Friday, May 8, 2020

From the New York Times: The Uncounted Deaths from Coronavirus

Found unresponsive at Home’: Grim Records Recount Lonely Deaths

Records kept by medical examiners in Florida offer a window into how the coronavirus has killed more than 1,600 people there. Many died at home.
Credit...Dirk Shadd/Tampa Bay Times, via Associated Press
MIAMI — A 71-year-old woman with nausea who was sent home from the emergency room, even though a doctor wanted to admit her. A 63-year-old nurse who was self-isolating while she waited for results from her coronavirus test. A 77-year-old man who was prescribed antibiotics by a doctor in another state for his fever and dry cough.
All were found unresponsive at home — the nurse on the sofa, where she was found by her husband — their lives claimed by Covid-19 before they ever had a chance to check into the hospital.
The agony of how the coronavirus has killed at least 1,669 Floridians, many of them older, is brief and matter-of-fact in the unadorned language of medical examiners, who summarize death in sometimes less than 200 words.
But a trove of short narratives from nearly all of the state’s deaths so far show that a substantial number of people have died suddenly after returning home from the hospital or visiting a doctor or a clinic. Many worsened, returned to the hospital and died there.
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Mostly, the cases — 1,490 are included in records released on Wednesday — show the many ways the unrelenting virus has found to cause death.
Florida, with more than 39,000 cases, started reopening most of the state on Monday and has recently seen an uptick in infections, following an earlier reduction when an order to stay at home was in effect.
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The New York Times and other news outlets obtained the descriptions of the deaths — the first such statewide data from anywhere in the country — through a public records request. The Florida Department of Law Enforcement, which oversees the state Medical Examiners Commission, redacted the 203 pages to keep the descriptions and probable causes of death private.
Florida has some of the strongest laws in the nation protecting the public’s right to view government records. Complete information from medical examiners on deaths has never before been kept secret. But the administration of Gov. Ron DeSantis, a Republican, has not been eager to release some coronavirus records. The state also initially refused to release information on nursing homes where outbreaks occurred.
Though large parts of the documents released this week were redacted, the text could nevertheless be extracted, copied and pasted into another file so that it could be read in full, The Times found. The spreadsheet did not include first or last names; each person was identified only as “the decedent.”
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The counties listed show where the person died, not necessarily where he or she lived. The day with the most deaths was April 20, when 50 people died. The date of death often differed from the day in which the death was reported to the state emergency operations center, which received a peak of 84 reports on April 9.
The medical examiners’ count, which includes everybody in Florida who had a test confirming the presence of the virus, differs from the one maintained by the state Department of Health, which excludes tourists, seasonal residents and other nonresidents.
The probable causes of death, in each case linked to the coronavirus, are the same, over and over again: Pneumonia. Acute respiratory distress syndrome. Complications from Covid-19. A significant number of people had underlying conditions such as hypertension, diabetes or obesity.
Each person’s story, though, is a little different, often in heartbreaking ways.
A 77-year-old man in Collier County died less than a month after his son and granddaughter visited from New Jersey, after which he had tested positive. A 59-year-old woman in Lake County fell ill after a family reunion in Tennessee that also sickened her sister. A 78-year-old man who worked at the port of Miami and his wife, also 78, were admitted to the hospital within 48 hours of each other and intubated. They died on the same day.
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An 83-year-old man in Broward County was intubated and waiting for a consultation on whether he should be admitted to hospice care. But a decision could not be made in time because his son, who was his caregiver, had contracted the virus and been admitted to the same hospital.
“There’s a family member behind every one of those numbers,” Dr. Stephen J. Nelson, the chairman of the Florida Medical Examiners Commission, said on Thursday, before the death toll had climbed to 1,600.
Dr. Nelson has pushed to make the full records public, including first and last names, without any state redactions. The commission began counting deaths during state emergencies after Hurricane Andrew in 1992, he said, in part to dispel unfounded conspiracy theories at the time that Florida was undercounting the number of people who had died during the hurricane by ferrying bodies to a barge off the Miami coast.
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“We’ve never had an issue like this in the past,” he said. “Every time the government issues an executive order for a natural disaster, we’ve kept a list of the dead. That has never been claimed to be secret and exempt or confidential.”
What is available is a grim accounting of untimely deaths, either isolated from family in the hospital or unexpected at home after the infection did not seem so grave or the person had appeared to be improving.
The plurality of the dead were between 75 and 84 years old. More than a third lived in a nursing home or other long-term care facility, according to separate data from the Department of Health. Some cases were linked to travel, especially to the New York region, which seeded many infections in the South. There were cruise ship passengers and crew members, an airport worker, several nurses and a phlebotomist.
A 60-year-old man in Palm Beach County was hospitalized with chills and a fever of 103 in April but felt “subjectively better” two days later and was discharged with antibiotics. “He was found unresponsive at home” by a family member five days later and died in the emergency room of the same hospital to which he had been admitted earlier.
An 84-year-old man in Palm Beach County with a medical history of hypertension, high cholesterol and chronic obstructive pulmonary disease went to his primary doctor with shortness of breath and a cough. Five days later, he was found dead at home by his wife.
A 72-year-old woman spent 37 days in the hospital after having tested positive for the coronavirus. She had improved “somewhat” and even tested negative for the virus. But the damage may already have been done: She died in the hospital anyway.
A 76-year-old woman in Miami-Dade County spent 10 days in the hospital but was treated, stabilized and discharged, sent home on oxygen. She returned to the hospital the next day in respiratory distress, suffered cardiac arrest and died.
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Then there are the deaths of younger people.
A 31-year-old man in Alachua County with a medical history of obesity, diabetes and lupus who had recently visited South Florida spiked a fever and went to an urgent care clinic in April, but he was discharged with a diagnosis of an ear infection and “told that he was not a likely candidate” for the virus. The next day he was hospitalized, transported to a larger medical center and taken to the intensive care unit, where he died five days later.
A 35-year-old man in Broward County was riding an all-terrain vehicle nine days after testing positive for the coronavirus. At one point, he stopped his A.T.V. and called his father, who had been trailing him, and told him he did not feel well. When his father drove up, he found his son unresponsive, slumped over on the A.T.V. He was taken to the hospital, where he was pronounced dead.
A 39-year-old disc jockey in Lee County who was twice denied a coronavirus test at an outpatient clinic was hospitalized in March with shortness of breath.
Three days later, he died.
Patricia Mazzei reported from Miami, Rebecca Halleck from New York, and Richard A. Oppel Jr. from Austin. Samarth Bhaskar and Jacob Meschke contributed reporting from New York, and Lindsey Cook from Duluth, Ga.
Patricia Mazzei is the Miami bureau chief, covering Florida and Puerto Rico. Before joining The Times, she was the political writer for The Miami Herald. She was born and raised in Venezuela, and is bilingual in Spanish. @PatriciaMazzei  Facebook
Rich Oppel is a national enterprise and investigative correspondent based in New York. Since joining The Times in 1999, he has also covered business, Washington, a national presidential campaign, and for six years was a war correspondent in Iraq, Afghanistan and Pakistan.

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