“The USA TODAY Network in New England and the Documenting COVID-19 project partnered to investigate how New England became a positive data anomaly in terms of COVID death reporting accuracy.
Across the region, excess deaths during the pandemic are almost completely accounted for by official COVID deaths, according to our analysis of Centers for Disease Control and Prevention mortality data and expected death models developed by demographers at Boston University. In other parts of the country, these COVID deaths were missed or certified incorrectly as other causes. [..]
Hospitals are a dominant and central data source to capture the pandemic’s death toll. But national data shows the country’s unexplained excess deaths aren’t typically coming from hospitals, as COVID’s role in death is clearer in these settings.
Connecticut Chief Medical Examiner Dr. James Gill said New England is “special,” in that all six states – Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island – have cohesive, statewide systems to probe death. Centralized state medical examiners are appointed medical doctors and oftentimes also forensic pathologists. They’re not politically affiliated, like many elected county coroners elsewhere, and they oversee an entire state.
“You are really able to have a good handle on the investigations, and they’re all done in a similar fashion,” Gill said, noting he has a close working relationship with state public health officials.
Those factors combine to create a strong system of public health surveillance, as opposed to states where county coroners are elected without required experience and death investigation processes can vary wildly within just a few miles.
For the hundreds of thousands of people who died of COVID-19, where they lived and died likely had an influence on how their death was evaluated and recorded on their death certificates. [..]
Vermont Chief Medical Examiner Dr. Elizabeth Bundock called death certificates “the foundation of the country’s mortality data.”
“It’s important not just for epidemiology, but it’s important for family members,” she said. “The cause of death, that’s important for current survivors and it could be important to someone the next generation away.”
Death certificate errors aren’t just a COVID problem, said Dr. Kathryn Pinneri, president of the National Association of Medical Examiners, one of two accrediting bodies in the U.S. Before the pandemic, it was estimated that one-third of death certificates contained errors.
But with the inconsistencies across systems, Pinneri said, it’s “apparent how easy it is” to miss COVID deaths. And overreporting is “just as bad,” she said. [..]
Centralized state medical examiners in New England play a critical role in death investigation both directly and indirectly. They directly investigate about 1 in 10 deaths in the region – usually deaths that happen for unnatural reasons, such as car accidents, drug overdoses or homicides. And though they almost never investigate deaths from natural causes, medical examiners do have to review and clear cremation cases, which encompass a large portion of natural deaths in New England.
But medical examiners in most New England states, except Massachusetts, are the final word for deaths related to a public health hazard, such as COVID. In states like Connecticut and Vermont, these highly skilled and trained professionals have a significant hand in proper data collection.
About 1,500 counties across the country have coroners handling death investigations as opposed to medical examiners. While medical examiners are certified doctors, coroners hold a political office that often requires no prior training or experience beyond proof of residence in the county. Medical examiners are usually appointed by state agencies, not elected.
[..] New England medical examiners have more resources in comparison to coroners. The median total budget is $75,000 for a county coroner office, while state medical examiner offices in New England have a median budget of more than $2 million.
Though state medical examiners cover much larger populations than county coroners, the difference in budgets translates to about $300 more per case in New England. Coroners’ budgets can vary widely. County coroners in Alabama average about $288 per case they accept, compared to New England’s $1,250 per case.
That additional funding means extra investigative muscle. Investigative ability is a major benefit of having a medical examiner involved in statewide data collection, said Connecticut’s Gill.
“A medical examiner is able to catch things that doctors can’t,” he said. [..]
Also standing out in New England, medical examiners are conducting autopsies at a higher rate than much of the country. Autopsies have long been known as a gold standard for proper death investigation, and yet the rate at which they’re done has decreased nationally over the years. [..]
For families of those who have died of COVID, an inaccurate death certificate has several consequences: Families aren’t eligible for up to $9,000 guaranteed through FEMA’s COVID-19 funeral assistance program. Future generations won’t have documentation of the historical event that took a loved one from their family. And friends and family are left with the burden of finding closure to a death that can’t be easily explained.”
Full article, H Barndollar and D Bergin, USA Today 2022.3.1