Is the official COVID-19 death count too low? Funeral directors, EMS workers say yes
We’re fixated on the official data, which is bad enough. But we may be missing a bigger and more lethal picture
We are now well into the second month of the COVID-19 crisis, which has been largely framed, in the New York region, by Gov. Andrew Cuomo’s and Gov. Phil Murphy’s daily briefings and daily data dumps, which include hospitalizations, the number of intensive care unit patients, intubations, patient discharges and confirmed cases.
Based on the arc of those data points, both Cuomo and Murphy have sounded guardedly optimistic in recent days that the public’s compliance with social distancing and stay-at-home orders are producing the desired effect of reducing the crush of demand on the health care system. Deaths and hospitalizations in both New York and New Jersey appear to be decreasing.
George Kelder is CEO and executive director of the New Jersey State Funeral Directors Association, whose members are responsible for dealing with bodies at the hospital, congregant care facilities and private residences. He warns that if we rely solely on official numbers carried on the TV, we may not fully appreciate the lethality of the virus, and indeed may overestimate our success in combating it.
In a phone interview, Kelder confirmed that on April 15 New Jersey’s Office of Vital Statistics and Registry, in accordance with the CDC’s National Vital Statistics System, had ordered that deaths of confirmed or suspected COVID-19 patients should no longer be reported with that disease as the immediate cause of death.
“The guidance, available on the New Jersey’s Electronic Death Registration System website, states that COVID-19 is not considered an immediate cause of death and should NOT be reported by the medical certifier on the first line of section 36a (CAUSE OF DEATH, PART I) of the death certificate,” the association advised its members. “Instead, the immediate cause of death, such as “Acute Respiratory Distress Syndrome,” should be listed on the first line. COVID-19 should be listed LAST in Section 36a after the immediate cause(s) has been listed.”
“During the five weeks of these fatalities, New Jersey physicians had been instructed to used COVID-19, Coronavirus 19 or ‘pending COVID-19’ as the primary cause of death,” Kelder said. “Last week, because of changes on the national level, the primary cause of death can no longer be COVID-19. It can be a secondary cause or a consequence of the primary cause of death. But the primary cause of death must be something other than the virus itself.”
Kelder observed that pervasive lack of testing, along with this bureaucratic gamesmanship around how COVID-19 deaths are to be classified, could mean that the numbers being used officially "would not be equal to what is happening on the street.
“My concern is that we will be getting a false sense of the fatalities based on an administrative and statistical change in reporting,” he said.
Lost in the abstraction of the daily graphs that track a the state’s “progress” is the actual scale of the number of deaths and how the volume is overwhelming the funeral industry itself.
Bob Prout is a third-generation funeral director who runs his environmentally-minded funeral home in Verona, New Jersey, with his daughter Julia. They have been dealing with the full gamut of COVID-19 confirmed and suspected cases in hospitals, congregant living and residential settings.
“Most people are having a hard time with the sheer volume of deaths and realizing that when a burial happens it is out of the funeral parlor’s hands,” he said during a phone interview. "Even if a family has set aside a burial plot, cemeteries have such a huge volume and a backlog.
“Even our state’s crematoriums are backed up as much as three weeks because the New York funeral directors are sending their bodies over here,” Prout continued. “I wish the governor would sign an executive order that for 60 or 90 days our state’s crematoriums would have to handle just the bodies of New Jersey residents who lived and paid taxes here.”
Kelder opposes such a restriction, saying it could end reciprocal arrangements between New York, Pennsylvania and New Jersey that make it possible for families in one of those states to bury a loved one in another.
The Prouts say they now consider that any body they encounter, no matter the location or circumstances, is a possible COVID-19 case. They take universal precautions based on the latest guidelines from their national trade association that tracks the CDC guidelines.
Personal protective equipment has also been a problem for the funeral industry. “We are at a critical stage on this and are looking to the New Jersey State Police to unlock the supply chain,” said Kelder. “When we look back at this it will be clear we have not factored in mortuary care as part of the health care system.”
