Long hours, strained resources and emotional overload: How the Cook County medical examiner’s office handled 10,000 COVID-related deaths

Katherine Rosenberg-Douglas, Chicago Tribune
·10 min read

They have dealt with more than 700 dead during the 1995 Chicago heat wave, the 273 people killed in the 1979 crash of Flight 191 and the remains of the 33 young men slain by John Wayne Gacy.

But as Cook County marked 10,000 confirmed deaths from coronavirus-related causes Wednesday, never before have the doctors, investigators and technicians at the medical examiner’s office had to handle so many dead in one year.

That number suggests a jarring number of residents will have lost at least one friend, family member or co-worker to the pandemic, while each medical professional, emergency responder or other front-line worker likely felt overwhelmed by the number of coronavirus patients treated or lost.

Under a charter that requires the agency to investigate and catalog every COVID-19-related death because of its threat to public health, starting in March 2020 to Wednesday the medical examiner’s office was the only local agency collecting information on every COVID-19 death in a county of 5 million people.

“It has been a hard year,” said Dr. Ponni Arunkumar, the Cook County medical examiner. “But I think everyone knows our mission is to determine cause and manner of death, and we’re going to do it and continue doing it until we’re done with this pandemic, and we need each other’s support.”

Cook County usually sees about 40,000 deaths a year, about 6,000 to 6,500 of which the medical examiner’s office has contact with, said Natalia Derevyanny, a spokeswoman for the medical examiner’s office. And 2020 was filled with record-breaking figures — never a good thing for a team that tallies lives lost. In 2020, there were more like 53,000 deaths, and the medical examiner’s office handled about a third of them, she said.

Derevyanny and Arunkumar shared details of the office’s plans and its coordination with other county agencies that kept its response to the pandemic from compounding the tragedies of the disaster.

But that doesn’t mean the past year — the most overwhelming of their careers — was easy for the 105 employees of the medical examiner’s office. They worked long hours, with strained resources, in seemingly endless shifts, all while battling the emotional overload of processing deaths on a previously unheard-of scale.

“With respect to staffing, they have worked additional shifts, additional hours to manage the caseload,” Arunkumar said. “And that is just the duration — you know it has been a long year. I think that’s what’s getting to us a little bit. It’s not that we have less staff, it’s just that we’ve been doing this for a long time.”

In 2020, the medical examiner’s office handled at least 16,049 deaths, about 8,200 of them coronavirus-related, Derevyanny said. In contrast, in 2019, the office handled 6,274 deaths. Last year saw more deaths than even the prior record year in Cook County, 1977, when the office dealt with 10,654 dead. In addition to the deluge of coronavirus deaths, in 2020, opioid deaths were up about 40% and homicides were up about 50%, with the greatest ever number of homicides from gunshot wounds, at 881, breaking the previous record of 838 set in 1994, Derevyanny said.

Of the employees, 21 are pathologists, or doctors, and 22 are forensic technicians, Arunkumar said. There are 29 investigators under lead investigator Christopher Kalka, and others work in roles such as communications, headed up by Derevyanny.

As the chief medical examiner, Arunkumar leads the pathologists who conduct autopsies and review records to determine a cause and manner of death. The cause is what led to a person’s death, such as head trauma, a gunshot wound or pneumonia from COVID-19. Manner of death is one of four things: natural, accidental, suicide or homicide — a death at someone else’s hands, not synonymous with murder. An “infinitesimal number” each year might be categorized as undetermined, Derevyanny said.

Contrary to what some have claimed, a death is not automatically counted in the COVID-19 toll by mere presence of the virus in a body, Arunkumar explained. The virus must have led to the primary cause of death, which happens most often through pneumonia.

But if an otherwise healthy person who happened to be carrying the virus is shot or is fatally injured in a car crash, that case is not considered a COVID-19 death.

The coronavirus also may be listed as a contributing factor, sometimes called a secondary cause of death. Arunkumar estimated that happened about 5% of the time in Cook County.

“So, for example, if a person fell and had head injuries, but they had COVID-19, which can cause an altered mental status, so they’re confused or disoriented and that made them fall. In those instances, you’ll see ‘blunt head trauma due to fall’ and then we’ll put the COVID-19 as a contributing factor,” Arunkumar said.

Kalka’s team determines whether a death falls under the medical examiner’s jurisdiction, and if it does, an investigator may go to the scene to examine more thoroughly, he said.

“We were running about 35 to 40 reported deaths a day before the pandemic and twice or three times as many since then,” Kalka said. “With 110 reported deaths a day, you can imagine the stress that comes with that. It becomes a juggling act. How do you keep people from burning out?”

