When was the first death from COVID in the United States? CDC investigates first 4 cases

Late last year, the federal government’s chief death statistician was told of a tantalizing discovery: someone had died of COVID-19 in January 2020, according to a death certificate, a revelation that would have accelerated the timeline of the spread of the virus in the United States. States of several weeks.

This death was ultimately not what it seemed to be. The person who certified it meant June 2020, not January. But this hit on the radar screen of Robert Anderson, the head of mortality statistics at a branch of the Centers for Disease Control and Prevention, helped launch a year-long low-key campaign at the agency to verify and recheck the former. COVID- suspect in the country. related deaths in the uncertain days of early 2020.

Now at least four possible deaths from COVID-19 as of January 2020 have survived Anderson’s verification. Spread across four states, they are now part of a scattered collection of clues to the early spread of the virus beyond China – some trustworthy, others less – that have started to attract more attention as scientists and intelligence officials try to figure out how the pandemic began.

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The chances that the CDC’s four new death cases – from Kansas, California, Alabama and Wisconsin – actually resulted from COVID-19 are slim, some scientists have said. This year, a doctor or other official certifier reclassified them as being related to COVID. But whether they did it purely on the basis of the person’s symptoms or using more useful blood or tissue samples is unclear.

The first death, Jan. 9, 2020, in Kansas was reclassified this spring based on the person’s symptoms alone, the state health department said, entrusting a doctor to assess the extent to which the the patient’s illness corresponded to the symptoms of COVID-19[FEMININELessymptômeslespluscourantsduvirusnotammentunefièvredesdifficultésrespiratoiresetmêmeunepertedugoûtoudel’odoratsechevauchentaveclessymptômesd’autresmaladiesrespiratoires

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A sign of the difficulty of reclassifying deaths that occurred long ago, CDC records include a fifth COVID-related death as of January 2020, in Oklahoma. But after an investigation by state officials, the medical examiner removed COVID-19 from the death certificate, the Oklahoma Department of Health said on Wednesday, meaning it will likely be removed from records soon. of the CDC.

It is not clear whether any of the suspected cases traveled to China.

“I guess they’re probably not all real, maybe not even one of them,” said Michael Worobey, an evolutionary biologist at the University of Arizona. It is highly unlikely that any of the people caught the virus in the United States, he said, but it is possible that some have recently traveled to China. “If any of them are real, it would be travel-related cases, and that’s conceivable,” he said.

Worobey’s research, including extensive analyzes of viral genomes and epidemic simulations, have indicated that the virus is unlikely to spread outside of China until mid-December 2019, making the deaths of non-travelers to the United States the following month, he said. It usually takes several weeks between infection and death, and a given case is unlikely to be fatal.

“Extraordinary allegations require extraordinary evidence,” Worobey said.

For Anderson, the reliability of the January 2020 deaths is not only a public health issue but also a personal concern.

A demographer by training who landed at the CDC in 1996 after watching a treacherous college job market, Anderson said some deaths were having a disproportionate impact, statistically speaking – and that includes COVID deaths at the start of the pandemic.

When states submit figures on deaths from COVID-19, the CDC normally takes them at face value, as it does for hundreds of thousands of deaths from heart disease or cancer in any given year. The agency recorded nearly 3 million registered deaths in 2019, and an error here or there does not change the overall picture of mortality in the country, Anderson said.

This is not the case for a possible death from COVID on the cusp of a pandemic. At the time, testing was scarce. Until The Mercury News in California recently reported on possible cases from January 2020, the first suspected death related to COVID did not occur until February 6, 2020.

When Anderson is made aware of COVID-related deaths in the first two months of 2020, he calls state health officials, who in turn request an audit from the doctor or medical examiner who signed the certificate of death.

In January of this year, for example, the CDC received a flurry of reports of people who died from COVID-19 in January 2020. At least, that’s what they said. Further verification revealed that most doctors simply forgot to start typing 2021 next to their signatures.

In another case this summer, Anderson confirmed that a medical certifier had intended to reclassify a January 2020 death as COVID-related, only for that certifier to reverse once the health department of the ‘State intervened.

On top of the drudgery, for Anderson, there is a single 2007 death that the agency said was caused by diphtheria, a serious bacterial infection that is virtually unprecedented in the United States. The CDC later determined that the death was not caused by diphtheria at all; a simple coding error was to blame.

“It was a little embarrassing to have it in our data file,” Anderson said. “Even though it’s just a death, in this context it has a big impact because it’s very high profile.”

Ultimately, however, without access to patient samples or medical records, the CDC must trust the people signing the COVID-19 death certificates, he said.

“I can’t say for sure that all of this is correct,” Anderson said of the January 2020 deaths. “But I think it is unlikely that the certifiers capriciously changed the death certificate.”

Most deaths from COVID-19 are straightforward to certify, said Marcus Nashelsky, professor of pathology at the University of Iowa who helped the CDC draft guidelines on how to attribute such deaths. For example, at the start of the pandemic, when nursing home patients weren’t always tested, he said, a known home outbreak, coupled with symptoms and signs characteristic of the virus, might be enough. to a doctor to report a COVID-related death.

Nonetheless, death certificates have become a hotly contested document during the pandemic. In some cases, disbelieving families have called for someone’s death certificate to be erased of any mention of COVID-19, said James Gill, chief medical examiner for Connecticut and president of the National Association of Medical Examiners. In others, families have urged that COVID-19 be added to a death certificate, apparently in an effort to become eligible for funeral funding under a federal aid program, he said. declared.

“It’s a very emotional thing for some families whether they like it on the death certificate or not,” said Gill. “It shouldn’t be. It is a matter of public health.

In the spring of 2020, Gill said, he became concerned that Connecticut was overlooking deaths from COVID-19, especially among nursing home residents whose complicated medical histories can sometimes obscure the causes of death. In a few hundred cases, he said, the medical examiner’s office has taken deep nasal swabs from bodies at funeral homes. The team found a number of cases.

With China refusing to share more information on its own early cases, the World Health Organization recently said it was helping researchers dig into case reports in late 2019 outside of China. In Italy, researchers have reported anti-coronavirus antibodies in blood samples from September 2019, as well as signs of the virus in a skin sample from a patient from November of the same year. Some scientists, however, questioned both results.

“The further back you can go, the more informative it can be – if you have real confirmed cases,” said Marion Koopmans, a Dutch virus expert whose lab re-tested Italian blood samples and could not confirm the first cases. “To report a much earlier introduction of the pandemic virus to an area, you need to have a high level of certainty. “

An analysis of U.S. blood tests released this summer suggested the virus may have circulated in Illinois as early as December 24, 2019, although scientists said those methods were fallible as well.

Keri Althoff, a public health researcher at the Johns Hopkins Bloomberg School of Public Health and lead author of this study, said small clusters of cases could have developed without triggering a full-blown epidemic. “It is not fully known where COVID was seeded in the United States,” she said, “but it probably wasn’t a single seed.”

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