Kelder says the greatest threat to the health of his members and their employees comes from surviving family members of a COVID-19 virus fatality who were likely exposed to that person when he or she was still alive, and are now infected with no symptoms. “We have surviving family members who think it is OK to break their quarantine to deal with the final arrangements for their loved ones,” he said.
On April 14, even before the changes to the way COVID-19 deaths are recorded, Newark Patch reported that officials in densely populated Essex County had conceded that the actual number of the deaths due to the pandemic were “much greater than indicated.”
Throughout the crisis it’s been the deaths in hospitals and senior citizens facilities that are counted and widely reported, whereas the elevated number of deaths at home received scant attention.
In an April 18 phone interview, the Rev. Tony Johnson and Jody Leight, who live in Orange, New Jersey, described seeing local EMTs respond to a neighbor’s home wearing biohazard protective gear, while a police patrol car stayed parked outside. Their neighbor’s body was retrieved from the residence five hours later.
Leight explained that their community has many undocumented immigrants “who are out there working jobs where they have no protective equipment. They are working jobs off the books and living four or five families to one house. How is social distancing even possible?” Orange has no hospital, she continued. “I am concerned we have hundreds of people here who are at risk and will most likely die in their homes.”
At one point earlier this month, the FDNY confirmed that over several days New York City was averaging well over 200 residential fatal heart attacks a day, a tenfold increase over the number recorded this time last year. As recently as this past weekend, the number of cardiac arrests were running exponentially higher than would normally be recorded this time of year.
In subsequent conversations with leaders of the EMS unions, I have been told that their members were encountering people who had actually been released from the hospital only to die at home, and others who had delayed seeking medical attention for fear of being taken to a hospital and exposed to COVID-19.
Dr. Joseph Fennelly, an internist who served for decades as the chairman or co-chairman of the Medical Society of New Jersey’s bioethics committee, thinks that the fight to contain COVID-19 can’t be just limited to the hospitals and congregant care facilities that have generated the headlines. The virus, he says, is not just inside these facilities but in the community.
“You have to look at this in terms of a cell, a living system, and what the energy is that feeds it,” he said. “You can’t get a handle on that without looking at the residential facet of this.”
One way to do that in real time, Fennelly posits, would be to track deaths at home in real time, even if they can’t be conclusively linked to COVID-19, as a way of getting a bead on what we don’t know.
Certainly, we should at least learn how many of those deaths at home were people who had already been discharged by hospitals. It would certainly put those patient discharge numbers, on which both Murphy and Cuomo rely so heavily, in their proper context.
A U.S. Navy destroyer is believed to have a significant coronavirus outbreak on board as it carries out a counter-narcotics mission in the Caribbean, U.S. officials told Reuters on Friday, marking the latest challenge for the military in dealing with the virus.
The officials, speaking on condition of anonymity, said that over a dozen sailors had tested positive for the virus. Given the size of ship, usually only a few hundred sailors, an outbreak like this is likely to cause concern and raise questions about whether it would have to return to the United States.
The cases on the ship appear to be the first onboard a ship currently underway at sea.
The aircraft carrier Theodore Roosevelt was in the Asia Pacific when it had an outbreak onboard, having to eventually dock in Guam. Nearly 850 out of the roughly 4,800 personnel on the carrier have tested positive on the Roosevelt.
As a person who grew up in a town that fought developers for years, I really appreciate this story.
1,000 West Point Cadets are scattered around the country, staying at home for their safety.
Trump is summoning them ALL back to New York, the worst pandemic hotspot, so he can one-up Pence, who will be in Colorado for the Air Force Academy commencement.
The danger of blood clots with the coronavirus has been noted many times.
A Mt. Sinai/Brown study found blood clotting treatment in 4 patients helped beat Covid-19.
