Autopsy reports from Santa Clara County in California have adjusted estimates of the first US fatality from COVID-19 by several weeks. The reports’ findings, announced yesterday (April 21) by the Santa Clara County Department of Public Health, show that one of the county’s residents died at home from COVID-19 on February 6—long before the first US fatality from the disease was reported near Seattle on February 29.

Further autopsies identified COVID-19 in another two people who died in the county on February 17 and March 6. Santa Clara declared its first fatality on March 9.

“This wasn’t recognized because we were having a severe flu season,” Jeff Smith, a physician and the chief executive of Santa Clara County government, tells The Los Angeles Times. “Symptoms are very much like the flu. If you got a mild case of COVID, you didn’t really notice. You...

As of this morning, the California Department of Public Health has reported more than 33,000 cases and 1,250 deaths statewide. Scientists, politicians, and members of the public have raised concerns over the last few weeks that official statistics underestimate the true number of COVID-19 cases and fatalities in part due to limited testing early in the US outbreak.

See “Watch the Spread of COVID-19

“Testing criteria set by the CDC [Centers for Disease Control and Prevention] at the time restricted testing to only individuals with a known travel history and who sought medical care for specific symptoms,” reads the announcement on the county’s public health website. “As the Medical Examiner-Coroner continues to carefully investigate deaths throughout the county, we anticipate additional deaths from COVID-19 will be identified.”

The findings from the autopsies are “very significant,” Ashish Jha, director of the Harvard Global Health Institute, tells CNN. “Somebody who died on February 6, they probably contracted that virus early to mid-January,” he adds. It could mean that “there was community spread happening in California as early as mid-January, if not earlier than that. . . . We really need to now go back, look at a lot more cases from January—even December—and try to sort out when did we first really encounter this virus in the United States.”

See “Coronavirus’s Genetics Hint at its Cryptic Spread in Communities

The CDC acknowledged in a statement updated today that many deaths due to COVID-19 may have been misclassified as pneumonia deaths in the absence of proper testing. Reported deaths due to pneumonia spiked in March in several states, including Florida, New York, and Washington—a trend that has long been recognized by public health experts as signs that COVID-19 was already spreading undetected in the large parts of the US population.

Speaking to The New York Times in early April, Geraldine Ménard, the chief of general internal medicine at Tulane Medical Center in New Orleans, said that staff had recorded “a ton of patients with pneumonia” earlier in the year. “I remember thinking it was weird. I’m sure some of those patients did have it. But no one knew back then.”

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