As the total of heat-related deaths reached 376 Tuesday-doubling earlier figures-more questions surfaced about the criteria used by the Cook County medical examiner to blame hot weather for the staggering toll.
Dr. Edmund R. Donoghue said his office still must examine 110 more bodies, so he expects the number of heat-related deaths to easily exceed 400. Of the 575 deaths investigated by the Cook County Medical Examiner’s Office since Friday, last week’s excessive heat was a contributing factor in 376 of them, Donoghue said.
Almost as many heat-related deaths have been recorded in Chicago since last Friday as occurred in the entire country in the summer of 1988. That summer, one of the hottest and driest of the century, claimed 454 lives nationwide, according to federal health statistics.
By Monday night, the medical examiner said that heat had contributed to 179 deaths in Cook County. The figure leapt overnight because his staff was able to examine 180 bodies held at area funeral homes, in addition to 92 bodies brought directly to the morgue.
Of those examined at funeral homes, 137 were determined to have died from heat-related causes. Donoghue said his staff will examine 60 more bodies held at funeral homes and 50 held at the morgue.
Donoghue said that officials from the federal Centers for Disease Control and Prevention in Atlanta are expected to come to Chicago and conduct an investigation. On Tuesday he continued to defend the large number of deaths listed as heat-related despite questions about whether heat really had been a significant factor in many of them.
“I think my criteria are absolutely fair,” Donoghue said. “I think the criteria are excellent.”
Donoghue listed three criteria for determining whether a death is heat-related: if the body temperature of the deceased is 105 degrees or above; if the deceased is found at home and the investigating officers report that the temperature is unusually high; or if the deceased is found decomposed in a home with an unusually high temperature.
Donoghue said heat was a secondary or contributing factor in a majority of the deaths. But neither Donoghue nor members of his staff would break out how many of the 376 deaths were caused primarily by heat. Most of the deaths were the result of conditions such as heart attacks or cancer.
It is likely, in fact, that medical officials will never be certain of the true cause of death in every case. That is because autopsies are not being done in every case. Instead, officials from the Medical Examiner’s Office are relying on police reports, medical histories, and interviews with families and friends.
“Autopsies, which include a physical examination of the body, are essential to diagnosis,” said Dr. Boyd Stephens, chief medical examiner for San Francisco.
Nevertheless, Stephens said he supported Donoghue’s conclusions: “The public should put trust in its investigators, including Dr. Donoghue. He’s a good examiner.”
The Cook County Medical Examiner’s Office declined to say how many of the dead had body temperatures in excess of 105 degrees, the most objective measure of an excessive heat-related death.
Donoghue said most of the deaths were listed as heat-related because the victims were found in homes that lacked air conditioning.
He said he welcomed the CDC review of his work and is confident of his numbers. “We’re predicting they’re going to say we may have underestimated it.”
In 1982, the CDC published a landmark study that seemed to foreshadow what happened in Chicago last week.
Government scientists retrospectively examined the sickness and death associated with the July 1980 heat wave in St. Louis and Kansas City, Mo.
Heat-related illnesses and deaths were identified by a review of death certificates and hospital, emergency room and medical examiners’ records in the two cities and compared with similar statistics compiled from the previous two years when there were no heat waves.
Deaths from all causes increased by 57 percent and 64 percent in St. Louis and Kansas City, respectively, but only by 10 percent in the less populated areas of Missouri.
Heatstroke rates were as much as 12 times higher in the elderly compared to younger people, three times higher among non-whites and six times higher among the poor.
That was not unexpected, the CDC wrote. The hearts of people older than 65 can’t work as hard to cope with increased stress from heat, they sweat less efficiently and are less able to adjust to changes in temperature.
Several major risk factors were found by the CDC. By far, access to air conditioning was the most important lifesaver-those without it faced a 49.4 percent greater chance of dying.
The inability to care for oneself, a history of alcoholism and the use of tranquilizers and other medicines were strong contributors to heatstroke death.
Poor people may have less access to air-conditioned facilities, may suffer from higher rates of underlying disease, and may not seek medical treatment immediately after becoming ill, the CDC found. With heatstroke, which can develop with little or no warning, such a delay can be fatal.
More Top Picks Best Jewelry Making Kits
The researchers found that two-thirds of people with heatstroke were reported to have been ill less than one day before hospitalization or death.
In a typical history, a person went to bed well and was found the next day severely ill, unconscious or dead.
“Therefore,” wrote the CDC, “even frequent observations of people at high risk may yield little opportunity for intervention in the majority of severe cases.”
The CDC pointed out a major difference in mortality between urban and less populated areas may be due to a phenomenon called the “heat island effect.”
Heat is retained by buildings and pavement. It is given off by large numbers of people, cars and factories. Winds ordinarily aren’t as brisk in the city, so the heat isn’t dissipated, the CDC wrote.
Summing up its research, the government predicted that “unless a coordinated community effort is mounted during the next major heat wave, the remarkable loss of life in 1980 and previous major heat waves will be repeated.”
But even Donoghue was shocked at the sheer number of Chicago’s heat-related deaths.
“When the heat wave came, I expected to see 35 cases a day,” he said. “I never expected to see 80 or 90.”
On an average day, about 135 people die in Cook County, of which the medical examiner investigates 17.
That’s because the medical examiner only investigates sudden, accidental or violent deaths, suspicious deaths, or deaths where the deceased had no physician.
In most cases, when a person dies, the Chicago police are called. If the police determine that the death was the result of natural causes and a physician is available to sign the death certificate, the Medical Examiner’s Office authorizes the body to be sent directly to a funeral home.
Even though the office has been examining five times the number of bodies it usually investigates on a daily basis, it is unclear whether more people on average have been dying in Cook County.
That’s because there is a lengthy lag in compiling daily death certificates.
Donoghue has acknowledged that many of those who are said to have died from the heat would have died anyway-either that day or in the near future.
“I have had a couple of cases where people had a past history of cancer and even though the cancer would have killed them eventually, they are said to be heat-related because they died before their time,” said Dr. Larry Simms, deputy medical examiner.
Donoghue confirmed that many of those listed as heat-related were facing imminent death. But he said he is required to list heat as a contributing factor because of the circumstances under which they were found.
Heat was a trigger of more deaths than have been documented so far, both Donoghue and Simms believe. Doctors may have signed death certificates of elderly patients without considering heat a factor.
In fact, Thomas Gossi, a funeral director at the John E. Maloney Funeral Home in Rogers Park, said three cases that they handled should probably have been categorized as heat-related under Donoghue’s criteria, but physicians attributed them to natural causes when signing the death certificates.
Coroners from across the country supported Donoghue Tuesday and said they believed his determination of the scope of heat-related deaths was on target.
Said Craig Harvey, chief of the Investigations Division of the Los Angeles County County Coroner’s Office: “When we have earthquakes, we may have a large number of people who die of a heart attack as a result of the earthquake. Is it earthquake-related or were they just going to have a heart attack? “