More reasons to wonder whether the death spike is real or engineered — and to call for an investigation of the Home Death event regardless
This article was first published on 7 September 2024. Revisions made and content added for republication on 4 March 2026.
Sudden changes in the number and proportion of autopsies conducted in New York City in spring 2020 raise more questions about what happened during the biggest mass fatality event in city history and why, especially with deaths occurring at personal residences. The disturbing shifts and unusual characteristics in official federal data add to the body of circumstantial evidence that authorities are not telling the whole truth about the scale and nature of deaths, or about the movement and treatment of bodies during the fatality spike.
Background
Autopsy conducted is one of many variables available for query in CDC WONDER, the U.S. mortality data warehouse. Each death can only be associated with one autopsy status:
- Yes (an autopsy was conducted),
- No (an autopsy was not conducted), and
- Unknown (there is no record showing if an autopsy was conducted).
Most deaths that occur in the United States are not autopsied. Prior to March 2020, roughly 10-14% of the 950-1200 resident deaths occurring each week in New York City were autopsied, 80-87% were not, and autopsy status reported as unknown for 3-4%.
Autopsy Status Data: Raw Numbers & Ratios
Similar to every time-series for New York evaluated thus far, nothing remarkable was occurring with the number or proportion of deaths autopsied in January or February 2020, before pandemic and national emergency decrees — i.e., no apparent “smoke signal” or sign of a “disturbance” involving a deadly novel pathogen spreading (Figure 1).
Figure 1: Autopsy Status of New York City resident deaths occurring weekly in weeks 2-12, 2020 (CDC WONDER)
After the federal government said 15 Days to Slow the Spread, No autopsy and autopsy Unknown deaths rose, and deaths with Yes autopsy fell. Table 1 shows the weekly raw numbers and percent change for weeks 12-22 in 2019 compared to 2020. Unknown rose slightly faster than No and peaked in the same week. Overall percent change from 2019 was higher for Unknown than it was for No (305% vs 278%). Yes declined by one-third to two-thirds from baseline each weekly, with the steepest drop occurring later in the event (65% in Week 19).
Table 1: Autopsy Conducted, New York City Resident Deaths, Weeks 12-22: 2019 v 2020, Totals & Percent Change (CDC WONDER)
Most of the eleven-week death increase in deaths were not autopsied, which is expected. No and Unknown returned to baseline by the end of May, when the excess death event ends, whereas Yes didn’t return to a normal level until late June (Figure 2). Smaller spikes in Unknown and No (and drops in Yes) were reported during subsequent waves of excess death but – like total deaths – never approached magnitude of the spring 2020 event.
Figure 2: Autopsy Status for New York City Resident Deaths Each Week, Jan 2018-Dec 2023
Figure 3 shows the six-year weekly ratios for autopsy status, including the dramatic shifts in March 2020. The proportion of deaths for which autopsy status was Unknown continued to rise through 2023. The ratio of Yes/No autopsies dropped again during the so-called ‘Omicron” wave in late 2021 and early 2022.
Figure 3: Weekly Ratio of Autopsy Status on Death Among NYC Residents, January 2018 – December 2023
The percentage of weekly deaths autopsied fell to less than 1% as all-cause deaths peaked (Table 2).
Table 2: Weekly Ratio of Autopsy Status, NYC resident deaths, week 7 – week 31, 2020
The “official” explanation for autopsies coming to a near halt was that forensic labs were closed and staff reassigned to process decedents sent directly from hospitals and nursing homes to city morgues.1 Even if such reassignment occurred, the drop is difficult to reconcile with the apparent underutilization of FEMA trucks sent for morgue storage, additional manpower provided by the National Guard, and the medical examiner’s hiring spree.2 3 The unexplained three-day, 11,000-death processing event further complicates any attempt to give the agency the benefit of the doubt.4
Conducting fewer autopsies during an excess death wave is a disservice to public health, if not a dereliction of duty, especially in a city where the medical examiner’s work is not automatically or routinely subjected to public scrutiny. Taxpayers should surely expect the medical examiner to conduct a normal number and a near-normal proportion of autopsies during an alleged “outbreak” event.
