The effects of one ongoing public health crisis continue to be seen by death investigators as another — and currently well-known — public health emergency continues to evolve with uncertainties ahead for the office of Madison County Coroner Stephen P. Nonn.
“We have been educating the public about opiate addiction and drug abuse deaths as a public health crisis for years,” Nonn said. “As the death toll from narcotics and dangerous drugs continued to rise along with the other collateral damage substance abuse brings, we began to focus on the problem as a matter of public health. The numbers of fatalities nationwide were staggering, and we saw it cause fluctuations in average life expectancy.”
The COVID-19 pandemic has brought a new perspective to Nonn.
“We still have drug-related deaths being investigated and they are certainly as tragic as the loss of any life is, but now we are seeing the elderly and infirm being victimized by an invisible threat,” he said. “Within a few short weeks, we have death numbers that surpass our overdose statistics. Experts predict that we are a long way from being done.”
To date, the Coroner’s Office has tallied 43 deaths caused by substance abuse since Jan. 1. However, and just since April 15, the COVID-19 virus has played a role in 47 deaths and still rising.
The Coroner’s Office coordinated with Madison County Health Department Director Toni Corona and Emergency Management Director Tony Falconio regarding ramifications of the COVID-19 virus back in February, before it was declared a state and national emergency.
“We have always had an excellent working relationship with Director Corona and her entire staff of professionals,” Nonn said. “We assist them with their epidemiology data on a regular basis and have always had them involved whenever our death investigations lead us to the slightest possibility of infectious or communicable disease.
“We have excellent communication with Director Corona, whether it is day, night, or weekend. Upon receiving a death report, she is notified immediately,” Nonn said. “She definitely is hands-on and has been readily available to assist in formulation of best practices and providing intelligence as this pandemic has evolved and continues evolving. We have been extremely fortunate to have Director Corona in the right spot at the right time to provide the crisis leadership needed with her knowledge, temperament, strength of character, and total commitment to the health and welfare of the citizens of Madison County.”
The Coroner’s Office has been assisting the Madison County Health Department by screening each death for COVID-19 indicators, with coroner’s investigators obtaining nasal swabs for testing where indicated. Additionally, the Coroner’s Office, under the auspices of the Health Department and Madison County Emergency Management, has been serving as the point of dispensing for personal protective equipment and related supplies for the county’s funeral service providers and death care professionals to assure crisis responders from all disciplines involved in the pandemic response were effectively managed.
The office developed investigative guidance documents, assessed and inventoried resources available through funeral homes, and made contingency plans for fatality management for worst- case scenarios.
“Fortunately, the mortality models have not played out the worst-case scenario,” Nonn stated. “But still, families are experiencing loss all the same and their grief is compounded by restrictions on the funeral industry that the family must endure when they want to say their final goodbye to their loved one.
“We temporarily suspended vacation requests until we had a better idea of how this was going play out,” he said.
Vacation requests have resumed but with the admonition that, as public safety officers, all days off are subject to cancellation in the event that the disease spikes and a surge develops. The continued concern is a fatality surge that would cause a temporary disruption in normal funeral service activity requiring remains to be held temporarily for the area hospitals and mortuaries.
“It falls to us that if the need arises, the Coroner’s Office must be able to step in and relieve the hospitals of the responsibility of decedent affairs so that they may focus on patient care while we provide for the safety, security, and care of a deceased loved one until funeral arrangements can be made,” Nonn stated.
The COVID-19 deaths do not present the same investigative challenges as other coroner’s cases since these deaths mostly occur in clinical setting, with most investigative details available through that avenue. The attending physician of the decedent decides on the cause of death and certifies the death certificate as opposed to the Coroner’s Office.
“They (the treating physicians) are quite well-equipped for that function,” Nonn said. “They know the patient’s clinical picture, the medical history, and the test results. The attending physician can best assess whether the COVID-19 virus was the direct cause of death or contributed to death by hastening or exacerbating other medical conditions.
“We all hope and pray that both of these public health crises end — and the sooner the better,” he said. “Until then we continue to perform our job by giving voice to the dead when it is needed and compassion to those who are left behind.”