In the beginning, when everyone got sent home to ride out the coronavirus pandemic, Pickens County didn’t have much to worry about. Its COVID numbers were low, almost nonexistent, even as the sheer volume of cases and deaths ramped up everywhere else.
“The pandemic came to the United States in March , but it didn’t come to Pickens County until a lot later,” says Kandy Kelley, coroner for Pickens County. “We really didn’t see any [deaths from COVID] until just a few months ago. And then, boom!”
If there’s a single word to boil the effects of the pandemic on coroners down to, “boom” would at least be a rank contender. The boom in COVID deaths in this county of 124,000 (including one-and-a-half coroners) echoes the boom in deaths coroners are seeing in a lot of places in South Carolina. It also echoes the population boom much of the state is experiencing.
Where the Upstate and Pee Dee blend, population is escalating, as Charlotte becomes less a city and more a metroplex reaching across the border. Along with all those new people coming to live here is the morbid B-side that more people will end up dying here.
For coroners like Sabrina Gast in York County, professional life has gotten busy over the past few years. According to the U.S. Census, the City of Rock Hill’s population grew by 12.2 percent over last decade, making it the largest city in South Carolina that isn’t in the Charleston area. The county, over the same period, grew by 24.3 percent.
Gast’s office grew barely at all.
“Our caseload has increased tremendously,” Gast says. “That backlogs our records; it’s backing up the process of the death certificates, where families are not getting certified death certificates.”
That backlog has pushed some certifications from five days, for “cut-and-dried” situations from which Gast can more easily sign off on a cause of death, to “12 to 16 weeks” for cases involving toxicology and autopsy.
A lot of this delay has to do with the coronavirus, yes, but while hundreds of South Carolinians die from
COVID every week, other deaths have not taken a holiday at all. More than 5,500 South Carolinians died from COVID in 2020, but 1,026 people died in motor vehicle crashes; thousands more died of heart disease, cancer, homicide …..
“In the cases that I’ve had,” Kelley says, “I had a house fire; I’ve had a man who jumped out of a window … I’ve had natural [causes] ....”
So it’s not as if COVID is all of the problem, but it certainly isn’t making things easier for already-strapped coroners’ offices, whose staffs have not grown along with the rate of people moving to South Carolina over the past few years.
“We had what we had before when we were really busy,” Kelley says. “Now we have COVID on top of it, which has made it really hard.”
She also used the word "nightmare" more than once.
And even where COVID is the problem, it’s not always directly the problem.
“The way it’s affected me more,” Kelley says, “is when people don’t … get proper medical care and they die. This lifted my numbers way up.”
Most direct-COVID deaths in Pickens County have happened in hospitals and nursing homes, and mostly among seniors. But Pickens is not a healthy county (it’s usually the state leader in suicides, among other problems) and South Carolina is not a healthy state. The latest rankings by the United Health Foundation put the state near the bottom for numerous health factors, including bad diet and poor healthcare access.
A telling example of how the state’s health problems intermingle with COVID is the rate of diabetes here – up 16 percent between 2012 and 2019, according to the NHF report. Another is alcohol abuse, which was up 20 percent over the same time period. Each of these issues got worse when the pandemic struck. Kelley says she has seen an uptick in deaths from residents who were afraid to go to the doctor for fear they might catch the virus.
Dayne Marsh, funeral director at Palmetto Funeral Home in Fort Mill, has the same perspective.
“There’s a correlation of people who pass away directly by COVID and there are some indirect things that I feel cause an increase in deaths too,” Marsh says. “People maybe need a surgery but couldn’t get to it, or people who quit going to the doctor because they’re afraid to go.”
Days for Marsh are busier because of COVID (direct or not) too, but he’s also as backlogged as any coroner's office. A combination of more deaths in a booming area with high COVID mortality rates, longer delays in getting death certificates certified, and having to restructure how to hold funeral services for families who opt for burial over cremation has led to doubled workloads – which means funerals are taking weeks longer to get to than they were before the pandemic.
This is part of what coroners everywhere call “the ripple effect.”
“A lot of places won’t take pending-investigation death certificates,” Gast says. Which means that families “can’t turn off utilities, they can’t get in safe deposit boxes, they can’t get life insurance. There’s lots of things holding up families ... and our hands are tied.”
Gast is also worried about small offices, like Kelley’s. In York County, which has seven coroners, a case of COVID in the office can be handled. It disrupts, Gast says, but it can be dealt with.
But in a place like Pickens County, where Kelley and one part-time deputy are it, one case of COVID could be a serious problem.
Kelley is worried too. She’s 61 years old and says her health has gotten worse over the past year – she’s gained weight and doesn’t sleep so well because she’s been on 24/7 call – and her deputy has multiple comorbidities that COVID tends to exploit.
In addition to being the coroner for York County, Gast is the president of the South Carolina Coroners Association. As such, she says refrigerated trucks and other support is available to small offices around the state. To date, no one has called upon the SCCA for help, but the presence of those extra trucks are evidence of a frequent, uncomfortable problem plaguing coroners around South Carolina.
Yes, storage of bodies. With delays in closing out postmortem and funeral processes, coroners and morgues regularly have to battle capacity issues. Morgues like Lancaster County’s, which is supposed to max out at a dozen decedents, has made a lot of local news lately for its constant struggles to find room for everyone.
Deese gets help from neighboring counties, chiefly Chester, Chesterfield, and Kershaw.
“We’re very fortunate,” she says. “A few of our sister counties that do have some extra storage, when it’s available there, are gracious and offer their facility for our overflow.”
It probably shouldn’t be a surprise to learn that coroners are a tight group. They are in frequent contact with each other, as well as with hospitals and funeral directors, often in an effort to find a place that can accept an extra body or two.
Much of this comes down to scale. In Kershaw County, Coroner David West has two deputies and is often able to take in someone who needs to be moved from Lancaster’s morgue for capacity reasons. Kershaw has similar capacity to that of Lancaster County, but has far less population.
Deese doesn’t call on her next door neighbor York County because York doesn’t have its own morgue. It shares morgue space with Piedmont Medical Center, though Gast says she has added extra storage space. In total, York should be able to house two dozen decedents at once, but even that, she says, can easily get pushed past capacity.
It is worth noting that overcapacity issues for morgues are fluid. The macabre shell game corners and funeral directors engage in so frequently can relieve a morgue's morning overcapacity problems by the afternoon.
That is, provided another office has help within reach. Marsh says he tries to be that extra hand.
“I’ve always had that open-door policy with my community,” he says. Palmetto Funeral Homes has four locations in York County, dozens of employees, and newly added storage areas, so space is not usually a problem for him. But he understands that this is a luxury.
“If you need me to hold someone in my care, I’ll do it for you," he says. "But that’s a lot to ask of some of your smaller firms that don’t have the space to install something like that.”