A new glimpse into WA’s earliest COVID-19 deaths – and why we may never have a complete record

On Saturday afternoon, Feb. 29, 2020, reporters joined local and state health officials, packing into a room for a news conference in downtown Seattle. Details were shared about what appeared to be the first COVID-19 death in the nation just the day before.

It was a man in his 50s and a patient at EvergreenHealth hospital in Kirkland. He had underlying health conditions – and no recent travel history.

“What we’re seeing is the tip of the iceberg,” Dr. Francis Riedo, EvergreenHealth’s medical director of infectious disease, said at the time.

But we now know the King County man wasn’t the first in Washington – or in the nation – to die of COVID after all.

In a recent review of the state’s earliest COVID deaths, the state Department of Health has confirmed at least four other Washingtonians died from COVID complications before or on Feb. 28, 2020. Three were from long-term care facility Life Care Center of Kirkland, the site of the first known coronavirus outbreak in the U.S., while DOH now believes the first person to die in the state was actually a Snohomish County woman in her 30s.

And the first recorded death in the country has since been attributed to Lovell “Cookie” Brown, a 78-year-old Kansas woman who died on Jan. 9, 2020, according to the Mercury News.

Bob Anderson, the chief of mortality statistics at a branch of the Centers for Disease Control and Prevention, said in a recent interview that it has not been uncommon for authorities to have missed some of the country’s early COVID deaths.

“We have seen quite a few death certificates that were amended with COVID-19 as the cause, especially those that occurred early in the pandemic,” Anderson said. “We probably underestimated them during that part of the pandemic because doctors often didn’t know what they were looking at and didn’t have a lot of experience with COVID-19.”

In Washington, state epidemiologists and the King County Medical Examiner’s Office later confirmed John Edward Parker, a man in his 50s, and Marion Krueger, a woman in her 80s, died on Feb. 26, 2020. Philip Walter Rodenberg, a man in his 80s, died two days later.

And the state’s first recorded COVID death occurred on Feb. 24, 2020 – four days before the state’s presumed first death. The woman, from Snohomish, had a travel history and underlying health conditions, said Kari Bray, spokesperson for Snohomish County’s public health department.

But little other information is publicly available about her, as her death wasn’t investigated by the Snohomish County Medical Examiner’s Office.

“Many (natural) deaths are not reported to us and it looks like this may be one,” Nicole Daugherty, the office’s operations manager, wrote in an email.

In early 2020, physicians and medical examiners who saw that viral pneumonia was a person’s cause of death might not have been able to detect whether the coronavirus had caused the illness, Anderson said. As the virus spread and affected people’s bodies in different ways, it became even more difficult to identify as a cause of death, he said.

Plus, he noted, testing wasn’t widespread at that point, so many COVID decedents were tested after they died.

While a few missed deaths likely won’t make a big difference from a public health standpoint, he said, it’s important to keep a record as accurate as possible.

“It’s important for people who died to have their cause of death specified correctly,” Anderson said. “… That gives the family closure, but then also corrects the permanent record. It’s important for tracking events over time.”

Since then, the state and country have developed much stronger disease surveillance systems to track COVID cases and deaths – though it’s likely there will never be a completely accurate pandemic death record, Anderson said.

In the case of the Snohomish woman, Dr. Chris Spitters, Snohomish County’s health officer, said she tested positive for the virus after she died. It wasn’t until May 2020, three months later, that a lab detected SARS-CoV-2, the virus that causes COVID, in a piece of her lung tissue.

“It certainly doesn’t change our current public health and disease control perspective on monitoring and guiding our way through the pandemic,” Spitters said. “More than anything, it just speaks to the reality of what it’s like to recognize a problem, then set up a surveillance system to detect the various outcomes.”

At the time, local health departments were tracking individual cases, hospitalizations and deaths, then reporting them to DOH.

Now, the process is more streamlined.

DOH compares new death certificate entries to newly positive COVID cases, then looks for matches and causes of death, Spitters said. If the cause of death and the COVID case line up, DOH will identify the death as “COVID-associated,” he said.

There are some gray areas.

If a person tests positive for COVID but has also been diagnosed with cancer or another disease, their exact cause of death might be more difficult to pin down.

In those situations, local health departments can request death information from hospitals or the medical examiner’s office to better understand the circumstances under which a person died, Spitters said.

“Surveillance systems for any condition are not perfect,” he said. “They’re set up to try and detect general trends. … COVID is just another example of that.”