Home Deaths Go Up, Home-Death Autopsies Go Down
Under normal circumstances, most deaths that are autopsied, and the highest proportion of autopsied deaths, are those that occur at home. This is because deaths in private residences are more likely than deaths in healthcare settings to occur unexpectedly, be unattended, or involve accidents, drugs, suicide, homicide, or other factors requiring investigation under the law.
Home deaths in New York City rose from 1,755 deaths to 6,206 deaths between mid-March and the end of April compared with the same period in 2019, an increase of roughly 250%. Because deaths at home are the category most likely to require medico-legal investigation, such a rise would ordinarily lead to more autopsies rather than fewer. No rise is evident prior to the federal emergency declarations, but the level remained elevated above baseline through the end of 2020 (Figure 4).
Figure 4: NYC Resident Deaths Occurring Daily at the Decedent’s Home (All Causes), 1 Jan 2019 – 31 Dec 2020
Given that deaths at home are the deaths most likely to require autopsy, one might expect the number of autopsies performed on such deaths to increase during this period. Instead, the opposite occurred.
Despite the increase in home deaths, autopsies conducted on deaths at home fell by 67% (Figure 5). Autopsies on emergency department or outpatient deaths also declined, though less dramatically (-38%). Autopsies conducted on hospital inpatient deaths remained relatively stable; however, most of the increase in autopsy Unknown deaths occurred in hospital settings, which will be discussed in a later section.
This means that the location experiencing the largest surge in deaths was also the location where autopsies declined the most.
Figure 5: Weekly Deaths Among NYC Residents Occurring in Hospital Inpatient, Emergency Dept/Outpatient, and Home for Which an Autopsy Was Conducted, Jan 2018 – December 2020
Orders for people to stay home could have meant that more deaths occurred in the presence of a household member or friend. The medical examiner would not usually assume jurisdiction over home deaths in circumstances that involve an expected death or that are not suspected to be due to a non-natural cause. For example, someone discharged from a hospital or nursing home may die at a personal residence, or someone may choose to die at home if given the option.
It is unlikely, however, that any increase in deaths at home by choice would displace the normal number of home deaths that are typically autopsied. As previously mentioned, the National Guard reportedly assisted with body removal from homes and with processing decedents at morgues, and the OCME hired more staff hired more staff.5 Periods of unusual or unexplained mortality are precisely when medico-legal investigation, including autopsy, is most critical. Yet the number of autopsies fell sharply. With additional manpower, why could a normal number of autopsies not be conducted?
Undisclosed Factors?
Other unsettling facts and reported events from the timeframe give additional reasons to question what happened with deaths at Home and the corresponding decline in autopsies.
Unexplained OHCA event concurrent to unexpected patterns in data related to drug overdoses. An unexplained out-of-hospital cardiac arrest (OHCA) event drove the spike in deaths at Home.6 A study of the event reported that cardiac arrests between March 1 and April 25 were “3.5 times more likely to present in asystole (OR, 3.50; 95% CI, 2.53-4.84; P < .001) and twice as likely to present in pulseless electrical activity (OR, 1.99; 95% CI, 1.31-3.02; P = .001) than in ventricular rhythms (ventricular fibrillation or ventricular tachycardia).”7 The study authors offered explanations such as “COVID-19 infection,” healthcare avoidance, and stress, none of which explain why the spike begins immediately after the “15 Days to Slow the Spread” campaign was declared, or why it didn’t exhibit more random variation.
The authors also reported a 183% increase in arrest call patients who were dead upon ambulance arrival, a lower success rate for resuscitation, and low use of naloxone (opioid overdose reversal drug) compared to the same weeks in 2019. FDNY was taken off of low-acuity calls in early March and redirected toward cardiac and high-trauma calls.8 An internal 27 March 2020 bulletin loosened oversight bulletin loosened oversight for refusals of medical aid (RMAs) including in situations where the patient had received medication or was at high risk of severe outcome.
