Local COVID-19 death certificates all show multiple co-morbidities

BY JENNIFER CABRERA

Alachua Chronicle has received information from Medical Examiner District 8 about 17 of the 20 deaths that have been attributed to COVID-19 in our county.

15 of the 17 reports list COVID-19 pneumonia or COVID-19 pulmonary disease as the primary cause of death. The other two list “complications of injuries sustained in fall” and “Ischemic heart disease” as the primary cause of death, with COVID-19 listed as a contributory factor. 

15 of the 17 cases appear to have been admitted to the hospital with COVID-like symptoms, although all tested positive for COVID at some point. The other two were admitted for falls.

The cases with COVID-19 listed as the primary cause of death had an average of 4.6 contributory factors, and none had fewer than 3 contributory factors. This is a sample entry from the “Probable cause of death” field with 5 contributory factors: “COVID-19 pneumonia. Contributory factors: diabetes mellitus, hypertension, cerebrovascular disease, coronary artery disease, and dementia.” 

All 17 cases had hypertension listed, followed by 12 with diabetes mellitus, 7 with chronic kidney disease, 5 with dementia, 4 with obesity, 4 with congestive heart failure, 3 with chronic obstructive pulmonary disease, and 3 with obstructive sleep apnea.

One woman had already been in hospice for “management of her senile degeneration of the brain” and was admitted to the hospital for “evaluation of altered mental state and a fever” and “acute kidney injury that was likely due to sepsis.” She was transferred back to hospice 11 days later “for continuing end of life care and management of her COVID-19” and died 5 days after the transfer.

Florida Governor Ron DeSantis has been calling for a better delineation of “dying with” vs. “dying of” COVID; decision-makers are using the number of deaths to justify emergency orders that close businesses and require face masks, among other things.

This “Description of incident” from one of the fall patients (edited to remove some information that could identify the woman) is an example of a death that appears to be “with” COVID: The woman “suffered an unwitnessed fall on July 8… imaging studies showed subarachnoid hemorrhage and subdural hematoma… While in the hospital, [She] underwent routine testing for COVID-19 and was found to be positive on the same day, although she was asymptomatic… [She] remained asymptomatic and required no breathing treatments, nor did she display any respiratory distress… [She] was transferred into a COVID-19 bed at [hospice] on July 10… remained at the center until her death on July 12. Her medical history included anemia, dementia, hyperlipidemia, hypertension, hypothyroid, and multiple falls.”

Another case at Shands, a 35-year-old male, was listed as a Dade County death from COVID-19: “[The decedent] was working on the roof of a home in Middleburg on 5/28. It started to rain and the decedent and his coworkers stopped working. Bystanders in the neighborhood and the workers on the roof observed a flash of lighting and heard a loud explosion, and several workers were thrown off of the roof. Immediately following the lighting strike, a worker on the roof observed the decedent collapse, fall off of the roof, and land facedown on grass. The decedent’s muscles were reported to be contracted and shaking, and caused the decedent’s body to roll over onto his backside. It was also reported by the workers that the decedent’s eyeballs were rolled back into his skull. Bystanders in the neighborhood observed the decedent on the ground, called 911, and started CPR until EMS arrived on scene. Following the lightning strike, the workers observed a large hole on the roof that appeared burnt. According to medical records, the decedent was transported via EMS to Orange Park Medical Center and was found to have spinal fractures with spinal cord transection, a skull base fracture, and pulmonary contusions. He was transferred on the same day to UF Health Shands Hospital for further management and was admitted to the surgical intensive care unit on mechanical ventilation. He tested positive for the COVID-19 virus on 5/29 and was transferred to the medical intensive care unit. In addition to acute hypoxic respiratory failure and neurogenic shock, he was found to have a subarachnoid hemorrhage, bilateral pulmonary contusions, C3 & C7 spinous process fractures, complete T4 spinal cord transection, a skull base fracture. Trauma surgery, neurosurgery, and neurocritical care continued to follow the decedent and the decedent’s condition did not improve. Examinations were consistent with severe hypoxic brain injury and his prognosis was poor. The decedent’s family elected to transition to full comfort measures on 6/9 and he was pronounced dead on 6/9.”

A Palm Beach County investigation found that 27% of their deaths listed COVID-19 as the only cause (there were none in Alachua County), and 14% had COVID only as a contributory cause (12% in Alachua County).

Of the 17 cases in Alachua County, 9 came from Parklands Care Center, 1 came from Windsor Rehab, 1 came from Hunters Crossing Place Memory Unit, and the others lived at home before being admitted to the hospital.

10 died at Shands, 3 died at North Florida Regional Hospital, 3 died at a hospice facility, and 1 died at home with hospice care.

They ranged in age from 53 to 93, with an average age of 74.