A US family's search for answers: Did their brother die of Covid-19?

Patrick Hidalgo died on March 2, 2020, the day after Florida announced its first confirmed Covid-19 cases. PHOTO: NYTIMES

MIAMI (NYTIMES) - The Hidalgo siblings buried their younger brother, Patrick, six days after he had texted them in the middle of the night last March to say that something was wrong: He was gasping for air. Two days after that, paramedics found his body in his Miami Beach apartment. One of his hands still held a rosary.

To his Mass of Resurrection came relatives from California and Maryland, ex-classmates from Boston, former colleagues from Washington. A woman he loved flew in all the way from Dubai, United Arab Emirates.

In the following days of March 2020, the coronavirus brought life in the United States to an abrupt halt. Only then, as their shock subsided and grief deepened, did the Hidalgo family start to wonder if Patrick, their 41-year-old brother who had radiated light and glued them together, had died of Covid-19.

Families who lost someone with little warning and no obvious explanation in those whirlwind early days of the pandemic were robbed of the comfort of knowing exactly what took the person they loved.

Patrick Hidalgo died in that murky period a year ago when the nascent virus outbreak - where it came from, how far it had travelled - was only beginning to be understood. As the first deaths were recorded across the country, families like his found themselves in a state of haunting uncertainty that has never gone away.

There have likely been a half-million more deaths linked to the virus than what has been officially reported, including more than 68,000 in the US, according to analyses of death rates around the world. Some families have gone to great lengths to try to get death certificates revised to list Covid-19 or to prove that the deceased had the virus in the first place. They often have little help from authorities, who are swamped - or, some people fear, downplaying the virus.

Unable to obtain definitive proof, families are left with the uneasy feeling that, had it not been for the pandemic, their loved one might still be alive.

"I don't know that we'll ever have closure or fully understand," said Rosie Hidalgo, one of Patrick's four older siblings. "And that's hard." That the virus could have contributed to Patrick Hidalgo's death had not immediately occurred to them.

He died March 2, 2020, the day after Florida announced its first confirmed Covid-19 cases. He was buried March 7. The NBA suspended its season, a decision that made the crisis feel real to many people, on March 11.

On March 13, a cousin who had gone to Hidalgo's funeral, Mayor Francis Suarez of Miami, tested positive. Others attendees wondered if Suarez had exposed them before realising that he had likely become infected after the funeral.

In June, the Miami-Dade County medical examiner concluded after an autopsy that Hidalgo had died of undiagnosed hypertensive heart disease, noting an enlarged heart. Some of Hidalgo's siblings rushed to doctors to check if they too might have sick hearts that could give out.

But it nagged at them. Heart disease? Their brother had suffered from serious acid reflux, but he ate egg whites and spinach and frequented the gym. He went to the doctor right away when he felt ill. What if the autopsy was wrong?

"Within literally days of his death, Covid became a thing; it kind of burst into the social consciousness," said Mike Llorente, a friend. "It seemed to me to be a much simpler answer." The siblings - Ellie, Rosie, Manny and Bibi Hidalgo - could not stop thinking about the possibility.

The children of Cuban exiles, they were raised in a deeply Catholic family big on community service and civic duty. Their mother, Eloísa Suárez Hidalgo, had been a political prisoner in Cuba. Their father, Manuel J. Hidalgo Sr, whom Patrick took to Mass on Sundays, made a point to bring his young children with him when he went to vote.

Patrick Hidalgo grew up in Miami, left for Georgetown, Harvard and Massachusetts Institute of Technology, and returned as a political organiser and social entrepreneur five years before his death, sending his siblings, all of whom lived in other states, updates about their parents via videos and texts.

"Every morning I wake up in shock," said his sister Bibi Hidalgo, who hardly let a day go by without speaking to her brother. "Every night, I can't go to bed, thinking, 'I can't tell my little brother good night. I'm not going to get one of his funny memes tomorrow.'"

Patrick Hidalgo believed Miami needed people like him, a former Obama administration staffer who contributed to the former president's 2016 speech in Havana. Barack Obama sent his family a condolence letter that remembered his "kindness, exceptional intellect, devotion to faith, and tenacity to fight for a better tomorrow."

Eleven days before he died, Hidalgo told a New York Times reporter about the Miami Freedom Project, an initiative he co-founded to advance progressive policies among the city's immigrants and their descendants, who tend to resist proposals that remind them of the left-wing Latin American governments they left behind.

