The Mystery of Patricia Dowd: First COVID-19 Death?

Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE screenshot.

There’s a story a few days ago that Patricia Dowd, a woman in Santa Clara County, Calif., who died on February 6, died of COVID-19, making hers the first COVID-19 death in the U.S.

While the impeccable public health reporting of the Daily Mail and the New York Post — among others — is claiming that she died OF COVID-19, the Santa Clara County Health Department press release doesn’t actually say that: it just says her death was “associated with” COVID-19.

Keep your eye on the ball here. Here’s the headline:

County of Santa Clara Identifies Three Additional Early COVID-19 Deaths

But then read the body:

Three individuals who died at home in February and March were positive for SARS-CoV-2

Santa Clara County, CA – The County of Santa Clara Medical Examiner-Coroner has identified three individuals who died with COVID-19 in Santa Clara County before the COVID-19 associated death on March 9, 2020, originally thought to be the first death associated with COVID-19 in the county.

The Medical Examiner-Coroner performed autopsies on two individuals who died at home on February 6, 2020 and February 17, 2020. Samples from the two individuals were sent to the Centers for Disease Control and Prevention. Today, the Medical Examiner-Coroner received confirmation from the CDC that tissue samples from both cases are positive for SARS-CoV-2 (the virus that causes COVID-19).

But then …

Additionally, the Medical Examiner-Coroner has also confirmed that an individual who died in the county on March 6 died of COVID-19.

See the difference? “Positive for” versus “died of”? “Associated with”?

There are some strange things about this case. The normal clinical progress with COVID-19 has been basically just like the flu, one of the things that made it hard to detect at first. Even some of the things like losing your sense of smell or taste are associated with colds and flu. In most cases, the patient eventually recovers, but in some cases, the disease progresses to pneumonia and the patient eventually dies. In some younger patients, they appear to be recovering when there’s a sudden exacerbation with pneumonia and the patient dies within a few days.

This case is different. The patient was apparently in good health when she reported flu symptoms but recovered within a few days. Then a few days later, she’s apparently well and texting friends. Two hours later, she’s dead.

Is it impossible it’s COVID-19 that did it? No. But that’s a very unusual presentation for COVID-19, an unusual course of the disease, an uncommon (at least) exacerbation to death.

From another tack, phylogenetics allows building a tree of related coronavirus strains with a pretty accurate “clock” in the number of accumulated mutations. (That thread explains it, but the basic idea is that the virus mutates about twice a month, and sequencing the viruses collected allows those generations to be identified.) Working backward through the parent virus, the grand- and great-grand-virus and so on puts the original introduction in Washington State at least some time no earlier than mid-January. (By the way, some of the hair-on-fire crowd are going “OMG OMG OMG it was here way earlier than we thought! Basically, only if all you’ve been reading is news.)

So, again, it’s not impossible but it seems she would at least have to have been one of the very first infections.

The last point is the actual testing. She died on February 6. The Health Department press release says she wasn’t a priority test; they just got results back from the CDC this week. But the CDC tests had known problems, and a high rate of false positives, especially early on.

So it’s a mystery, and given HIPAA and such I’m unlikely to be able to resolve it myself. But the lead pipe in the library is that it wasn’t at least a normal COVID-19 death, and it wasn’t actually determined that COVID-19 was the cause of death.

If the actual test was a false positive, that would clear up a lot of these questions.

I wonder if there’s any incentive to check these things?

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