HJBR Sep/Oct 2021

DIALOGUE 10 SEP / OCT 2021 I  HEALTHCARE JOURNAL OF BATON ROUGE   Editor When someone is marked as a CO- VID death, are you identifying whether or not it was a preexisting condition and they just happened to have COVID at the time, or are you marking that as a COVID death — if maybe they had tested positive for COVID but were asymptomatic? Clark For East Baton Rouge Parish, early on in the COVID pandemic, I developed what my protocol was going to be to define a COVID death. A lot of coroners around the state did the same thing, and we all kind of had similar protocols. The protocol we uti- lized was the following. First of all, the patient had to present with respiratory symptoms. They had to have cough, congestion, shortness of breath, low oxygen saturation, et cetera. They had to have a positive COVID swab, and then they had to die as a result of the respiratory illness. So, you couldn’t have the first two and then die in a car wreck and be called COVID. You had to meet those strict criteria. When we looked at those individuals, though, all of them had secondary co-mor- bidities that probably contributed to their complications with the virus, meaning that we saw individuals, of course, that had advancing age, obesity, hypertension, dia- betes, some that had lung disease (but that didn’t turn out to be as big of a comorbidity as the other ones). We saw on every case that presented, just like I described it, that the individuals had one or more of those comorbidities. Now, it’s not to say that during that same timeframe, we still had people dying of end stage liver and renal disease, still dying of heart attacks and strokes and other natural processes, still dying from sepsis and bacte- rial pneumonia. We were very clear on how we differentiated and defined the two cat- egories, and we would not lump somebody into a COVID death diagnosis if, in fact, they didn’t meet the three criteria that were out- lined from the beginning. Editor That’s one concern that some people have brought up, that that is happening around the country. Do you think that you’re somewhat unique in identifying COVID death that way? Clark It’s hard to speak for other states. I feel 100% confident it’s happening in East Baton Rouge, because I’m the one that’s defining it. I feel probably 99% confident in the state of Louisiana that the criteria is being followed similar to mine. Now, once we move across state bor- ders, I’m not really sure what they’re doing in New York and California, et cetera. I’ve heard stories, of course, probably like you and your readers have, that say they’re call- ing everything a COVID death, because they get more money for it. I can assure you, in Louisiana, we do not get more money for calling something COVID versus not. It’s the same, financially speaking. So, I’m not sure what to believe in that scenario, I really am not. Editor What are you seeing as the leading cause of death that your office is involved in assisting? Clark The leading cause of death is still nat- ural disease, which is what you want for a population. As a coroner, the specifics of natural disease, I don’t really follow that closely. Although, we have followed COVID very closely, because we didn’t really know at the beginning how bad it was going to be. For all intents and purposes, because humanity lacked any immunity to it what- soever, it could have wiped us all out, so it did become of unique interest in a natural disease category from the beginning. Where a coroner, and myself included in that, becomes more interested in following specifics has to do with unnatural death, because a lot of times, unnatural deaths are preventable. We’ve seen drastic increases in our homicide rate, drastic increases in our overdose statistics. Motor vehicle collisions, believe it or not, went up in 2020, which I thought was very unique, because most people were quarantined and at home. I think there was a lack of traffic law enforce- ment going on during the COVID quaran- tines and the stay at home orders, so people were driving with excessive speed because they weren’t going to get pulled over and given the ticket. Those are the numbers I really follow closely, because those are the ones I think we really need to impact because of their [preventable] nature. Just to give you some examples, in 2020, “I’ve heard stories, of course, probably like you and your readers have, that say they’re calling everything a COVID death, because they get more money for it. I can assure you, in Louisiana, we do not get more money for calling something COVID versus not. It’s the same, financially speaking. So, I’m not sure what to believe in that scenario, I really am not.”