AUSTIN (KXAN) — It’s been five days since temperatures in Austin rose back above freezing but damage across the city remains — and some damage hasn’t even begun to be assessed.

Wintery weather blankets Dell Diamond in Round Rock on Feb. 14 (KXAN/Andrew Choat)

The Texas Department of State Health Services (DSHS) says it will likely take several more weeks before the state has an idea of just how many deaths are related to last week’s historic winter storms.

There are reports across the state of deaths related to the storm.

These include a Williamson County man who died of hypothermia, a man found dead in a 35-degree Bexar County home, an 11-year-old boy in the Houston area who died during an extended power outage, and the Texas Tribune’s reporting that six Texans experiencing homelessness died during the storm.

But before the state can formally tally a death total, the conditions of those deaths have to be validated by medical examiners — a process that will take a while.

Snow coming down at 5th Street and Congress Avenue in Austin. Feb. 14, 2021. 11:30 p.m. KXAN Photo/ Frank Martinez.

In Travis County, for example, how long it takes the medical examiner to complete an autopsy report varies from case to case, though on average the report is ready 30 to 90 days after receiving a body. During that time, relevant information (such as toxicology) is gathered and given to the pathologist, who then determines the cause and manner of death, a county spokesperson said.

DSHS explained that the state’s disaster epidemiologists will review the information from medical examiners across Texas to determine how many deaths were actually related to the winter storm. Additionally, DSHS plans to look through media coverage of the storms to identify deaths that medical examiners may not have listed as disaster-related.

“This process takes a while to complete and it will likely be weeks before we have a preliminary number to share.”

Spokesperson, Texas Department of State Health Services

When these local statistics are submitted to the state, DSHS said the deaths will be grouped based on whether they are directly, indirectly, or possibly related to the storm.

According to DSHS:

  • Direct —Refers to a death caused by the environmental force of the disaster (e.g., wind, rain, floods, or earthquakes) or by the direct consequences of these forces (e.g., structural collapse, flying debris).
  • Indirect— Refers to unsafe or unhealthy conditions, or conditions that cause a loss or disruption of usual services that contributed to the death. Unsafe or unhealthy conditions may include but are not limited to hazardous road conditions, contaminated water supplies, scattered debris. Disruptions of usual services may include but are not limited to utilities, transportation, environmental protection, medical care, or police/fire.
  • Possible— Refers to a death that occurred in the disaster-affected area during the disaster period. The cause of death appears to be directly-related or indirectly-related to the event but for which there is inadequate information available to make that determination at the time of recovery.

A spokesperson for Travis County told KXAN that the county’s medical examiner received 86 cases (bodies) between Feb. 13 and Feb. 20. Of these, 64 were from Travis County and 22 were from places outside the county that do not have medical examiner’s offices.

That is a higher number of cases than what the Travis County Medical Examiner’s Office saw during the same time frame in the year prior: 70 cases (this includes cases from both Travis County and outside counties). But in 2020, temperatures were not nearly as cold as they were this month and the region was not yet aware of any local COVID-19 transmission.

As of Wednesday, a Travis County spokesperson confirmed that only one of the 86 deceased individuals from last week had yet to be identified.

“It is not possible to state at this time how many cases received by the Medical Examiner’s office were a direct result of the winter storm.”

Spokesperson, Travis County, February 24

The details of these deaths can be challenging to parse.

For example, a woman experiencing homelessness in Austin was found dead in a tent on February 15 at the state-sanctioned homeless encampment, according to Austin police. First responders who were called to the site were told someone had suffered cardiac arrest, then arrived to find the woman already dead.

According to the National Weather Service, the highest temperature that day at Austin-Bergstrom International Airport (four miles away from the camp) was 23 degrees and the lowest temperature was nine degrees. Another resident of the camp told KXAN his guess is that the woman died of hypothermia.

