Editor’s Note: Last week, KEEL-AM co-hosts Robert J. Wright and Erin McCarty interviewed Caddo Parish Coroner Todd Thoma about the classifications of coronavirus deaths. Below is a transcription of his remarks.
Robert J. Wright: Let’s start with the headline I saw yesterday — and I’ll just read verbatim — said, “Feds classifying all coronavirus patient deaths as COVID-19 deaths regardless of cause.” What does that mean? Because in my mind, it means someone is cooking the books. Am I off the mark there?
Todd Thoma: Robert, I don’t even know where to start. No, you’re not off the books. That’s probably happening to a degree, and the reason for that is, say, that a 60-year-old man with hypertension, diabetes, congestive heart failure, has a cardiac arrest at home, gets rushed to the emergency department, and in the emergency department they swabbed him, and he’s COVID-positive, and they’re unable to resuscitate him and he dies. He’s probably going down as a COVIDrelated death, even though it may not have been the COVID virus that actually caused his death. So it’s an incidental finding sometimes, and some of these are being listed in the numbers. But what people need to understand is these numbers are not going to be accurate. There’s nothing about these numbers that are good. They’re not solid numbers.
Erin McCarty: What’s the biggest flaw?
TT: First of all, lack of testing. Not everybody’s being tested, so consequently, we don’t know how prevalent the disease is. If you are only testing symptomatic people and those four people are positive and one of them dies, you have a fatality rate of 25 percent because we know how many people died, but we don’t know how many people have the disease. We have a numerator, but we don’t have a denominator because we’re not testing the general public. What happens is people may come in with an upper respiratory infection, a little cold, body aches, but they’re not febrile, they’re not short of breath, those people are not being tested. They’re being told to go home and look for these symptoms, and if you have these symptoms, come back. Well, if we tested those people, they’d probably be positive. So we really don’t know how prevalent the disease is or what the actual fatality rate of this disease is going to be.
For all of these people that stick on these numbers and say, “Ooh, let’s look at the numbers,” the numbers aren’t going to be accurate no mater what happens. There’s going to be a flaw in those numbers. What people need to understand is this is serious. It’s prevalent. It’s very, very common in the community. I tried to explain this to somebody the other day. Somebody asked me about their isolation procedures. They said we’re isolating people who have had contact with people that are known COVID and we’re telling them to go home and quarantine for two weeks. I kind of laughed and said, “Just keep doing your policy.” And he said, “Why did you laugh?” And I said, “Let me tell you something. Right now in Caddo Parish we have a thousand confirmed cases. How many of those thousand people do you think went to Kroger, Brookshire’s, Walmart, Sam’s, Lowe’s sometime during the last couple of weeks? Basically, all of them did. So it’s in the community. It’s spread, and the risk is there. People are going to have contact.
The idea is you have to stay home, you have to hand wash, you have to disinfect your hands, disinfect your house. When you’re out of the house, wear a mask. That will help you in case you’re spreading the virus. So the numbers we have are going to get better three years from now, but these daily numbers are not very accurate.
RW: But in your mind, this is not some big, national medical scandal; it’s just the way medicine works when you have limited results.
TT: It is the attempt to keep up with the severity of the illness. You know, there’s other factors, Robert, that I think you and I have touched on once upon a time. Anytime you do a test, there’s going to be false positive and false negative results. When I swab somebody for COVID, and I get a negative result, maybe as many as 10 percent of them are false negative where they actually were positive and another 10, 15 percent are positive that’s negative. So you don’t think that that’s very bad, and it all depends on which test you’re using. … But if you’re talking about a thousand people with a 10 percent false positive result, you’re talking about a hundred people, so the numbers are probably not going to be — they’re not to go to. It’s an idea to keep up with the prevalence, it’s an idea to look at the curves, it’s an idea to look at the epidemiology, but they’re not hard, fast numbers.
EM: Two teenagers who died, one in New Orleans and one in Calif., heart attack and sepsis, respectively, but both were COVID positive and they’re now listed as COVID deaths. Who makes that decision to list them as Covid deaths, and why are they making that decision? TT: Well, there’s several different reasons for that, and heart attack is a vague comment. I don’t know the exact result of what happened in that case. I think we touched on this before, but about 20-25 percent of the people that we’re seeing have an involvement with the virus in their hearts, and that’s what’s killing the younger people. It’s not the co-morbid pneumonias that’s doing that. It’s the inflammation of the heart tissue itself. So that’s why very few young people are dying. It’s the older people with co-morbid conditions. Sepsis can happen at any given time. This is the same thing I’ve been telling you before. But if someone like that dies and is tested and is Covid positive, chances are they’re not going to get autopsied, and the reason they’re not going to get autopsied is because of the risk to the health-care official.
Now I know that we touched on that the last time I talked to you, but you need to understand that from my standpoint, from the coroner’s standpoint, my job is not to find out why everybody in Caddo Parish dies. My job is to investigate deaths to make sure no crime has been committed and there’s no public health risk. That doesn’t require a full autopsy. If I can swab them and they’re Covid positive, there’s a health risk associated with that. If somebody dies at home of multiple medical problems and the scene shows me no crime has been committed, (then) no crime has been committed. So those people are going to get released, and the law allows me to get their medical records and do an evaluation and make my best determination what cased the death.
Not everybody needs to be autopsied, especially when the amount of information that you can get would put healthcare people at risk.
EM: What are you looking for as coroner? If you say the numbers are “Eww, watch out for them,” what are you looking for to see if we’re making headway and we’ve crossed over and things are getting better?
TT: The best numbers to look at to see where we’re getting better is the number of hospitalizations that occur in your community and the number of people put on a respirator in your community because what happens is the deaths are going to fall behind that. People can stay in the intensive care unit for five, six, seven days and die of complications that occur. But if you watch the number of people being admitted to the hospital, if that number plateaus or starts to fall, you can expect the deaths will start to fall beyond that. So that’s a good indicator of how bad it is in the community and how many people are getting infected.
EM: Are we there yet? Are we getting there?
TT: Actually, the reports that I see, our numbers are going down. So that’s a good sign. Now that does not mean that the virus is out of the community. That’s still going to be quite a while. Weeks, weeks, weeks. So the best thing for your listeners to know is to understand that the risk is out there, the virus is out there. It’s everywhere. So limit the amount of time you spend around other people. Go to the grocery store only when necessary. Don’t go every day because you need something. Only pick up essentials. Be aware of what happens when you’re there. Stay a distance away from people. One of the things I’m not real happy about in a lot of these grocery stores that we’re seeing and other kinds of stores is that they’re funneling everybody into one entrance when they have multiple entrances there. All you’re doing is taking people that are potentially infected and moving them into a mass gathering area where everybody’s right next to each other going in. Just be aware of that. Hand washing, stay a distance away from people, wear a mask if you’ve got a mask. Just be sensible.
THIS ARTICLE WAS PUBLISHED IN THE April 17 ISSUE OF FOCUS SB - THE INQUISITOR.