Wavis Jordan, a Republican who was elected last year to serve as coroner of the 80,000-person county, says his office “doesn’t do COVID deaths.” He does not investigate deaths himself, and requires families to provide proof of a positive COVID-19 test before including it on a death certificate.
Meanwhile, deaths at home attributed to conditions with symptoms that look a lot like COVID-19 — heart attacks, Alzheimer’s and chronic obstructive pulmonary disease — increased.
“When it comes to COVID, we don’t do a test,” Jordan said, “so we don’t know if someone has COVID or not.”
About a million more Americans died in 2020 and 2021, compared to pre-pandemic years. Some 800,000 of those have been attributed to COVID-19, leaving about 195,000, which public health experts suggest may be due to COVID-19 but unidentified as such. Why the possible mis-classification? Our decentralized system of investigating and reporting cause of death, as reflected in what's happening in Cape Girardeau County. The story continues:
Short-staffed, undertrained and overworked coroners and medical examiners took families at their word when they called to report the death of a relative at home. Coroners and medical examiners didn’t review medical histories or order tests to look for COVID-19.
They, and even some physicians, attributed deaths to inaccurate and nonspecific causes that are meaningless to pathologists. In some cases, stringent rules for attributing a death to COVID-19 created obstacles for relatives of the deceased and contradicted CDC guidance.
These trends are clear in small cities and rural areas with less access to healthcare and fewer physicians. They’re especially pronounced in rural areas of the South and Western United States, areas that heavily voted for former President Donald Trump in the 2020 presidential election.
Cape Girardeau County in Missouri; Hinds and Rankin counties in Mississippi; and Lafayette Parish in Louisiana are four of the 10 counties with the greatest spike in deaths not attributed to COVID-19. In those communities, official COVID-19 deaths account for just half of the increase in deaths in 2020.
If official figures are to be believed, in Lafayette Parish deaths at home from heart disease increased by 20% from 2019 to 2020. Deaths from hypertensive heart disease, or heart ailments due to high blood pressure, doubled and are on track to remain that high in 2021.
What the story doesn't note is that in many rural places, the county coroner is an elected official for whom no medical education is required.
Speaking of rural healthcare, Texas Public Radio recently reported on the closure of rural hospitals in that state since 2005. Jaymie Lozano and Kaysie Ellingson write as part of a series titled "Rural Healthcare: The Other Texas Drought," dateline Bowie, near the Oklahoma state line, population 5,218, where the hospital closed a few years ago.Rural hospitals like the one that was in Bowie are up against many obstacles. They often face low reimbursements from insurance companies, and that's if their patients are insured. Many of the hospitals rely on patients and Medicare payments, but their populations are older or declining.
Perhaps the biggest part of that problem can be traced far back.
In 1965, the Medicare and Medicaid programs were established by the federal government in the Social Security Act. The programs, Medicaid especially, were a large source of income for hospitals - Medicaid is supposed to cover people with low-incomes who can’t afford services on their own. Those reimbursements have gotten lower due to federal budget cuts.
"Those cuts included a 2% reduction in all Medicare payments to all doctors, hospitals and providers," explained Don McBeath, government relations director for the Texas Organization of Rural and Community Hospitals (TORCH).
Aside from the budget cuts, McBeath said there are multiple reasons the closures are happening. Not only are Medicare and Medicaid reimbursements to medical facilities not high enough to keep up with the increasing costs of providing healthcare, but the amount of uninsured Texans increases every year and many rural communities are seeing a decline in population.
"It creates a recipe for disaster because a hospital is like any other business," McBeath said. "It's expensive to operate, and you have to bring in enough money to pay for the costs to operate. If you look at a rural hospital, there are some days where some of them don't have a single patient. Or other days, maybe five or six patients."
The latter part of the story focuses on West Texas, also the setting for this Washington Post story from a few years ago about a doctor who serves more than 10,000 square miles.
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