Autopsy room at the Travis County Medical Examiner’s Office (KXAN/Sarah Rafique)

Travis County will need to identify this woman’s body, then determine whether heart failure, hypothermia, or something else was the cause of her death. That process could take weeks to months.

It is the medical examiner’s job to determine someone’s cause of death. However, Travis County noted in a response to KXAN that the examiner does not associate or link the total number of deaths to any particular event.

While the community may be used to receiving daily updates on COVID-19 death totals from Austin-Travis County, a Travis County spokesperson explained even for COVID-19 deaths, final autopsy reports still take between 30 to 90 days to complete.

Travis County Medical Examiner’s Office (KXAN/Sarah Rafique)

KXAN asked the Travis County Medical Examiner’s Office: is it possible the public may never know exactly how many people died in Travis County as a result of these winter storms?

“The medical examiner’s office will make final determinations of the cause and manner of death of each individual who was examined by our office during the period of the storm,” a Travis County spokesperson responded.

The spokesperson also cautioned, “how the cause and death are related to the storm may be a matter of interpretation.”

“For example, a car accident that occurs because of driving on icy roads may ultimately be determined to have a cause of death of blunt force trauma, with the manner as an accident. Some may ‘relate’ that death to the storm, although the cause and manner of death shown on the death certificate may not reflect that.”

Spokesperson, Travis County February 24, 2021

Commander Mike Benavides with Austin Travis County EMS explained that ATCEMS medics — in a winter storm or in any other instance — do not have the authority to determine someone’s cause of death. ATCEMS employees can only share if a person was involved in a particular incident and obtain a pronouncement of death at the scene.

Benavides explained that police officers and firefighters each have terms they use for when they believe a person is obviously dead, and when ATCEMS arrives at the scene, medics decide either to begin, continue, or end efforts to resuscitate the person. When the ATCEMS employees don’t believe the person can be resuscitated, they call the medical director to obtain a pronouncement and time of death.

Ice on Martin Luther King Jr. Boulevard on Feb. 14 (KXAN/Frank Martinez)

A person’s cause of death is not always what bystanders may assume, Benavides said.

For example, he suggested that if a person fell and died after walking on an icy sidewalk, it may be difficult for anyone watching to tell if it was the slippery ice that killed the person or a cardiac event that caused the person to fall.

Benavides has seen news reports from around Texas in the past week suggesting that people “froze to death” at home.

“I think it’s kind of a leap to say, because it was cold outside or it was freezing, to say they froze to death,” Benavides said.

“Is it possible? Absolutely,” he continued. “Did it happen like that? No clue.”

“That’s why the medical examiner’s role in this is important, because the medical examiner and law enforcement are the ultimate determining authority for cause of death.”

There are certain instances, like when a person has a gunshot wound to the head, where the cause of death may be obvious to medics. But even then, Benavides emphasized, it is up to the medical examiner to do the evaluation on the cause and manner of that person’s death.

February 15 (KXAN/Frank Martinez)

While ATCEMS doesn’t currently have any kind of formal alert asking staff to be on the lookout for people who may have died during the winter storms, Benavides said, “we know that’s always a possibility with any type of natural disaster.”

Tuesday, Bexar County Sheriff Javier Salazar told reporters he believes “at this very moment there are people lying dead inside homes that we still haven’t discovered” as a result of the winter storms.

Salazar announced Tuesday that his office would create an investigative unit to look into around fifteen deaths during the recent winter storm and to figure out whether freezing temperatures or power outages contributed to those deaths.

Although Salazar said it’s still too early to tell if negligence by a utility company contributed to these deaths, he did not rule out the possibility that charges could be filed if the investigation finds negligence.

When asked if Travis County was carrying out a similar investigation, a spokesperson for the Travis County Sheriff’s Office said “we are not currently working any cases involving suspicious deaths that occurred during the winter storms” and that TCSO has “not been informed by the medical examiner that we have any deaths that fall into that category, therefore we have no active investigations.”

This article was updated on February 25, 2021 to reflect updated data from Travis County.