The number of reported COVID-19-related deaths in the state of Pennsylvania, and the process of reporting those deaths has been under scrutiny recently by the Pennsylvania State Coroners Association.
Last week in Franklin County, the number of deaths jumped from 0 to 10 in the matter of 24 hours. Franklin County Coroner Jeffrey R. Conner said last Wednesday he was only reporting one COVID-19-related death in his office. That morning, he reported two additional deaths attributed to the virus. As of Wednesday afternoon, Franklin County was reporting six deaths attributed to the virus. The Department of Health said the number of 10 deaths was due to reporting “probable” cases, and adjusted the number after further investigation.
“WellSpan has been super in their reporting since day one. I am not aware of any deaths that happened in Franklin County Nursing Homes. They have sent some to the hospital that died, but their tests came back negative. My office has responded to one in-house death thought to be COVID, but the test results came back negative. As far as the DoH, they are causing MAJOR problems throughout the state. They are not following the law,” Conner wrote in an email to The News-Chronicle.
As of Wednesday afternoon, Franklin County was reporting 264 total positive and probable cases of coronavirus, with 2,746 negative test results.
In Cumberland County, Coroner Charles “Charley” Hall said he is having a similar experience.
Hall wrote in an email to The News-Chronicle last week:
“With the coronavirus, we are not being involved in most of those cases. This is from the Department of Health. Doctors are to sign the Death Certificates. When nursing homes and hospitals do call us (which is NOT on every COVID case), we simply take the information on the deceased and record it. Although the law says any death involving a communicable disease which poses a public health hazard must be reported to the coroner, the Department of Health has said hospitals, nursing homes, etc. do not need to call the coroner. Because of this we have had only six deaths reported to my office. There are a multitude of problems with the Department of Health and the Pennsylvania State Coroners’ Association of this pandemic.”
As of Wednesday afternoon, Cumberland County was reporting 15 COVID-19-related deaths, with 324 positive and probable cases and 1,375 residents testing negative for the virus. Across the state, there were 43,366 positive and probable cases reported, with 170,517 negative tests reported, and 2,195 reported deaths.
Across the country, there have been more than 1 million Americans infected with the virus, with 110,933 recovered and 56,699 deaths reported.
“I feel for the Department of Health to truly have an accurate account of the COVID deaths, they need to follow the Coroner’s Law and have every COVID death reported to the coroners,” Hall continued. “Another thing they are doing is tracking these deaths by county of residence, NOT county of death. That is totally opposite of what we normally do. If a person dies in Cumberland County, then that is the Cumberland County Coroner’s jurisdiction and if needed would be investigated by my office. It doesn’t matter where they lived. I know of at least one case where the person died in Hershey Medical Center of COVID, but it is being shown with the Department of Health as a Cumberland County death because they lived in my county. That is not an accurate picture of this pandemic and its deaths. Very frustrating.”
Charles E. Kiessling Jr., president of the Pennsylvania State Coroners Association and Lycoming County Coroner, said the law posted on pacoroners.org, states, “Any death due to contagious disease that constitutes a public health hazard are to be reported to the coroners.”
Kiessling said the Department of Health’s legal counsel disagrees with the law, and said the coronavirus deaths are attributed to natural causes that don’t have to be reported.
Nate Wardle, press secretary for the Pennsylvania Department of Health, explained why the deaths are not being reported to the coroners.
