Ruptured Heart Caused First COVID-19 Death in U.S., Autopsy States

A California woman who is thought to be the first person to die of COVID-19 in the U.S. suffered a ruptured heart, according to an autopsy report.

Patricia Dowd, 57, died on February 6, 2020, the report exclusively obtained by the San Francisco Chronicle stated.

The autopsy report signed by medical examiner Dr. Susan Parson said that Dowd complained of flu-like symptoms in the days leading up to her death. Dowd was described as "mildy obese" but had no known underlying conditions. The document showed that as well as her heart, COVID-19 had spread to her trachea, lungs, and intestines. Parson found evidence that Dowd's left ventricle had ruptured, and this was linked to COVID-19.

Dr. Judy Melinek, a forensic pathologist from the San Francisco Bay Area who was not involved in the autopsy, told Newsweek: "What is unusual about the autopsy findings is that the heart is normal size and shape and has no cholesterol in the coronary arteries, and yet the heart muscle is damaged and there is a rupture. Typically when you see hearts that rupture it is in the setting of high blood pressure and high cholesterol. Ms. Dowd was overweight, but she didn't have either."

Asked why the heart ruptured, Melinek said: "When the muscle was looked at under the microscope there was inflammation and molecular studies showed that the cells had evidence of infection with SARS-CoV-2, the COVID-19 virus."

However, Dr. Andrew Connolly, a pathologist at the University of California San Francisco who was not involved in the autopsy, told the San Francisco Chronicle that the virus or an immune reaction may have caused Dowd's heart to become inflamed.

It was previously thought that the first coronavirus death in the U.S. was on February 26 in Washington State, and in Santa Clara County on March 9.

According to the San Francisco Chronicle, the Santa Clara medical examiner's office stored Dowd's tissue because she didn't test positive for viral infections like the flu but it was not possible to screen it for COVID-19 when she died. The U.S. Centers for Disease Control and Prevention on Tuesday confirmed COVID-19 played a role in her death.

CBS SF Bay Area reported the medical examiner of Santa Clara County has reclassified nine deaths from flu to coronavirus in the past week, including Dowd's.

In a letter on Friday sent to the country Board of Supervisors, medical examiner Dr. Michelle Jorden said according to CBS: "Some cases are not yet closed and were not included in the current COVID-19 death count."

Melinek said: "It is possible that some deaths might be reclassified if the medical examiner or coroner looks back and identifies virus in autopsy tissue that wasn't initially recognized because of the lack of testing or lack of recognition of community spread at the time of the death."

She went on to stress that most COVID-19 deaths aren't reported to a medical examiner or coroner, "as they are not sudden, violent or suspicious.

"The disease course is slow and patients generally get medical attention before they die. Given that Santa Clara County just recognized that this death from early February was related to the virus, and antibody studies done at Stanford University indicate that the infection is more extensive than their testing is capturing, there is a decent chance that there were deaths in late January that occurred in a hospital setting that were misclassified in that county."

Melinek said its imperative that researchers look at death certificates in Santa Clara to see if there were more deaths than usual from acute respiratory distress syndrome and pneumonia, which are complications of COVID-19. "That could be an indicator that there was community spread and COVID-19 deaths in the U.S. before Ms. Dowd's death on February 6," she said.

Dowd is among the more than 3 million people worldwide to have been diagnosed with COVID-19. According to Johns Hopkins University, 211,326 have died, and 896,196 have recovered. New York is the U.S. state with the most confirmed COVID-19 cases, as shown in the Statista graph below, with California coming fifth.

This article has been updated with comment from Dr. Judy Melinek.

covid19, coronavirus, statista
A graph showing which U.S. states have the most coronavirus cases. Statista

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

  • CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
  • A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
  • Cloth face coverings can be fashioned from household items. Guides are offered by the CDC. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html)
  • Cloth face coverings should be washed regularly. A washing machine will suffice.
  • Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

  • Clean hands frequently with soap and water, or alcohol-based hand rub.
  • Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
  • Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
  • Avoid touching your hands, nose and mouth. Do not spit in public.
  • Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

  • Avoid close contact with others if you have any symptoms.
  • Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
  • If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
  • Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
  • Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask and glove usage

  • Healthy individuals only need to wear a mask if taking care of a sick person.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective when used in combination with frequent hand cleaning.
  • Do not touch the mask while wearing it. Clean hands if you touch the mask.
  • Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
  • Do not reuse single-use masks.
  • Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
  • The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.