LEAVENWORTH, Kansas — Peaches Foster’s mother, Lovell “Cookie” Brown, died in a hospital on Jan. 9, 2020, in the middle of America, 7,200 miles from Wuhan, China, and weeks before the world understood that a mysterious respiratory virus was circling the globe and threatening humanity.
But on Wednesday afternoon, when a clerk slid her mother’s amended death certificate through the opening in the window at the vital statistics office in Topeka, Kansas, Foster finally learned what she had long suspected: “It’s COVID. I knew it,” she said, then burst into tears.
That’s how she discovered her mother is now listed as the first known person in the United States to die with COVID-19.
Three months ago, Brown’s doctor quietly added “COVID 19 PNEUMONIA” as one of the causes of her death, not only amending her death record but also effectively rewriting the timeline of when the pandemic reached the United States.
For more than a year, the Feb. 6, 2020, death of a San Jose woman named Patricia Dowd was considered the U.S.’s first COVID-19 death. So how, nearly a month earlier, on the same day that the World Health Organization first reported a novel coronavirus was responsible for China’s outbreak, does a 78-year-old great-grandmother in Leavenworth, Kansas, enter this story?
A Bay Area News Group investigation published last month revealed at least five death certificates from January 2020 in five states — California, Oklahoma, Alabama, Wisconsin and Kansas — had been amended in recent months to include COVID-19 as a factor. Kansas’ was the earliest. The puzzling revisions not only appear to turn the clock back on the virus’ arrival in the U.S. but also suggest that it had surfaced much sooner in America’s heartland, far beyond the country’s early coastal hotspots.
Until this week, Brown’s family had no idea their mother’s ICU doctor had amended her death certificate. They’d received no call from the hospital. No conversation with state officials.
Peaches Foster reacts outside the Office of Vital Statistics in Topeka, Kansas, on Wednesday, Sept. 1, 2021, having just received an amended death certificate stating that her mother Lovell Brown died of COVID-19. (Ray Chavez/Bay Area News Group)
Privacy laws kept the person’s identity a mystery, but recently updated data from Kansas’ health department listed the date of death and county of residence. Reporters from this news organization reached out to family members in Leavenworth County whose loved ones had died on that date and managed to contact Foster through her mother’s funeral home. When she was told someone’s death certificate had been changed to include COVID-19, Foster was convinced it was her mother and determined to find out if her hunch was right.
That set off a furious hunt this week, with Foster crisscrossing northeast Kansas in her 2007 Cadillac Escalade, a hand-me-down from Brown, in search of answers.
It remains a mystery when or where Brown, a devout Jehovah’s Witness whose life revolved around her tight-knit family, may have contracted the deadly virus. It’s also unclear why her doctor — who has yet to explain his decision — took the extraordinary step to change her death certificate more than a year later.
In her final months, Brown rarely left home other than to go to medical appointments for her diabetes and chronic obstructive pulmonary disease (COPD) and to check that her lungs were still clear after a bout with lung cancer years ago. She spent time on and off in a nursing home in the months leading up to her death recovering from a stroke and other illnesses.
“She didn’t travel. Just here to the doctor,” said her son, Kevin Brown, who finds it painful to discuss the events of more than a year ago. “It’s hard thinking back.”
But when talk of the virus began to dominate local news reports in March 2020, he remembers his sister, Peaches, turning to him and saying, “I think Mom had COVID.”
In the days and weeks before her death at Providence Medical Center in Kansas City, Kansas, Lovell Brown had a splitting headache, a raspy cough, a fever, diarrhea, body aches and other symptoms that would soon become all too familiar across the world.
“She couldn’t even sit up,” Foster said.
And at Christmas, when her family brought her favorite foods to the nursing home, Brown complained that everything tasted bland. The cabbage needed salt. The scratch-made spaghetti sauce was off. The water tasted of bleach.
Days later, she was rushed from her home of more than 30 years in northern Leavenworth to nearby Saint John Hospital gasping for air before being transferred to Providence, where she spent a week in the intensive care unit fighting for her life before dying midafternoon, surrounded by loved ones.
