Death managers, public health, and COVID‐19: An exploratory study

• Published date: 01 September 2023
• Author: Staci M. Zavattaro
• Date: 01 September 2023
• DOI: http://doi.org/10.1111/puar.13655

SYMPOSIUM ARTICLE

Death managers, public health, and COVID-19:

An exploratory study

Staci M. Zavattaro

School of Public Administration, University of

Central Florida, Orlando, Florida, USA

Correspondence

Staci M. Zavattaro, School of Public

Administration, University of Central Florida,

528 W Livingston St., Orlando, FL 32801, USA.

Email: staci.zavattaro@ucf.edu

Abstract

The ongoing COVID-19 pandemic has exacerbated cracks in the United States’

healthcare systems—along with its deathcare systems. The pandemic as an ongo-

ing mass fatality incident highlights the need to understand the public servants

engaged in deathcare work, as they are a vital part of the emergency response

equation. This exploratory, descriptive study focuses on the ways in which medical

examiners and coroners (ME/Cs) in the United States provide core emergency

management services to communities, relying on findings from interviews with

18 ME/Cs throughout the country. Findings indicate how COVID-19 cases are

counted is difficult, the pandemic changed how ME/Cs operate in response, and

burnout is eminent for these public servants.

Evidence for practice

•ME/Cs need to be included in all stages of emergency planning to ensure a

robust response and capability for handling mass fatality incidents.

•ME/Cs play a larger role in public health than might be understood, so better

digital and physical infrastructure is needed to connect ME/C data with other

public health agencies.

•Shedding light on death management highlights the need for a more complex

understanding of government and governance, indicating that the dead can

contribute to public value.

INTRODUCTION

A coroner in a small Louisiana parish told the story of a

patient showing up to a rural hospital where there is no

surgeon, cardiologist, intensive care unit, or real specialist

of any kind. The patient had something called aortic dis-

section, whereby the aortic wall was beginning to sepa-

rate and tear. The problem was easy to diagnose in the

small hospital, but because of the ongoing COVID-19 pan-

demic, the case became tricky. In normal operations, a

medical helicopter would evacuate the patient on a

15-min flight to a hospital for immediate surgery. In this

case, there were no beds, so it took 3 hours to get the

patient transferred. Eventually, the patient made it to a

hospital but “died on the operating table,”the coroner

explained. “Had they been transferred timely, they would

have survived. That’s an example of how COVID can kill

you without having COVID.”

Such was the story throughout the United States and

globally during the still-ongoing COVID-19 pandemic. The

virus overwhelmed already fractured healthcare systems

(Haldane et al., 2021; Kim et al., 2020) and disproportion-

ately affected already-vulnerable populations (Gaynor &

Wilson, 2020). The coroner in Louisiana explained even

before the pandemic, U.S. healthcare systems were

stretched to the limits, but “eventually the rubber band

breaks.”While research into the ongoing pandemic has

necessarily focused on healthcare workers and other first

responders, another part of the equation is missing:

deathcare or last responders. The purpose of this paper is

an exploratory, descriptive study asking a seemingly sim-

ple question: How did COVID-19 affect public sector med-

ical examiners and coroners?

Findings come from a content analysis of interviews

with 18 medical examiners and coroners throughout the

U.S. Each is a public servant either elected (coroners) or

appointed (medical examiners) to their position. Based on

the data analysis, three major challenges emerged when

answering the research question: counting COVID-19

deaths was challenging; COVID-19 altered death

Received: 4 April 2022 Revised: 7 April 2023 Accepted: 26 April 2023

DOI: 10.1111/puar.13655

Public Admin Rev. 2023;83:1339–1350. wileyonlinelibrary.com/journal/puar © 2023 American Society for Public Administration. 1339