Trump administration considers leveraging emergency coronavirus loan to force Postal Service changes
President Trump has railed for years against what he sees as mismanagement of the agency, which he argues has been exploited by sites such as Amazon
So, this is more “sarcasm”, right?
Trump asked NASA if their technology could sterilize the inside of people’s lungs to kill coronavirus
This is the result of ‘sarcasm.’
“Immunity passports” in the context of COVID-19
24 April 2020
WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.
Damn it, Trump!
Illinois Poison Control Gets More Calls After Trump Incorrectly Wondered If Disinfectants Can Fight Coronavirus
One caller said he or she gargled with a mixture of bleach & mouthwash in hopes of controlling coronavirus.
My own thread documenting Trump’s PPE piracy:
The Plan for Dogs to Hunt Out the Coronavirus
Labradors and spaniels can sniff out malaria in humans, and scientists say we may be just weeks away from unleashing them to spot virus superspreaders.
Europe’s Economy Was Hit Hard Too, But Jobs Didn’t Disappear Like In The U.S.
She’s not wrong about embalming.
Medical supplier says FEMA seized 400,000 N95 masks, has them ‘just sitting on a loading dock at JFK’
I can’t decide if this is rank incompetence or by design, but neither is in any way acceptable.
71 percent of jobless Americans did not receive their March unemployment benefits
Now imagine the Great Depression without FDR’s “New Deal” but with social distancing and insufficient testing to even open the markets, that’s where we are right now.
White House economic advisor Kevin Hassett says unemployment rate will approach Great Depression
- Speaking to reporters on the White House lawn on Sunday morning, Hassett said the unemployment rate could hit 16% and “the next couple of months are going to be terrible” for economic data.
- Hassett described the coronavirus shutdown as “the biggest negative shock that our economy I think has ever seen.”
- “You’re going to see numbers as bad as we’ve ever seen,” Hassett said.
First the party in majority drops the ball and allows the USA to become the epicenter of this terrible plague and now they want to blame someone else?! His incompetence has always been a national security risk. Look at the numbers! Total confirmed cases: 965,435 — Total deaths: 54,856 — Total recoveries — 106,985 Looking at these numbers I can’t imagine we’re even half way towards reopening the economy.
And not one flag at ordered at half staff ordered by this administration.
President of the plague.
Hammer them back, they don’t have a good argument. Is the stimulus working? Are hospitals getting supplies? Are the people ok? These are valid questions.
Skip the China talk and pivot towards what America is doing for Americans right now.
Simple point. Endless options. Demand empathy from these people.
“You keep talking about China but how does that help Americans in isolation right now?” Or “Americans suffering on the fronts lines or their hospital beds?“ Or “Americans weeks away from financial ruin?”
It won’t matter where the plague came from if we can’t pull together to right this ship of fools and save ourselves.
Read the memo
The Financial Times of London still showing the US at an accelerated rate of infections. Free to read Great graphics
Expand to see full image
If you’re curious where this pandemic actually came from, read or listen here. This is all anyone should understand right now, the geopolitical ramifications won’t matter until we contain this disease.
Pelosi says ‘guaranteed income’ plan for Americans worth considering as House Democrats push forward with next big coronavirus bill
“We may have to think in terms of some different ways to put money in people’s pockets,” Pelosi said on MSNBC. “Others have suggested a minimum income, a guaranteed income for people. Is that worthy of attention now? Perhaps so.”
Her comments came as House Democrats push forward to unveil a major new economic rescue bill in coming days. Democrats want to boost aid for cities and states, increase funding for nutrition assistance, and raise financial support for individual Americans. The emerging Democratic bill is certain to run into opposition from most Senate Republicans, and could set off a fierce ideological and partisan battle about how much further the federal government should go in its coronavirus response as the nation’s economy reels heading into the election.
A basic income would protect what markets we have left as well as our people.
Sharing this because it made me feel good. Also sharing my personal response from my hidden mountaintop lair…sorry, Chuck Berry…