Kalka has been with the agency for six years, having moved his family to Chicago from New Orleans when a unique role that combined his law enforcement and medical training became available. He had been a homicide detective, retired young and decided to become a nurse after helping his wife study for her nursing exams. He was nearly finished with his schooling when he took the job, rendering years of schooling obsolete by relocating with less than a semester to complete before he would have earned the nursing degree, he said.

Any death that’s not a natural death attended by a physician is handled by the investigations staff, he said. And every body taken to the medical examiner’s office is expected to be examined within 24 hours.

Because most people with COVID-19 symptoms were under a physician’s care, his team was not as affected by 2020 1/4 u2032s 8,200 additional deaths as were others. But going from investigating a portion of about 6,000 deaths to a portion of 16,000 was still time-consuming.

“Because the pandemic was constantly evolving, we had to keep up with the questions we ask, a rudimentary set of symptoms and that evolved so we were keeping up to date with the latest CDC guidelines and keeping an open line of communication,” Kalka said. “That takes time. and it takes effort.”

Before the pandemic, Rebeca Perrone, an indigent coordinator who has worked for the office since 2015, arranged about 30 cremations a month for families of deceased county residents unable to afford burial otherwise.

During the pandemic, that number doubled, she said. And despite the creation of an additional 66,000-square-foot morgue opened as supplemental space to the office’s permanent building, it became clear she also needed to convince families there was no time to lose in picking up a relative’s body or their cremated remains.

“The huge difference has been people who don’t have the money to bury their loved one. Or who are too afraid to come in. In the very beginning, a lot of people were telling me, ‘We’re just going to wait for it to be over.’ And that was just not realistic,” Perrone said. “I had to be a little more stern with them: ‘We don’t have time for you to wait until this is over.’”

Perrone’s insistence with people facing one of the most painful experiences in life certainly doesn’t indicate a lack of respect. Most years, she handles logistics for about 500 cremations. In 2020, that jumped to about 750, a 50% increase. It’s because it is so important to her personally, and to the office generally, that protocol had to be strictly adhered to, so each grieving family was afforded the same dignity and care as the next.

“Many people, especially elderly people, would just say point-blank: I’m not coming to do anything in person. I let them do what they need to do, and I appreciated and respected them letting me know,” she said. “I would let them know that if they wanted the cremation, all remains come back to my office and I’ll hold them for one year. I’ll still have people saying I’m not coming to pick them up in a year, we do have families that will do that. And for those, we do an indigent burial two or three times a year.”

In 2020, Derevyanny had to invent a range of new processes, coming up with a way to track COVID-19 deaths internally and ways to disseminate that information to the media and the public.

Derevyanny also credited various agencies in helping to create a plan as early as January 2020, especially the county’s emergency management department.

“We were looking around the country, we were seeing what was happening. We had no idea how many cases we’d have, let alone how many deaths we would have,” Derevyanny said. “And we knew we needed to be prepared for any eventuality. Our hope was that we would put all of these plans into place and we wouldn’t have to use any of them. That really would be the ideal that somehow, miraculously that this virus would skip us.

“The whole goal was to ensure that we were treating all of these decedents in the respectful manner that we would want our loved ones treated if they died during this pandemic,” she said.

So the plan focused on how the county was going to store bodies if conditions deteriorated so much that the agency couldn’t keep up with the influx of bodies. The first wave in May came closest, but through planning, they always had access to much more space to temporarily store bodies than was needed, she said.

The county focused on real estate early on, Derevyanny said. The office secured a lease for the 66,000-square-foot surge center. And rented about 20 refrigerated trailers to station outside city and suburban hospitals as overflow space for hospital morgues, which typically hold anywhere from five to 12 bodies, she said. The trailers were equipped with shelving that would allow each one to hold about 30 bodies, with the idea that the trailers could be moved to where they were most needed.

“So when hospital morgues became overwhelmed, they could decompress those morgues by putting them in those trailers while still housing them respectfully. And if necessary take them to the surge center,” Derevyanny said. “It all worked the way it was supposed to.”

Perrone, the indigent coordinator, said the ever-increasing numbers were difficult to take, as were interactions she had with people estranged from their family members who had died. Part of her job is reaching out to next of kin, and she does her best to gauge from people’s reactions when she tells them where she’s calling from whether they’re bracing themselves on the other end of the phone line.

“It’s been a hard year from the beginning. In April we cremated 100 people, the most we’d had. I kept wondering, is it going to get worse? Is there going to be another surge?” Perrone said.

The mounting numbers and up-close understanding of how bad the pandemic had become also worried her, out of concern for her grandmother. Recently, she said she read about how vaccine appointments were coming open, and she finally had the slightest sense of hope.

“It’s a serious relief. People are getting vaccinated,” Perrone said. “Coming here every day for the last year, knowing my grandma is 92 years old and being constantly worried about her, it’s a wonderful relief to finally feel like there may be an end in sight.”

kdouglas@chicagotribune.com

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