For the first three full months of the COVID-19 pandemic, Mecklenburg County paramedics responding to 911 calls found an unusually high number of dead bodies when they arrived.
Between April and June, Medic says it responded to 287 calls in which the victim was dead when the ambulance pulled up to the scene — a 20% increase in deaths compared with the same period a year earlier.
The number of people who died after a resuscitation attempt rose 43%, to 143.
Ambulances aren’t always called when people die, but Medic deputy director Jonathan Studnek says the data suggests that more people are dying at home.
“To me, that says we have seen an increase of deaths witnessed by EMS for a variety of reasons that we would not have expected if the system were stable and acting normal,” he said.
In addition, the total number of people dying in Mecklenburg made April the third-deadliest month in at least the last six years, state data show. It’s clear that more people are dying, and they’re dying in different ways than usual.
What’s unclear is why. Medical professionals offer two theories:
Was the coronavirus responsible for some of those additional at-home deaths, which were then attributed to a cause other than COVID-19? Mecklenburg County’s Health Department said it does not routinely administer COVID-19 tests on people who die at home.
Or did people die at home in greater numbers because they feared COVID so much that they avoided needed medical care?
At Charlotte-area hospitals, doctors have said many patients are reluctant to come in and receive medical treatment because of the fear of contracting COVID. For instance, at Novant Health, the number of people heading to the ER with possible heart attacks fell 40-50% at its peak this spring. At Atrium Health, they were down about 40%.
In other parts of the country, officials have noted an increase in in-home deaths — raising questions of whether COVID deaths have been undercounted.
In North Carolina, health officials count COVID deaths conservatively. The state’s tally of COVID deaths includes only those in which a doctor believes that person died from the disease, and when a lab-confirmed test also showed they had the novel coronavirus.
Other states also count “probable” COVID cases, in which doctors believe a person died from COVID — but there was never a test to prove they were infected.
Mecklenburg County saw more deaths than usual in April, but it was a only a small increase in deaths compared with those hard-hit states and cities, like New York City and Michigan.
A total of 588 Mecklenburg County residents died of all causes in April — the deadliest April in at least five years, according to preliminary data from the state. The average number of deaths for the last five Aprils was 488 people, and the second-most number of April deaths was in 2016, when 530 people died. Data for May and June is incomplete.
The number of deaths in Mecklenburg in April 2020 was the highest April in at least six years, state data show. The county’s 38 official COVID deaths do not fully account for the increase.
The emergence of COVID deaths does not fully account for the April increase: The state’s report says 38 of Mecklenburg’s April deaths were attributable to COVID. That number was less than the number of deaths attributed to heart disease (103) and cancer (93) and more than were attributed to strokes (30), lower respiratory disease (29) and Alzheimer’s (25) and flu and pnemonia (13).
Raynard Washington, Mecklenburg’s deputy health director, says the health department is trying to understand how the pandemic has affected overall mortality. He said the health department has established a system that reviews all death certificates to uncover uncounted COVID.
Since late March, Mecklenburg County has said 195 people have died from COVID. Washington said his initial review of death certificates has found fewer than 10 cases of probable COVID deaths that weren’t counted.
He said that secondary effects — such as people not getting preventative care or waiting too long to go to the emergency room — could be pushing deaths higher.
“We did some preliminary analysis of emergency department data and we did see there were some decreases in the causes for visits that we would have otherwise not be expected to be impacted because of COVID, for things like strokes,” he said. “And so we don’t know just yet whether there has been increase of excess deaths due to those kinds of chronic conditions where people have either chosen to avoid care or accessed care soon enough.”
While at least 588 people died in the county in April, there were two other months in the last six years that had more. In January 2018, 626 people died in what the Centers for Disease Control and Prevention said was a “high severity” flu season. In January 2019, 597 died.
Experts say that as the pandemic continues, the best way to measure its effect is by looking at what’s known as “excess mortality” — when there are more deaths than expected.
“Excess deaths is a really interesting measure,” said Cara Frankenfeld, an epidemiologist with George Mason University. "It’s just how many deaths do we see overall that is higher than what we would expect given historical data. And in many areas, we don’t see big spikes as a percentage.”
She said the full effect of COVID won’t be known for months or years, when a detailed examination of mortality is studied.
“And the reason why excess mortality can be helpful is that we don’t have to rely on confirmation of cases,” she said. “We’re just seeing more deaths now. We don’t know exactly what they are from, but we are seeing more deaths. And the likely scenario is that they are COVID deaths. And we don’t have to tease out — if the death is coded as a stroke, is that a COVID-related stroke, or a stroke that happened for another reason?”
In places like New York City there was a dramatic increase in excess mortality in March and April. When there usually would have been about 1,000 deaths a week, New York City saw weeks when there were more than 5,000 total deaths.
At the peak of Michigan’s battle with COVID-19, the state recorded about 1,100 more deaths than expected — an increase of roughly 70%.
The pace of Mecklenburg County’s official COVID deaths has stayed approximately the same since April, at about 50 people a month.
Business As Usual
At Charlotte funeral homes, funeral directors say they’re not noting much of a difference. They have had to make a number of changes — limits on the numbers of people attending memorial services, for instance, and increased sanitation measures.
But as far as the numbers of deceased people, they say it’s mostly business as usual.
“COVID is not a huge trend,” says Jeff Dimond, manager of Harry & Bryant funeral home in Myers Park. “You have some people passing (of it), but it’s really very few. I would have thought it would be more.”
He said he knows of people in the funeral business who headed to New York to help with all the deaths there in April, but there has been nothing comparable in Charlotte.
“I wouldn’t say it’s too much different than flu season — at least that is my experience here,” he says.
This story was produced in a partnership with the Charlotte Ledger Business Journal.
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