In the early weeks of the COVID-19 pandemic, Los Angeles County Chief Medical Examiner-Coroner Dr. Jonathan Lucas — charged with reviewing the causes of nearly 10,000 deaths a year — saw a disturbing trend: the number of people dying at home had jumped drastically.
Though he did not know the cause at the time, and some mystery still remains, Lucas now believes he was seeing firsthand the ramifications of the COVID-19 pandemic which would soon sweep the country — killing more than 180,000 Americans by the end of August.
When COVID-19 cases began to surface in the U.S., home deaths started to escalate and continued to build through the following months, according to records compiled by Lucas’s office and obtained by The Times.
In the first six months of the year, there were 330 more home deaths in Los Angeles County than in a typical year, according to a Times analysis. In April alone, the number jumped by nearly 60% over April of last year — an increase of 167 deaths.
Just 48 of those deaths were officially linked to COVID-19. Experts and officials say that is likely an undercount and that many more could have been caused, to some degree, by the deadly coronavirus. Concerns that some cases were missed prompted the governor to ask medical examiners to go back and more thoroughly review deaths from the early days of the pandemic — before rigorous testing regimes were in place.
On April 18, Ramon Arthur Rivera Jr., 56, died at his home in Palmdale after complaining to family members about severe headaches and stomach pain. He was not diagnosed with COVID-19 while he was alive, but the county medical examiner swabbed his remains soon after his death and identified the virus.
That routine testing was not done for hundreds of deaths in the first three months of the year because county medical examiners had yet to begin screening for the virus.
States across the country are noticing a similar trend. The New York City medical examiner’s office, for example, announced in April that it was seeing 10 times more at-home deaths per day than before the pandemic—suggesting that the city was possibly undercounting the toll of COVID-19.
The Times partnered with Dr. Andrew Noymer, an epidemiologist at UC Irvine, to look for a similar trend in Los Angeles County. Noymer examined five years of deaths recorded by the Los Angeles County Medical Examiner-Coroner and calculated the expected number of deaths for each day of 2020. The Times compared Noymer’s predictions with the actual number of deaths.
The significance of the excess home deaths was greatest in the earlier days of the pandemic, before testing was widespread.
“We are almost certainly missing COVID deaths in home deaths,” Noymer said.
In late April, Gov. Gavin Newsom proposed a solution. He requested that county medical examiners and coroners reexamine all deaths from December 17 to March 16 to look for signs of COVID-19. More than 2,500 deaths passed through Lucas’s office during those months. Nearly half were home deaths.
If evidence of the virus is found during that more rigorous review, tissue samples are sent to the Centers for Disease Control and Prevention for testing. However, that process has been bogged down by delays with test results taking months to process.
Deaths before March 16
Coroner determines whether
a case showed signs of having COVID-19
at the time of death. If so, the examiner
confirms that the required tissue samples
are available for testing and passes them on.
County Department of Public Health
decides which cases to prioritize.
California Department of Public Health
organizes the testing schedule.
Centers for Disease Control and
Prevention tests eight to 10 cases a
week for the entire state.
Results can take months.
Coroner swabs bodies
that showed COVID-19 symptoms —
similar to how living patients are
County Department of Public Health
tests the swabs sent by the medical
examiner. Results are typically available
in two to three days.
More than four months into the pandemic, Lucas believes his office is no longer missing COVID-19 deaths. He believes the continued increase in at-home deaths may be caused indirectly by the lockdown and fears of the virus, which scare some members of the public away from seeking medical help for other conditions.
“It just seems to me that more people are staying at home,” Lucas said. “And there’s going to be more natural deaths that would normally occur in other locations.”