"This community is all about freedom, especially those that have fled dictatorships," he said. "It becomes this driving force of your life, or your parents' and grandparents' lives." Hidalgo's siblings sifted through text messages to trace his final days. A physical therapy appointment. The gym. Friday night out with friends. A presidential campaign event for Senator Elizabeth Warren. A prayer group in his apartment the night before he died.

They read and re-read the text message to the family group chat about waking up in a cold sweat, short of breath. He thought it was related to stress. That morning - Sunday, March 1 - Rosie Hidalgo called her brother to ask if he was OK.

"He said no," she said. He told her he felt tired and run down, as if he were coming down with something.

"He was so involved in so many things," she added. "He thought, 'Maybe I'm just running myself ragged.'" It was the last day Patrick Hidalgo was seen alive. He sent his final text at around 1am March 2. The paramedics found his body a day later, on Super Tuesday.

When Rosie and Ellie Hidalgo went to pack up his apartment, a doorman recalled how Patrick Hidalgo had bid farewell to his prayer group at the entrance of the building on the eve of his death. He had a cough and told the doorman he did not feel well. "That's the last person he ever spoke to," Rosie Hidalgo said.

The siblings asked the medical examiner's office five times between April and June to send samples of their brother's remains for coronavirus testing. Darren J. Caprara, an office spokesperson, said the tests are conducted only when justified, and there were "no obvious indicators" when Hidalgo's body arrived in March.

"Symptoms such as shortness of breath and a cough were brought to our attention long after we had determined his cause of death from autopsy," Caprara said in a statement. Based on Hidalgo's medical history and the autopsy findings, he said, his office stands by its ruling that hypertensive heart disease was the cause of death.

Through a friend, the family reached Dr Charles C. Marboe, a pathology and cell biology professor at Columbia University Medical Centre, and hired him in May to consult on Patrick Hidalgo's case. Marboe reviewed the autopsy tissue samples and completed a two-page report in October.

"I do not see a specific definitive cause of Mr Hidalgo's death in the material provided," he wrote.

But one autopsy finding was of note: acute lung injury that included bleeding in tiny air sacs called alveoli. He had seen similar symptoms in many early Covid-19 deaths in New York.

The lung bleeding could also have been caused by another viral infection or from gastric acid, he said, though no food particles were found to suggest that Hidalgo's reflux was the cause.

"It looked similar to changes that we have seen due to Covid-19 damage," he said.

There was no way to know for sure, in part because of the poor quality of the tissue samples, a consequence of the days that elapsed between Hidalgo's death and when his body was found.

"I feel bad about it, because I know it's not any help for the family," Marboe said.

When the nation's first coronavirus deaths were reported early in 2020, many people wondered whether symptoms they had had that winter might have been caused by the coronavirus. Experts in the United States have said it was likely most of those illnesses in December 2019 and January 2020 were the flu. But by the time Hidalgo died, it was March, when the virus was already spreading.

Hidalgo's siblings felt validated by Marboe's report. They publicised it and denounced elected leaders' failure to alert the public earlier that the virus was likely spreading. They said there was a "high probability" that their brother had died of Covid-19 because of the "wilful negligence" of former President Donald Trump, the state and the county, who had failed to warn the public that it was dangerous to continue going about their lives as usual when a deadly virus was on the loose.

"It's been such an incredible agony, thinking what we could have done differently," Bibi Hidalgo said. "He would have stopped going to the gym. He would have stopped going to restaurants. He would have gone to the hospital that morning if we had been aware that the pandemic was already circulating all around the United States."

After his death, one of Patrick Hidalgo's nieces enrolled in the University of Miami and campaigned for President Joe Biden as her uncle might have done. Another niece took a semester off from Tufts University and worked for the Miami Freedom Project. His family and friends dedicated Election Day to him, going precinct to precinct to deliver personal protective equipment, snacks and water.

On Tuesday, the anniversary of his death, the family held a memorial Mass at a chapel at Georgetown University, his alma mater. A musician played Amazing Grace and The Beatles' Let It Be. More than 100 people joined on Zoom.

Through tears, Bibi Hidalgo led the prayers of the faithful.

"We lift up a special prayer for everyone who has passed away due to Covid-19," she said, "including our dear Patrick."

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