More than two months after Galveston County officials publicly announced a 4-year-old Bacliff girl died because of COVID-19, the Galveston County Medical Examiners’ Office released a report saying that claim can’t be verified.
While Kali Cook tested positive for COVID-19 shortly after her death, she had no signs of organ damage from the virus, according to an autopsy report completed by Galveston County Chief Medical Examiner Erin Barnhart on Friday.
The lack of organ damage “renders a diagnosis of COVID-associated death inadequate in this case,” Barnhart wrote. The official report now calls the cause and manner of Kali’s death “undetermined.”
The report was released publicly Friday afternoon through the Galveston County Medical Examiner’s Office.
In an interview with The Daily News, Barnhart acknowledged the final conclusion of the autopsy was unsatisfying.
“This is not how we want an autopsy exam to turn out, and it’s definitely rare,” Barnhart said. “It’s not usually how our autopsy exams end. But at the end of the day, if we’ve looked at all the information we’ve gathered, all of the testing and we don’t find any definitive cause of death, it’s the best way to rule the case.”
On Sept. 9, the Galveston County Medical Examiner’s Office published a press release announcing the “Galveston County’s first COVID-related death in a child.”
The press release didn’t identify Kali by name, but her identity became public after a Dickinson elementary school principal posted a picture of the girl and identified her by name. Kali’s mother, Karra Harwood, contacted The Daily News after the health district’s initial press release went out and confirmed that she had been told her child died because of COVID-19.
Harwood said Kali died hours after she developed a fever. At the time of Kali’s death, multiple members of her family, including Harwood, were positive for COVID-19.
Kali’s death was widely reported on as an example of the risks unvaccinated children face from COVID. It came at time when pediatric hospitalizations from COVID-19 were reaching record heights in the county and in Texas.
Now, there’s officially no answer about what caused her death. The report says Kali also tested positive for adenovirus and for “human rhinovirus/enterovirus.” Both viruses are associated with the common cold.
A toxicology report came back negative. The autopsy found no signs of abuse or congenital defects.
The report said it’s possible Kali died because of a fatal seizure or an asphyxial event; because of toxicity from an untestable substance; or a cardiac arrhythmia. Kali had a medical history of febrile seizures and frequent respiratory illnesses.
The cause of death could be changed again if additional information becomes available, according to the report.
The Galveston County District Attorney’s Office on Friday afternoon confirmed it had reviewed the autopsy report and that no criminal charges were being considered over Kali’s death.
The Daily News and other news organizations reported Kali’s death as a COVID death after speaking to the health district and Harwood.
But questions about that determination were raised not long after the health district released its initial announcement. On Sept. 10, the health district and the medical examiner released a joint statement, saying it hadn’t determined a “final cause of death.”
Galveston County Local Health Authority Philip Keiser said the circumstances about the way Kali’s death was described were different from other COVID-related deaths. Because of that and because of Kali’s age, he asked the medical examiner’s office to perform a full autopsy on her.
The request was belated, however. Investigators had to retrieve the girl’s body from a funeral home to perform the autopsy, officials said.
Barnhart said she regretted the way the initial information about Kali’s death was released.
“I wish I could go back and redo that whole sequence of events,” Barnhart said. “It was released at some point by my office that she tested positive for COVID, and we also released that she died of COVID-19, that was going to be the cause of death. I don’t know exactly when that happened, or how that happened, or who said what. But it’s pretty clear that it happened at some point, and I obviously really regret that.”
The report raises questions about the way COVID-related deaths are determined and reported. During the pandemic, the medical examiner’s office’s practice has been to classify a death as COVID-related if the person tested positive for the virus, officials said.
The office doesn’t perform full autopsies on every suspected COVID death because it doesn’t have regular access to facilities to perform autopsies on people with infectious diseases. Most autopsies are done at the medical examiner’s office in Texas City; but in Kali’s case, the autopsy was performed at the University of Texas Medical Branch in Galveston.
The health district operates separately from the medical examiner’s office. The health district tracks vital statistics in the county, including deaths and causes of the deaths.
During the pandemic the health district has conducted its own investigation into COVID-related deaths that are reported to it from other entities. In some cases, the health district’s investigators have determined that some reported deaths should not be counted, officials said.
As a result, the death toll reported by the county is lower than the toll reported by the Texas Department of State Health Services and other entities.
While the health district issued a press release about Kali’s death, it has never included her in its official published death count. To date, the health district has confirmed 574 COVID- related deaths of Galveston County residents.
The youngest identified COVID-related death in the county was a person between the ages of 21 and 30 years old.