Interestingly, drug overdose deaths in New York City personal residences did not increase substantially during these weeks (Figure 6) and drug/psych calls to 9-1-1 were down 31%, according to data reported in an FDNY-affiliated study.9 Because opioid deaths in the U.S. tend to occur at home, if drugs or contaminated agents played a role in driving up Home deaths, autopsies would be critical to determining the extent and possible sources.10 11
Figure 6: New York City Weekly Deaths Occurring at Decedent’s Home: Circulatory, COVID-19, and Drug/Alcohol-Induced (Underlying Cause, 2018-2020) Source: CDC WONDER
Non-sensical and disproportionate COVID Home deaths. After heart-related causes, deaths that blamed COVID-19 were the next-leading cause of deaths at home. A home COVID death is questionable in any circumstance, yet New York City comprised 40% of all U.S. home COVID deaths in April 2020 (Figure 7). This is strikingly disproportionate and inconsistent with anything reported in other U.S. cities. At the time, media insisted COVID deaths at home were undercounted12 — implying a mechanism by which a respiratory virus would frequently cause sudden death inside private residences. Being struck by lightning is one force capable of causing cardiac arrest presenting in asystole, as can poisoning from cocaine or fentanyl. Without baseline information from autopsies, few conclusions can be drawn. Decedents with a COVID assignation were very likely those for whom a positive SARS-CoV-2 test was recorded.
Figure 7: 2020 Monthly COVID-attributed deaths occurring at decedent’s home, New York City versus United States minus New York City. Source: CDC WONDER.
Changes in ambulance dispatch patterns: Total dispatches went up initially, as did refusals of medical aid (RMAs); meanwhile, ambulances transporting patients dropped. So, people were suddenly calling for help, help was being sent, but help was being refused (by paramedics or the patient), and fewer people were being taken to hospitals.
Paramedics had also been told to keep people away from hospitals and also received directives that discouraged them from giving full lifesaving measures to patients in cardiac arrest.13 Such protocols coupled with a drop in autopsies conducted gives the appearance of protecting those who issued and carried them out.
NYPD investigation of DOAs. NYPD units respond to all incidents involving a person who dies on scene. My records requests for the daily number of NYPD responses to such incidents were never fulfilled, but a veteran NYPD DOA (dead on EMS arrival) detective I spoke with off-the-record reported that he saw no National Guard units removing bodies from homes. He also stated that medicolegal investigators from the OCME had stopped responding to DOA scenes roughly two weeks into the emergency period (late March to early April). This observations fits with contemporaneous reporting about teams comprised of two National Guardsmen and an OCME staffer working together to retrieve bodies but it raises questions about why a decision was made to remove OCME staff from NYPD death scenes.
The detective questioned the legitimacy of the home death spike and said the magnitude was inconsistent with his unit’s experience in spring 2020 and would’ve required a staggering amount of overtime work and pay. He said many deaths he was involved with were determined to be “COVID,” he said, irrespective of manner of death.14
He also shared that his unit responded to an unusual number of calls involving drug overdose deaths in the same building in January of 2020. Based on the location provided, I attempted to secure corresponding police reports but was unsuccessful.
Chicago comparison. One way to contextualize New York City’s autopsy patterns is to compare them with another large U.S. jurisdiction that experienced excess deaths during the same period. Cook County (Chicago and its inner suburbs) experienced a Home excess-death event in spring 2020, but not at the magnitude observed in New York City.15 Fewer deaths at home were attributed to COVID-19, and there was no drop in the number of autopsies conducted (Figure 8).
Figure 8: Weekly Resident Deaths, Autopsy Status – Yes and Unknown, New York City and Cook County, January 2018 – September 2023
Unlike the medical examiner’s office in New York City, determinations by the Cook County Medical Examiner are public, and death records are subject to FOIA. In other words, the Cook County ME’s office appears to operate under far greater transparency and legal accountability than its counterpart in New York City.
