The Galveston County Medical Examiner’s Office on Friday conducted a full autopsy on the body of a 4-year-old girl who reportedly died of COVID-19, officials confirmed Friday.
The result of the autopsy could add new information about the death of Kali Cook, who died on Sept. 7 at her family’s home in Bacliff.
The Galveston County Health District on Thursday announced a child had died and was being counted as the county’s first COVID-19-related pediatric death. Kali’s mother, Karra Harwood, later confirmed the identity of her daughter and said the cause of her death was COVID-19.
The medical examiner’s office determined Kali was infected with COVID by conducting a test after her death on Tuesday.
Officials said Friday they hadn’t rescinded or corrected any information released about Kali’s death. An autopsy could reveal other information, including about any pre-existing health conditions the girl might have had that might have contributed to her death.
The autopsy eventually would lead to a declaration of a “final cause of death,” officials said.
In a statement released at 4:10 p.m. Friday, Galveston County Local Health Authority Dr. Philip Keiser and Galveston County Chief Medical Examiner Erin Barnhart said the autopsy had been completed, but the results hadn’t been finalized.
“An autopsy was conducted today by the Galveston County Medical Examiner’s office on the young child who passed away this week and tested positive for COVID-19,” according to the statement. “We will not have the final cause of death until all results come back from today’s autopsy. We will update the public with more information as it becomes available.”
Some results from the autopsy, such as toxicology tests, could take weeks to return to the medical examiner’s office.
In an interview Friday afternoon, Keiser said Kali’s death warranted more investigation, partly because of how quickly her mother said she went from first showing symptoms to dying.
“From our point of view, for a 4-year-old to die so quickly from COVID is unusual,” Keiser said. Because the child wasn’t in the care of a physician and not at the hospital at the time of her death, health officials don’t have a lot of information, Keiser said.
“If she were in the hospital, we’d know a lot more,” he said.
Kali’s only symptom of COVID-19 was a fever she developed about 2 a.m. Tuesday morning, Harwood said, noting the child had been given medicine for the fever.
Kali was found dead about 7 a.m. Tuesday.
Kali hadn’t tested positive for COVID-19 before her death and didn’t receive any medical treatment after she developed symptoms. Harwood said she herself wasn’t vaccinated and had been diagnosed with COVID on Monday.
Harwood told The Daily News her daughter had never been diagnosed with any immune disorders or other ailments. But she said Kali tended to get sicker than her siblings.
Because Kali tested positive for COVID-19, the virus will be listed as a contributing factor in her death, medical examiner’s office spokesman John “D.J.” Florence said.
“The child was definitely positive for COVID,” Florence said. “I can’t tell you, and we won’t know until after the autopsy and any tests they run after that, what the official cause of death will be.
“But we know at least a contributing factor will be COVID, if not the actual cause of death. We just don’t know right now.”
Florence made a comparison to the way other causes of death are determined. In a situation where a morbidly obese person dies of a heart attack, that person’s obesity would be listed as a contributing factor on an autopsy report, Florence said.
The medical examiner’s office X-rayed Kali’s body and performed an external exam when she was taken to the office Tuesday, Florence said. It was only on Thursday that officials decided to conduct a full autopsy.
It’s unclear why a full autopsy wasn’t ordered immediately. The decision was so abrupt the medical examiner’s office had to retrieve Kali’s body from a local funeral home to conduct the autopsy on Friday. Her body already had been released after the initial examination, Florence said.
The news of the deeper investigation puts a spotlight on the opaque ways COVID-19 deaths are tallied, particularly when they occur outside of a hospital setting.
When a person in Galveston County dies at home, they’re considered an unattended death. Typically, people who die that way are taken to the Galveston County Medical Examiner’s Office in Texas City for a preliminary death investigation.
During the pandemic, one of the first things medical examiners do when working with an unattended death is to conduct a COVID test, officials said. As a practice, the Galveston County Medical Examiner’s Office doesn’t go further into an autopsy when a COVID-19 test comes back positive, officials said.
An exception is being made to that policy in Kali’s case, officials said.
The medical examiner’s office reports causes of death to state and local officials, including the health district, which for months have produced daily updates to the number of people whose deaths have been attributed to COVID.
But not every COVID death recorded by the medical examiner is counted by the health district. The Galveston County Health District keeps its own count and conducts its own investigations into COVID death reports, Keiser said.
As evidence of that, Keiser pointed to discrepancies in the number of local deaths reported by the health district and the number reported publicly by the Texas Department of State Health Services.
As of Friday, the health district reported 472 deaths among county residents. The state health department reported 567 deaths in Galveston County.
Some of that discrepancy might be reporting lag or inaccurate information about where people lived, Keiser said. But another part of it is the health district has investigated some of the deaths in the state count and excluded them from its tallies because of a lack of evidence of the virus.
“When we have the information, we don’t count them as COVID deaths,” Keiser said. “We have cases like that, where people have died in [motor vehicle crashes] and have clearly died with COVID. We don’t report them.”
As of Friday, Kali hadn’t been counted in the health district’s tally, officials said. At the very least, the health district was waiting until it could determine whether she had any pre-existing health conditions.
Every death reported by the health district during the pandemic has specified that the person who died had a pre-existing health condition. The district has never included information about what the conditions were.
The Galveston County Sheriff’s Office and Texas Child Protective Services were called to the Bacliff home where Kali died on Tuesday. Officials said it’s standard practice for both agencies to respond to incidents where children were found dead but that no criminal charges had been filed related to Kali’s death.
There was no evidence Kali was physically abused, and Keiser and Florence said there were no signs of trauma when the child initially was examined.