Ever since, Foster and her daughter, LaToya Foster, have been shaken by the death of the family matriarch who doted on her nine grandchildren and was always the first to clown around. In her younger days, Brown tended bar, smoked and sang Elton John in a rock band before her sister, Dean, encouraged her to become a Jehovah’s Witness. As a military wife, she raised three kids — one boy and two girls — at bases around the world before settling close to family with her now-late husband, Tyrone, in this city about 30 miles northwest of the Kansas City metro area.
“It took everything I had to walk out that door and leave her,” Foster said, recalling how she got sick to her stomach when her mom stopped breathing and stayed for hours in the room. “That was my best friend.”
Brown’s original death certificate said she’d died only from a stroke and chronic obstructive lung disease. But in May of this year, that changed.
Why is still a mystery. Her death is now included in the Centers for Disease Control and Prevention’s official record of U.S. COVID deaths, but the agency wouldn’t comment further.
John Swartzberg, an infectious disease expert and professor emeritus at UC Berkeley, said it may never be possible to know whether Brown had COVID-19 without tissue or blood samples. It’s not yet clear whether any samples remain, and Brown was cremated shortly after her death. But the symptoms and timeline of her illness fit the usual pattern, he said, so it’s entirely possible she was infected. While many of the early identified COVID-19 cases involved travel to and from Asia, not all did. And both experts and antibody studies of donated blood samples suggest the virus was already spreading in the U.S. by late 2019.
“It does teach us we need really robust surveillance internationally going forward for the next COVID-22 and so on,” Swartzberg said.
George Rutherford, a UCSF infectious disease expert, is more skeptical about Brown’s death being linked to COVID-19. Without a laboratory confirmation, similar to how Dowd’s early death was later connected to the virus, he said, “I think it really muddles our understanding unless you have a real smoking gun.”
None of that mattered to Foster this week as she set off on her quest.
“We’re investigating,” she informed everyone she met, patiently brushing aside bureaucracy and stonewalling at every turn.
On Monday, she requested a new copy of her mother’s death certificate but was told it could take days. The next day, she went to the hospital and called the doctor who certified the death certificate, but he said he was too busy treating COVID-19 patients to talk then. She drove back and forth between the hospital and nursing home, requesting medical records and begging for more information. On Wednesday, she found out the death certificate was ready and headed for Topeka.
“I need the closure,” LaToya Foster said.
Peaches Foster had planned to wait to open the document with LaToya, who was at work at a dollar store back in Leavenworth. But when the clerk handed her the form without an envelope, it jumped right out at her: COVID-19.
“Oh my goodness,” she said, “it’s hard.”
What prompted a doctor to go back a year and a half later and change the death certificate? Swartzberg asked. “That’s the elephant in the room.”
It’s rare for death certificates to be amended, experts say. When reached by a reporter Wednesday on his cellphone, Thomas Fulbright, the ICU physician who certified Brown’s amended death certificate, said he couldn’t talk about the case because of patient privacy rules.
A spokesperson for Providence hospital, Sam Allred, said he also couldn’t provide specifics but promised to help Brown’s family get a better understanding of what happened.
“We’ll work with her to try to get any answers we can,” Allred said.
John Eplee, a Kansas state lawmaker and family physician who has treated COVID-19 patients, calls the case a “headscratcher” but isn’t surprised at the idea of the virus spreading in Leavenworth, a military town with lots of international travelers and several prisons and jails.
“It’s like congregate settings on steroids,” Eplee said.
Brown’s death, he said, suggests the virus was percolating here before experts realized it.
“I think there are other cases like this case in Leavenworth,” he said. “They’re just not known at this time.”
And they may never be.
“I think this will go on forever,” Eplee said. “We’ll be gone, and we’ll still be speculating about how and where it started.”
Peaches Foster isn’t worried about where her mother fits into those bigger questions. For her, the pandemic is personal. Ten months after her mother’s death, an aunt and uncle, Brown’s sister and brother-in-law, also died of COVID-19 weeks apart.
The disease has killed more than 600,000 people in the United States.
A piece of paper now says Foster’s mother was the first. “It doesn’t bring her back.”
Staff researcher Veronica Martinez contributed to this report.