“A death attended to by a medical professional, which includes a physician, certified registered nurse practitioner, physician assistant or dentist who is a staff member of a licensed health care facility does not need to be referred to a coroner. These medical professionals, through their hospital or facility, would have access to our data system and if they do not have access to our death reporting area, more information on that can be found here: https://www.health.pa.gov/topics/Reporting-Registries/Pages/State-Registrar-Notices.aspx.Deaths are referred to a coroner if a death case occurs when a medical professional is not able to certify the death, or if the circumstances surrounding the death suggest the death was sudden, violent, suspicious in nature or was the result of other than natural causes. A death of natural causes, such as from COVID-19, can be certified by a medical professional and does not need to be reported to a coroner. The Coroner’s Law in the county code comes into play when the coroner views the body. If the death is attended to by a medical professional, the coroner would not see the body. The coroners only have authority if they are referred to the death case, which again occurs if the death is not witnessed, or if it is sudden, violent or suspicious. A death associated with COVID-19 would not be sudden, violent or suspicious, and in most cases would occur in a healthcare setting. Flu is an infectious and contagious disease, and coroners do not investigate flu deaths. The disease prevention and control act requires reporting of disease data to the department at all times, regardless of if it is during a pandemic. We have the authority to set the data points for the report. The department is charged with creating and maintaining the commonwealth’s system of vital statistics per 35 P.S. 450.201. Vital statistics are defined as ‘the registration, preparation, transcription, collection, compilation, analysis and preservation of data pertaining to births, adoptions, legitimations, deaths, fetal deaths, marital status and data incidental thereto.’ 35 P.S. 450.105. Each death that occurs in Pennsylvania is to be reported to DoH per 35 P.S. 450.501. Guidance for coroners can be found here: https://www.health.pa.gov/topics/disease/coronavirus/Pages/Coroners.aspx.”
Wardle said the DoH doesn’t feel there is a lag or significant discrepancy in reporting the data because “this is the way that deaths are typically reported to the department.”
Kiessling said the staff at nursing homes and hospitals in Lycoming County have agreed to report the deaths to his office.
However, last week, the DoH was reporting two coronavirus-related deaths in Lycoming County that he knew nothing about.
“I opened up my own investigation. I made a request to vital records, and they sent me a seven-page manual along with a 10-page document I had to fill out for each death, plus pay a $9 fee for each request. I reached out to our legislators, and said this needs fixed. This is my job. I am elected to serve the county to investigate deaths. Now that I have questions about these deaths, I have to spend time filling out two 10-page documents and send a check for $18? That’s not happening.”
Kiessling said the two deaths have since been removed from the county’s report.
He said he is seeing significant fluctuation between the number of deaths reported by the coroners and from the DoH, and noted adding probable cases to the tally should be done with extreme caution.
“For instance, you could have two people in the same room in a nursing home, 5 feet apart. One shows symptoms of the virus, and passes away. Then the other person shows symptoms and they pass away. Yes, you can probably say they died from the virus, too. But if you have someone down the hall or on another floor that passes away, I think that person needs to be tested before a cause of death is put on their death certificate. When we investigate a death and the person has drug paraphernalia around them, we don’t say they probably died of an overdose. We do toxicology reports to sort that out. We can do a pending death certificate, but we finalize it once the results are received.”
Kiessling feels the data is going to be skewed because the DoH isn’t just collecting data from the 67 coroners in the state, but collecting it from multiple points.
“The sad thing is, coroners could have had 67 points of entry into the Department of Health data collection. I think that would have been more accurate because we investigate deaths. That’s what we do every day. We would get information on the person’s existing medical conditions, how they presented upon death, what medications they were taking etc. When you pull information from the electronic death registry system, that’s just a snapshot of that person’s issues at the time of death. It’s not the whole picture. The coroners could have more information to know which counties can open and which ones need to stay shut down. We should be talking to the survivors and finding out how long their symptoms lasted, how they think they acquired it, did they travel to high risk areas. That will project who needs to be quarantined if and when it comes back. Hopefully we don’t have an onset of spreading infections and an increase in deaths, but there are a lot of unknowns right now.”
Kiessling said, for example, if you go back to those Lycoming County residents who were tested positive at the end of March, and have since been quarantined and show no more signs of infection, they could probably be removed from the list of positive cases to help flatten the curve.
“We don’t want to get careless with this, but we also have to look at the real numbers to base the decisions on which counties and services need to be shut down. We have to be very cautious. The governor decided certain areas can open up on May 8. We have to do it carefully. If anyone develops symptoms, they have to stay home and not try to go to work and be out in public. It might not kill you, but it could certainly kill someone else that has existing comorbidity issues.”