Although the decrease in autopsies conducted on New York City Home deaths is low as a raw number, the fact that it occurred simultaneous to and amidst a host of other odd events and data patterns casts suspicion over the drop. A failure to perform a number normal autopsies, if not a number commensurate with the cardiac event, gives the impression of trying to cover up undisclosed factors.
Autopsy Unknown Deaths
Autopsy unknown deaths made up a relatively small proportion of all deaths reported during the event but are still cause for concern due to how much they increased from the previous year, the proportion of such deaths relative to the U.S., where the deaths occurred, and the number that list COVID-19 as underlying cause.
New York City shows 432 autopsy-unknown deaths during weeks 12-22 in 2019, versus 1,883 in the same weeks in 2020 — a 305% increase (Table 3).
Table 3: Raw number of New York City resident deaths for which there is no record showing if an autopsy was conducted, Week 12 – 22, 2019 and 2020, with weekly percent change from 2019 to 2020.
The city’s proportion of autopsy unknown deaths is normally consistent with its population ratio, i.e. 2-3% of all such deaths in the U.S. In April, the proportion rose to 17% (Figure 9). Notably, the NYC increase for autopsy unknown in weeks 12-22 of 2020 versus the same weeks in 2019 was 30% of the U.S. increase (Table 4).
Figure 9: Raw number of New York City resident deaths for which there is no record showing if an autopsy was conducted, Week 12 – 22, 2019 and 2020, with weekly percent change from 2019 to 2020.
Table 4: 2020 increase from 2019 in Weekly Deaths-Autopsy Unknown: U.S. vs New York City
All but a few autopsy-unknown deaths that list COVID-19 as the underlying cause occurred in hospitals (97% = 1,187 / 1,226). This raises questions about record management, decedent storage, pick-up, and transport.
Sixty-five percent (65%) of autopsy-unknown deaths list COVID-19 as underlying cause (n=1,226/1,883). Nearly all (95%) of those COVID-19 deaths are “COVID-only” deaths, i.e., the only cause listed is COVID-19, which means the associated death certificate or record is “incomplete” with respect to cause of death.
The timing of deaths with an unknown autopsy status rose and fell with the all-cause death peak. As shown in Figure 10, nearly all “autopsy unknown” deaths with COVID on the death certificate were COVID-only deaths in the first three weeks of the event. The proportion declined thereafter but remained high until the drop to baseline.
Figure 10: Weekly Deaths, NYC Residents, Autopsy Status Unknown, All Cause v COVID Underlying Cause versus COVID-19 Only Cause, March – May 2020
Were these deaths that were taken directly from the hospital to a morgue, crematorium, or to other places of disposition without anyone recording whether an autopsy was performed (or without an autopsy record being retained)? More importantly, who were the decedents? What proportion are buried on Hart Island, where unclaimed decedents are sent?
Because decedents for whom COVID-19 is the only cause of death listed and for whom autopsy is unknown arguably have at least two record-keeping issues, it’s reasonable to wonder “if” those decedents existed at all — and if they died in the timeframe alleged. We might expect better recording in hospitals than other places of death, given that patients are usually attended by multiple staff and deaths take place under observation. More than a thousand hospital death records with incomplete information on variables that could be considered critical during a time when patient intake was reportedly lower than normal is grounds for an audit.
Autopsies: Another Anomalous Dataset
Federal autopsy data give Americans another reason to wonder what happened in New York City in the spring of 2020 – and whether all the deaths that are claimed to have occurred between mid March and the end of May occurred in those weeks, or occurred at all.
As long as death records remain inaccessible to the public, and the names of all 38,000 or so people whose deaths comprise “the spike” remain undisclosed, the figures shown in this article should be treated with circumspection and used to call on authorities to prove the spike is not manipulated, or produced through errors, distortions, or other forms of data engineering.
