Coroner in rural Missouri removes Covid from death certificates at families’ request

There may only be about 140 people each year who die in Macon County, in rural Missouri, but ever since the Covid crisis began, the region’s coroner has been faced with a complicated ethical question: whether to list coronavirus on official death certificates when the family of the deceased asks that it be removed.

According to an investigation by the Kansas City Star, the Macon County coroner has removed Covid from at least 10 death certificates so far, a reflection of the deeply politicised nature of the pandemic. Instead of listing Covid as the primary cause of death, Macon County coroner Brian Hayes told the paper he will list another underlying health condition, if it genuinely contributed to the person’s death.

“A lot of families were upset. They didn’t want COVID on the death certificates,” Mr Hayes said. “I won’t lie for them, it’s gotta be true, but I do what pleases the family.”

When it comes to the coronavirus, Macon County is even more conservative than the already red state of Missouri. Just 38 per cent of its residents older than 18 are vaccinated, well below the state average of 51.3 per cent.

The practice of striking Covid from death certificates is controversial in public health circles, as it may obscure efforts to get an accurate picture of the virus in a certain area. But the impulse behind it isn’t a new one. During the height of the HIV/AIDS epidemic, many families asked that the official cause of death be changed, owing to the considerable societal stigma against those with the disease.

And it’s not the only controversial practice coming out of Missouri around the pandemic. The state is one of just a few across the country that doesn’t count “probable” Covid deaths — cases where a PCR test hasn’t confirmed someone’s Covid status — along with California, Colorado, Nevada and Maryland.

As a result, state data shows roughly 80,000 fewer cases and 1,000 fewer deaths than statistics from local health departments, not only creating disparate pictures of the virus, but potentially leaving local health departments in a financial hole because federal coronavirus aid to health facilities is dependent on the scope of the pandemic in their respective area.

In recent days though, the trend of asking Covid be removed from a death certificate has gotten a new wrinkle. Once families learned that the Federal Emergency Management Agency helps reimburse the cost of funerals of those killed by Covid, some asked that the disease be put back on official documentation.“

Now everybody wants it on the death certificate because they get (money) from FEMA, where before, nobody wanted COVID on it,” Robert Smith, coroner for nearby Pettis County, told the Star. “In my personal opinion, a coroner shouldn’t be asking a family what they want on it. It’s not up to them. That’s his job ... To me, that’s unethical.”