Philly investigating 1,742 percent more respiratory deaths, and many at-home deaths

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Deaths investigated by the Philadelphia Medical Examiner’s Office have skyrocketed during the COVID-19 crisis.

The office investigates about one-third of all deaths that occur in Philadelphia. These include “found bodies,” or deaths that happen outside hospital settings, such as drug overdoses or homicides. It also includes some deaths in hospitals, such as child fatalities, or deaths for which the causes are not immediately clear.

Natural deaths investigated by Philadelphia’s Medical Examiner’s Office shot up 171% in April alone, a time of year when overall fatalities typically begin to decline. The total number of deaths investigated by the office that were ultimately linked to respiratory disorders rose more than 1,700% during the pandemic –– from just seven deaths between February and April of last year to 129 this year, including cases that ended up being from COVID-19 and those that did not.

James Garrow, a spokesperson for the city Department of Public Health, said the increase in deaths requiring investigation had taxed the capacity of an office that has also had to shoulder the burden of receiving and storing hundreds of bodies from hospitals and funeral homes.

“It has definitely caused a strain,” Garrow said. “But MEO employees have risen to the occasion and done a great job.”

Garrow said both the COVID-19 and non-COVID-19 respiratory deaths –– such those from  influenza or pneumonia –– that the Medical Examiner’s Office investigated, had increased during the pandemic because the office was conducting far more tests than before. Difficulty in supplying and administering COVID-19 test kits during hospital care leaves the office to take on the duty of later confirming the nature of an apparently respiratory-related death.

“Sometimes, hospitals have sent bodies to the MEO for investigation before the results of the COVID testing was completed,” Garrow said.

But there are other factors at play, too, primarily an increase in deaths at home, which also falls to the Medical Examiner’s Office to investigate.

The perception of hospitals overwhelmed by COVID-19 may be keeping some sick patients home, said Jay Giri, a cardiologist at the University of Pennsylvania.

“Maybe they are developing COVID and sitting at home and dying. Maybe they have a garden-variety heart attack without COVID and they die at home, or maybe they have COVID and that triggers a heart attack or stroke and they die at home,” Giri said. “Any of those things could be happening.”

Most of the deaths from heart disease investigated in February, March and April 2020 by the Medical Examiner’s Office occurred at home, but that was also true last year during this time.

A trend of surging at-home deaths has been documented elsewhere — in part, because the ill appear to be avoiding hospitals awash with COVID-19 patients. In Philadelphia, emergency medical services calls are down by 10%, and paramedics suspect that’s why.

However, Philadelphia’s Health Department initially downplayed the scale of the at-home death toll in mid-April, when Health Commissioner Thomas Farley stated that there were just four at-home COVID deaths.

“Because of the way the disease has been shown to function, people with a worsening condition by and large are going to the hospital,” Garrow said last month.

But the number of at-home deaths for both COVID-19 and other causes is clearly rising. As of Saturday, the number of confirmed COVID-19 deaths found in private residences was 37. That number includes three people who had been hospitalized with COVID-19 and were discharged into home hospice care.

Garrow also said an additional 103 deaths were still pending investigation –– although he said he believed many of those would ultimately be linked to drug overdoses, not COVID-19.