The Chicago area’s chief medical examiner starts her day with a numbers problem: how to manage three times the number of deaths as before the coronavirus pandemic with the same number of pathologists.
On a recent morning when The Associated Press got exclusive access to the Cook County Medical Examiner’s Office for the day, Dr. Ponni Arunkumar scanned a list of 62 new death cases. The average last year was 20 a day.
“We’ve never gone through anything like this,” she said of the workloads.
Get the latest news on COVID-19 in your inbox. Click here to sign up for our daily coronavirus newsletter.
Forty of the 62 cases were coronavirus deaths. The oldest to die was a 105-year-old whose obituary described her as a White Sox fan who loved dancing. The youngest was a 53-year-old man who was jailed for allegedly blinding someone in one eye during a barroom brawl.
Medical examiners worldwide face similar challenges, and some are buckling under the emotional strain. But there was no sign of that at the Cook County facility, where employees seemed to be coping well with the historic surge in deaths. The pandemic has only deepened their sense of camaraderie, said the office’s director of fatality management, who oversees a temporary morgue set up off-site to handle the influx of corpses.
“We lean on each other,” Victoria Raspante said.
The 45-year-old Arunkumar has an air of calm about her. Soft-spoken and quick to smile, she has a knack for keeping those she supervises at ease.
According to figures updated Tuesday, her office has handled 5,323 cases already this year, 2,551 of them COVID-19 deaths since the first confirmed coronavirus death in mid-March. It had 6,254 deaths for all of 2019. Her 18 pathologists have sometimes worked 12-hour days, seven days a week.
The hope was that stay-at-home orders would sharply reduce gun deaths in Chicago, which has had more homicides than Los Angeles and New York combined for successive years. A drop-off in killings would help keep caseloads at more manageable levels.
That hasn’t happened.
The office has had 111 homicide cases since mid-March when the pandemic began in the county compared to 113 over the same period last year. One of the 22 non-COVID cases this day is a 21-year-old man who was killed in a drive-by shooting as he sat on a porch.
At 8:30 a.m., Arunkumar and six fellow pathologists began autopsies on shooting victims and others whose cause of death wasn’t clear.
She pointed to a bullet hole in the shoulder of the man who was killed in the drive-by, his bloody clothes nearby. Another pathologist retrieved the bullet through the wound.
Between autopsies, Arunkumar walked into the facility’s main morgue, where around 250 bodies lined rows of floor-to-ceiling shelving. It was filled to capacity.
Downstairs, Rebeca Perrone stacked 24 boxes of unclaimed cremated remains on shelves that already had 500 others. Some of those cremated were homeless. Others lived alone, estranged from their families.
More remains are going unclaimed these days — a sign that more families can't afford the $250 collection fee because of the economic turmoil caused by the pandemic, said Perrone, who arranges funerals for the unclaimed dead and helps poorer families find resources for burials.
Perrone refused to complain about her heavier workloads. Her job sometimes includes informing relatives that a loved-one has died.
“It’s actually nice to be able to talk to someone on the worst day of their life and say, ‘This is what we can do to help,’” she said.
On the second floor, investigative-unit chief Christopher Kalka said his 27 investigators were also putting in long hours. People who witness suspicious deaths are now asked whether the deceased complained of losing their sense of smell or taste, which are possible symptoms of COVID-19.
All homicides require an autopsy. Most COVID-19 deaths don’t, as a hospital records review is considered sufficient.
Not all COVID-19 cases are clear cut. Pathologists concluded in one man’s death that the virus didn’t directly kill him, but that it affected his balance. He then fell and broke his hip, causing fatal complications.
Doing fewer autopsies in COVID-19 cases reduces staff exposure to the virus. Risk of infection from the dead is low since it is often transmitted via spray from a sneeze or cough. No one who works at the office has tested positive.
Staff didn’t conduct an autopsy on the inmate who was allegedly involved in the barroom brawl. They gave his body a swab test like the ones given to the living to confirm the presence of the virus, though they did it in a room with reduced air pressure so that viruses can’t seep out.
His body was wheeled into a smaller refrigerated unit for coronavirus deaths, an orange biohazard tag affixed to his body bag.
At an afternoon conference call to talk through the day’s cases, Arunkumar sat alone with other pathologists phoning in. Pathologists mostly review records from home these days to reduce the risk of spreading the virus at the office.
One said she had more than 80 cases to review, including many COVID-19 cases.
“This is absurd,” she said without anger.
Upgrades at the office in recent years have helped avert crippling backlogs during the pandemic. Changes included putting records online. That’s enabled staff to work from home and clear cases faster.
A key to operations now is a perishable-goods warehouse that was converted to a temporary morgue. National Guard troops unloaded bodies on the day the AP visited. Medical examiner's office staffers measured and photographed the bodies at the loading dock before soldiers took the body bags to one of three rooms the combined size of a football field. They laid them gently on specially constructed scaffolding.
One room held 130 bodies, but the site can hold up to 2,000. Two of the three rooms were mostly empty — an encouraging sign amid the grimness.
Raspante worked seven-day weeks for several weeks at the makeshift morgue before recently getting days off. When her kids ask about her job, she doesn't tell them she’s among the dead all day, every day.
“I tell them that I help hospitals learn why people get sick,” she said.
Death is in the job description, but that doesn’t mean those who work at the medical examiner's office are unmoved by the surge in dead, Arunkumar said. They cope by checking on each other more. Staff also adhere to a strict rule: Treat the dead with the respect they’d want extended to their own loved-ones.
Doing that “makes it easier to handle what we are doing," she said.