomatic.
When someone dies at home without having been seen by doctors it takes some investigative work to decide whether they should be tested, he said. That may involve asking loved ones what types of symptoms they had or looking in trash cans to see if there are a lot of tissues.
“We’re doing the best we can,” Balacki said.
Each day Balacki submits to the state all COVID-19 deaths that occurred in the county through the statewide electronic death certificate system. Each day the county commissioners announce the latest numbers for Montgomery.
Balacki said most of the victims tested positive before they died. But not every case is easy to determine. At least that’s what Hollenbach discovered this month when a 50-yearold Lancaster County man died in Reading Hospital after being transported there following a car crash in Reading. The man died six days later of acute respiratory failure and acute respiratory distress after testing positive for COVID-19. “It’s believed that the man actually went into a coughing fit that resulted in the car crash,” he said. “So what killed him was the COVID-19, but what brought him to the hospital was the car crash.” In another case, the office was called to the residence of a woman who was known to have tested positive for COVID-19 but an investigation showed illicit drug use may have been what caused her death. He said they’re still waiting on toxicology results to make a final determination. Schuylkill County Coroner David Moylan said he thinks these are examples of another problem. He said he believes in some cases deaths caused by respiratory problems will be labeled as COVID-19 related fatalities and in other cases it will never be determined that COVID-19 was the cause. That’s unfortunate, he said, because he expects that after the virus eventually fades it will return, so reliable information will be crucial. Lehigh County Coroner Eric Minnich said he’s confident his death count is accurate because of the good working relationships his office has with the county, St. Luke’s University Health Network and the local longterm care facilities. The office is not, however, able to track each county resident who dies of COVID-19 in other jurisdictions or notify other counties that their residents died in Lehigh. “It’s just not logistically possible now,” he said, due to how steadily and historically busy his office has been for the last month. Balacki can relate. He said the past month has been extremely busy, working around the clock to handle all the cases. “We’ve been swamped 24-7,” he said.
Precautions taken
Balacki stressed that those who work in the office have been following the same precautions as the health professionals and first responders on the front lines.
He said there is still little research about whether COVID-19 is contagious after death so the staff is wearing masks, face shields and personal protective equipment when near bodies.
Dr. Rachel Levine, state secretary of health, has said the deceased are contagious.
VandePol said in a statement that like many of her colleagues around the state, she is also dealing with limited resources when it comes to testing out in the field and locating enough space for her staff to conduct their investigations.
“Some coroners and medical examiners are starting to make their own test kits, and perhaps we’ll be doing the same soon,” she said. “We’ve been fortunate so far to receive some from hospitals, some from the Bureau of Laboratories in Exton and some from our county health department, but there’s never enough to go around.”
VandePol said the shortage of testing supplies is a systemic failure beyond the local level and believes the true death toll will never be known because of that failure.
But, she said, she has found inspiration by the sacrifices of so many in her community. One example she pointed to was how funeral homes are providing refrigerated storage space for her office when they need it.
“That is how we are getting through this, one day at a time,” she said.