First COVID deaths in the United States earlier – and in different places – than previously thought

In an important twist that could reshape our understanding of the early days of the coronavirus pandemic, death records now indicate that the first COVID-related deaths in California and across the country occurred in January 2020, weeks earlier than expected and before authorities knew the virus was circulating here.

A half-dozen of this month’s death certificates in six different states – California, Alabama, Georgia, Kansas, Oklahoma, and Wisconsin – have been quietly altered to list COVID-19 as a contributing factor, suggesting the virus’s deadly path has swiftly reached far beyond the coastal regions which were the country’s first known hot spots.

So far, on February 6, 2020, the death of Patricia Dowd of San Jose had been considered the country’s first coronavirus death, although where and how she was infected remain unknown.

Even less is known about what is now believed to be the country’s first victims of the pandemic. The Bay Area News Group found evidence of this in the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) interim tally of coronavirus deaths – widely regarded as the definitive source of data on deaths in the United States – and confirmed the information through interviews with state and federal public health officials. But amid privacy concerns and a heated debate over pandemic policies, the exact names, locations and circumstances of these deaths have not been publicly disclosed. It’s frustrating for some experts.

“We have to sit down and really assess what this thing was, when it started, how did we handle it, did we create more problem than necessary, could we have handled things differently?” Said Matthew Memoli, director of the clinical studies unit at the Infectious Diseases Laboratory at the National Institutes of Health in Bethesda, Maryland. “There is a lot to think about here.

For example, the remote nature of the deaths – in the West, Midwest, and South – might suggest that restrictions on travel and social interactions should have been used in more places much sooner – and that such rapid response could be a more critical tool during the next pandemic. In January, when the United States announced it would begin restricting travel from China and other international hot spots, the virus may have already crossed state borders.

While California, Georgia, Alabama, and Oklahoma have acknowledged or have not contested that a death certificate in their states from January 2020 was amended to include COVID, none of the states have provided more details to reporters from this news organization, citing privacy laws. The Wisconsin Department of Health Services now lists the probable COVID death of a woman aged 50 to 59 on January 22, 2020 in its data. Kansas did not respond to a request for comment.

The new data appears to be the result of months-long efforts by so-called certifiers – coroners, medical examiners and doctors across the country tasked with explaining when and why people die – to examine closer to the deaths that occurred over the months. Before the epidemic.

The Bay Area News Group first reported in April that the CDC was investigating why several COVID-related deaths before Dowd’s death began appearing in state and federal government records earlier this year. Back then, most of them were explained as incorrect dates and other data issues.

But last week, the federal agency told that news agency it had worked with state officials to contact certifiers in five cases – pending news of a sixth – and has confirmed that the January 2020 death certificates have now been intentionally revised to include COVID.

“Certifiers are reluctant to change death certificates unless there is a good reason to do so,” said Robert Anderson, chief of the mortality statistics branch at NCHS.

But what led a coroner or physician to make such a significant and possibly historic change in these cases is unclear. Anderson, whose team collects data on deaths in every state, said his agency did not have that level of detail.

When a person dies for unknown reasons, death certificates can be updated months and even years after a person’s death to reflect new information. During the pandemic, a coroner who originally attributed a death in early 2020 largely to a respiratory virus may later learn the person had traveled to China, where the virus originated, or had contact with someone. one who had it, and will come to the conclusion that she had COVID. Coronavirus testing was not common in early 2020, but if health workers were drawing blood at that time, a medical examiner could later test the sample for the virus or antibodies, or perform a PCR test. for the virus on a tissue sample if an autopsy was performed.

It is likely, said John Swartzberg, an infectious disease expert and professor emeritus at UC Berkeley, that those early cases were initially considered colds or flu.

Dowd’s mysterious death was not originally attributed to COVID. It took more than two months for tests to reveal the otherwise healthy 57-year-old San Jose woman had been infected with the COVID-19 virus when she died.

The existence of the January 2020 deaths would significantly alter the timeline of COVID’s arrival in the United States. China first announced a mysterious viral pneumonia in late December 2019 and reported the first death from the disease on January 9, 2020. The United States initially recorded its first case in mid-January when a traveler was tested positive on his return from Wuhan, China. The first deaths reported in the United States at the end of February were also linked to travel.

In its current death toll, which reflects the six newly discovered deaths, the NCHS now lists the country’s first COVID death in the week of January 5 to 11 – the first full week of 2020. The agency is in the last few. stages of preparation for its 2020 annual mortality report, a review and analysis of all deaths in the United States last year.

Swartzberg believes – and the new death data suggests – it’s entirely possible that COVID was present in the United States as early as December or even November. The time between infection and death from COVID is typically around three weeks.

“I guess the virus was introduced a number of times before it was identified as a problem,” Swartzberg said, noting that states like Alabama and Oklahoma generally don’t see a lot of travel to and from China.

Memoli from the National Institutes of Health agrees.

“I always thought it had to be here in the US long before we identified it as a big deal,” Memoli said.

His team is studying thousands of people across the country and their research suggests that as of July 2020 there were around five unidentified cases for every known case and possibly more. This information may also suggest, Memoli said, that the virus was spreading earlier than previously thought. The same goes for a CDC analysis of thousands of blood samples from nine states. The samples, collected by the American Red Cross in December 2019 and January 2020, found evidence of antibodies to COVID-19 in all nine states, but there is no record of whether any of those people fell ill or died.

However, some states, including California, choose not to recognize amended death certificates in their official COVID death counts.

The California Department of Public Health acknowledged in a statement to this news organization that a January 2020 death certificate now lists COVID as a significant condition contributing to death. “However,” the department said, “there has been no laboratory confirmation of COVID for this individual and, as such, this is not a confirmed death from COVID.”

Anderson, whose agency calculates the country’s official death toll, sees it differently.

“The death certificate is the permanent document of the deceased person,” he said. “If COVID is on the death certificate, then it’s a COVID death. You can’t just ignore it.

The mortality data tracking system, he said, relies on the medical expertise of death certifiers, since the CDC compiles records on about 3 million deaths in the United States each year. In their review of several months before finalizing the data for publication, the CDC is tracking anything out of the ordinary, like these premature deaths from COVID, to make sure there haven’t been unintentional errors made by certifiers or during data entry.

But experts say more analysis is needed. For example, it might be possible, based on the remaining evidence, to examine the viral characteristics of the six early deaths and determine the origin of the strains and whether they were related.

The CDC declined to say whether it was conducting such an investigation.