57-year-old Patricia Dowd, whose early February 2020 was later determined to have been caused by an undiagnosed COVID-19 infection, becoming the first recorded American death in the pandemic, was actually not the first COVID death in the U.S. after all.

Coroners and medical examiners in several states have quietly amended six death certificates in recent months, altering the official timeline of when COVID-19 likely first entered the country. And while it is still unknown where Dowd became infected, we now have a mystery about these six other people, some of whom died in January 2020 in states where very little travel to and from China occurs.

Bay Area News Group reported Monday on the revised data from the CDC's National Center for Health Statistics (NCHS), which shows deaths from all respiratory illnesses in the first three months of 2020. The data now shows that deaths attributed to COVID-19 occurred in each of the first weeks of January, the first occurring in the week ending January 11, the first full week of the new year. China did not report its first COVID-related death until January 9, having first reported on the novel, circulating virus in December 2019.

The deaths occurred in California, Georgia, Kansas, Alabama, Oklahoma, and Wisconsin.

Given that COVID deaths tend to occur an average of three weeks after infection, with some occurring up to six or more weeks later, this means that the virus was actually spreading in the United States in December, if not in November — something that several epidemiologists surmised early on in the pandemic. These new deaths also confirm that what some California hospitals first detected as an "early flu season" might actually have been attributable to undiagnosed COVID, possibly before China had even disclosed the existence of the virus.

Dowd died on February 6, a week after the first known case of COVID was detected in the Bay Area in a man who had traveled to Santa Clara County from Wuhan.

The Wisconsin Department of Health Services says that another woman in her 50s died on January 22 of probably COVID complications. The other four states have declined to disclose any details about their early COVID deaths, citing privacy concerns.

"We need to sit back and really assess what was this thing, when it started, how did we handle it, did we create more of a problem than we needed to, could we have handled things differently?” says Matthew Memoli, director of the clinical studies unit at the Laboratory of Infectious Diseases at the National Institutes of Health, speaking to Bay Area News Group. “There’s a lot to think about here.”

Memoli adds that he "always thought it had to have been here in the U.S. well before we identified it as a big problem."

While it remains possible that the so-called certifiers of these deaths made judgments in error, these officials tend not make amendments to death certificates without significant reason to do so. Experts tell Bay Area News Group that the changes were likely made because new evidence was found — either a blood sample taken from the patient was available to be tested, or it was later learned that the patient had traveled to a hot spot of the virus, like Wuhan.

The fact that the deaths occurred in such disparate places across the country, though, suggests there was widespread community transmission occurring months before health officials began putting restrictions on businesses and travel. Epidemiologists have previously argued that the coronavirus likely took many unsuccessful paths into the country before finding successful ones on the West Coast and in New York City, leading to the first known outbreaks. This new data gives credence to this idea, and broadens the geography for those entry points.

Memoli and his team have been doing research that suggests that by July of last year, there were probably five or more undetected COVID cases for every recorded case in the country.

The CDC has also been studying blood samples from the American Red Cross taken in December 2019 and January 2020 in nine states, and they've found COVID antibodies present in all nine states.

Previously: New Autopsies Show Community Transmission of the Coronavirus In Santa Clara County In January or Earlier

Photo: UCSF