- Campanile, C., & Marsh, J. (2020, September 17). “COVID-19: The largest mass fatality incident in modern NYC history, officials say.” New York Post. https://nypost.com/2020/09/17/covid-19-the-largest-mass-fatality-incident-in-modern-nyc-history-officials ↩︎
- Hockett, J. (2024, June 25). “FEMA records confirm it sent refrigerated trailers to New York City in spring 2020 but suggest that most weren’t used as mobile morgues.” Wood House 76. https://archive.ph/NuskX ↩︎
- Durr, E. (2022, March 10). “New York National Guard COVID mission tops 2 years.” U.S. National Guard. https://www.nationalguard.mil/News/Article/2962009/new-york-national-guard-covid-mission-tops-2-years/ ↩︎
- Hockett, J. (2023, November 15). “Why (and how) did the New York City Medical Examiner process 11,000 deaths in three days?” Wood House 76. https://woodhouse76.com/2023/11/15/why-and-how-did-the-new-york-city-medical-examiner-process-11000-deaths-in-three-days/ ↩︎
- Records I obtained from OCME show jobs were posted. Some openings weren’t fulfilled to
“target” despite a high number of applicants, some were canceled, and others remained
open for months and were never completely filled. See Supplemental Image below. ↩︎ - It appears to be the “original” and most significant “Died Suddenly” event in the past four years — much more substantial than anything involving a shot or booster. ↩︎
- Lai, P. H., Lancet, E. A., Weiden, M. D., Webber, M. P., Zeig-Owens, R., Hall, C. B., & Prezant, D. J. (2020). “Characteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City.” JAMA Cardiology, 5(10), 1154–1163. https://doi.org/10.1001/jamacardio.2020.2488 ↩︎
- Otis, G. A. (2020, March 8). “FDNY pulls firefighters back from potential coronavirus calls.” EMS1, republishing reporting from the New York Daily News. https://www.ems1.com/coronavirus-covid-19/articles/fdny-pulls-firefighters-back-from-potential-coronavirus-calls-xDcHJXmczmKdiD4s/ ↩︎
- Prezant, D. J., Lancet, E. A., Zeig-Owens, R., Lai, P. H., Appel, D., Webber, M. P., Braun, J., Hall, C. B., Asaeda, G., Kaufman, B., & Weiden, M. D. (2020). “System impacts of the COVID-19 pandemic on New York City’s emergency medical services.” Journal of the American College of Emergency Physicians Open, 1(6), 1205–1213. https://doi.org/10.1002/emp2.12301 | See Supplemental Table below. ↩︎
- Chichester, K., Drawve, G., Sisson, M., McCleskey, B., Dye, D. W., & Cropsey, K. (2020).“Examining the neighborhood-level socioeconomic characteristics associated with fatal overdose by type of drug involved and overdose setting.” Addictive Behaviors, 111, 106555. https://doi.org/10.1016/j.addbeh.2020.106555 ↩︎
- Assuming the data are representing an actual real-time event, a release of super-charged illicit and/or prescription medications (controlled or accidental) is a feasible culprit. That said, I’m not sure there’s any reason to believe such a catalyst – or any catalyst such as “panic” – would generate a curve with the properties we see. For consideration of the latter, see “The Sound of Sirens: New York City and London, spring 2020”, including comment section. ↩︎
- Buhrmester, M., & Goldstein, J. (2020, April 5). “Coronavirus deaths may be undercounted, New York Times analysis finds.” The New York Times. https://www.nytimes.com/2020/04/05/us/coronavirus-deaths-undercount.html ↩︎
- https://woodhouse76.com/wp-content/uploads/2026/03/EMS-ORDERS-NYC.pdf ↩︎
- The detective also shared that his unit responded to an unusual number of calls involving drug overdose deaths in the same building in January of 2020. Based on the location provided, I attempted to secure corresponding police reports but was unsuccessful. NYPD has ignored my freedom of information requests for DOA call data. [Information also reported in “Eleven Sets of Serious Problems with the New York City Mass Casualty Event of Spring 2020”]
. ↩︎ - Approximately 48% increase in weeks 12-22, 2020, versus the same weeks in 2019. (CDC WONDER) ↩︎
Supplemental Image
Records requested from the NYC Officer of the Medical Examiner on December 8, 2023, and received on May 17, 2024.
Supplemental Table
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