Colton Toliver of Bayfield died two months shy of his 38th birthday.
Little information about Toliver appears online: News reports and his obituary show some run-ins with the law, faith in God and a fighting spirit in his battle against addiction. His mother, Kelly Toliver, could not be reached to share more about him.
Toliver’s life was complicated, and – because his death was originally linked to the COVID-19 outbreak at Hilltop House in Durango – so was his passing.
In December, San Juan Basin Public Health reported in a news release that Toliver’s death was associated with the outbreak, but an autopsy found his death was not caused by the disease. He died from an accidental methadone overdose.
The apparent discrepancy concerns Durango resident Adam Howell, who requested Toliver’s autopsy report Jan. 13.
“The reason it’s important for our community to understand the causes of these people’s deaths is because ‘death due to COVID’ and ‘death among COVID cases’ are being used as reasoning for these shutdowns of society,” Howell said.
In Colorado and around the nation, faster spread of COVID-19 triggers stricter public health responses, such as business and school closures. Deaths caused by COVID-19 are one way to measure a community’s viral spread.
In May, Colorado began distinguishing between deaths caused by COVID-19 and deaths among cases, when someone had COVID-19 but did not die because of it. The state had been reporting both together, which inflated its overall COVID-19 death statistics.
Howell said there was secrecy in COVID-19 data reporting and SJBPH was not transparent with its records. He questioned the health department’s news release, The Durango Herald’s associated reporting and the family’s obituary (which said Toliver died of COVID-19).
For SJBPH, the issue came down to terminology.
“It’s been a really complicated thing to communicate to the public – deaths among cases and deaths caused by COVID-19,” said Brian Devine, deputy incident commander for COVID-19 at SJBPH.
In La Plata County, SJBPH reported 30 deaths among cases as of Tuesday. The Colorado Department of Public Health and Environment reported 24 deaths caused by COVID-19 in the county as of Jan. 9, the most recent report from the Centers for Disease Control and Prevention.
“When people see reports of deaths among cases or deaths associated with an outbreak, it’s natural for people to assume that means death caused by the virus,” Devine said. “Not all of them are.”
The Hilltop House outbreak was confirmed Nov. 28 and ultimately resulted in 27 cases among residents and six among staff members, according to CDPHE records.
When Toliver died Dec. 9, he was already out of the hospital after his battle with COVID-19.
Some people relapse into symptoms after their health improves initially. At the time of his death, it was still too soon to say he had fully recovered according to state and federal standards followed by SJBPH, Devine said.
That’s why SJBPH announced a death associated with the Hilltop House outbreak as part of its weekly reporting Dec. 14. The department chose the term “associated with” intentionally, he said.
“We don’t want to say the outbreak has killed this many people when we don’t know that,” Devine said.
Toliver’s autopsy was Dec. 15, the day after SJBPH’s announcement. At that time, Michael Arnall, the prosector who conducted the autopsy, and Jann Smith, the La Plata County coroner, did not find any signs of COVID-19.
“You can tell when you do an autopsy whether the individual has COVID,” Smith said. “He did not have any signs of COVID when we did the autopsy. If he had, my pathologist would have stopped the autopsy immediately.”
Death during the pandemic has meant isolation for patients in their final moments and an interrupted, difficult grieving process for families.
When someone’s death is tied to COVID-19, it also gets recorded by multiple agencies.
The epidemiologists at SJBPH record deaths among cases because it helps them to identify people who are no longer actively spreading the virus.
The epidemiologists don’t determine what caused a person to die. They don’t receive copies of autopsy reports or death certificates. They don’t know which of the 30 people in La Plata County who died while having the disease actually died because of it.
That responsibility falls on coroners’ offices, medical professionals and the CDC. The CDC reports the number of deaths back to state health agencies.
For members of the public, understanding COVID-19 data can be difficult or confusing.
“San Juan Basin Public Health could be more specific with their reporting,” Howell said. “To say that Colton Toliver’s death was associated with the outbreak definitely misleads people into thinking that somehow COVID-19 played a role in his cause of death.”
It’s not just about death numbers and tracking viral spread, said Claire Ninde, SJBPH spokeswoman.
“I hope that people remember, as we try to remember, that they were not just statistics or names on a list, but that each of them was a whole person with a whole life,” Ninde said. “Hopefully, our community will come together to grieve for everyone that has been lost.”
smullane@durangoherald.com
The headline for this story has been updated to attribute the cause of death determination to an autopsy report.
