A county coroner in the state of Missouri is honoring requests from family members to alter the cause of death on the death certificates of their loved ones who have died from COVID — an action that, if replicated in other areas, could be disastrous results for purposes of tracking the true toll of the pandemic in the United States.

The 11 COVID deaths out of a total of 30 in Macon County, Missouri — which has a population of about 15,000 — that have been wrongly categorized are a small enough number to be statistically insignificant. However, some have rightly argued that actions like these are probably responsible for the current total number of COVID deaths in the U.S. being undercounted.

Speaking to The Kansas City Star on the matter, Macon County Coroner Brian Hayes said he altered the cause of death on at least six certificates at the request of family members. Instead of COVID, he listed a different condition such as pneumonia as the cause of death. Or, as he put it, in some cases saying that a death occured because “grandma had one lung and smoked all her life.”

The reasons for these requests appear to be politically motivated, as these Macon County residents don’t want to admit that their loved ones died of a virus that many in the country have tried to downplay, explained Hayes, who is a Republican.

“A lot of families were upset. They didn’t want COVID on the death certificates,” Hayes told the newspaper. “I won’t lie for them, it’s gotta be true, but I do what pleases the family.”

The admission by Hayes that he changes coroner reports at the request of families suggests that coroners in other Republican-dominated parts of the country may also not be recording COVID deaths as they should be. Reporting on Hayes’s actions, journalist Andrew Jeong from The Washington Post wrote that his undercount “comes amid broader recognition that the number of covid fatalities in the United States is probably higher than the official tally of 614,000.”

Indeed, researchers at the University of Washington estimated in July that the number of cases of coronavirus alone in the U.S. is likely undercounted by as much as 60 percent. The true tally of deaths in the country could be as high as 900,000.

Missouri, like much of the nation, is experiencing troubling increases in its coronavirus infection and hospitalization rates. The state is currently sixth in the nation in terms of how many residents have COVID-19 on a per capita basis, with 46 out of every 100,000 individuals in the state currently testing positive for it. It’s also fifth in hospitalization rates compared to the rest of the country, with its daily hospitalization number reaching 2,053 residents, on average, as of this week — an increase of 34 percent from where that rate was just two weeks ago.

Residents aren’t doing as much as they can to protect themselves from the virus, with only 42 percent of the state being vaccinated at this time, a rate that makes it the 13th worst state in the nation on that metric. Additionally, less than half of the state (49 percent) has received at least one dose of any of the vaccines that are available for protection against coronavirus.

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