Introduction to the Grant 

This grant project is physically based out of the Cobb County Medical Examiner’s Office (CCMEO) with use of a Cobb and Douglas Public Health (CDPH) Epidemiologist to perform all testing, sample preparation, data/project management, and communication between the two facilities and all others involved. Conveniently, the CCMEO and CDPH’s lead district facilities are less than 1/2 a mile away from each other. Both groups, with the addition of the Georgia Department of Public Health (GA DPH) and the Georgia Public Health Laboratory (GPHL), share access to data for purposes of surveillance, case follow-up, and other analyses. 

Cobb & Douglas Public Health Jurisdiction 

The Georgia Department of Public Health funds and collaborates with 18 separate public health districts, with CDPH being the Marietta 3-1 District. CDPH covers Cobb County and Douglas County. Cobb County comprises 345 square miles, including the cities of Marietta, Kennesaw, Smyrna, Acworth, Powder Springs, Austell, Mableton, two national parks and the unincorporated areas of Cobb County, with an estimated population of 766,802. Douglas County comprises 201 square miles, including the cities of Fairplay, Villa Rica, Douglasville, Lithia Springs, Austell, and the unincorporated areas of Douglas County, with an estimated population of 132,403. CDPH, as one of the largest public health districts in Georgia, is responsible for the protection and safety of nearly 900,000 residents. In order to provide adequate coverage and care for the residents in the Marietta 3-1 Public Health District, CDPH has 5 different Public Health Center locations as well as 2 Environmental Health locations. 

CDPH has been dedicated to a mission of creating healthier lives in a healthier community since 1920 by promoting health and safety through education and communication, providing access to exceptional medical services, tracking and preventing the spread of disease, and ensuring that the community is prepared for public health emergencies. In 2015, CDPH was recognized as the first public health district in the state of Georgia to achieve accreditation from the Public Health Accreditation Board (PHAB). To receive accreditation, CDPH had to demonstrate that it met or exceeded a set of national quality standards and measures through a rigorous, multi-faceted, and peer-reviewed assessment process.  

Cobb County Medical Examiner’s Office Jurisdiction 

CCMEO has jurisdiction of decedents that expire within the boundaries of Cobb County that fall under The Georgia Death Investigation Act (§45-16-24), except when death is on state property (investigated by Georgia Bureau of Investigation), or death is of military personnel at Dobbins Air Reserve Base (investigated by the Armed Forces Medical Examiner System). As noted by the Act, cases that require investigation include deaths: as a result of violence; by suicide or casualty; suddenly when in apparent good health; in any suspicious or unusual manner, with particular attention to those persons 16 years of age and under; after birth but before seven years of age if the death is unexpected or unexplained; as a result of an execution carried out pursuant to the imposition of the death penalty under article 2 of chapter 10 of title 17; when an inmate of a state hospital or a state, county, or city penal institution; after having been admitted to a hospital in an unconscious state and without regaining consciousness within 24 hours of admission; as a result of an apparent drug overdose; or when unattended by a physician.  

Acceptance of jurisdiction by the CCMEO means that a Medical Examiner (a medical doctor that has completed training in anatomic, clinical, and forensic pathology and is licensed by the state) will sign the death certificate. The extent of examination required for these deaths, if any, is at the discretion of the Medical Examiner. When possible, the Medical Examiner will honor family wishes regarding the extent and type of the examination performed within the bounds of the Georgia Death Investigation Act and best practices within the field of forensic pathology. 

Most counties in the state of Georgia, including Douglas County, have Coroners instead of medical examiners. Coroners are elected or appointed officials that can complete a death certificate, which means that any death within the county that requires further investigation must be sent to the Georgia Bureau of Investigation for a forensic pathologist to perform the autopsy. Due to these differences in death investigation protocol, Douglas County was not included in this grant project. 

Relationship Between CDPH and CCMEO 

Prior to beginning this grant, CDPH and CCMEO had an excellent working relationship. CCMEO was a primary reporter to CDPH for many diseases and deaths in the county, but thankfully they did not have to report too often. 

At the onset of the COVID-19 pandemic, the relationships between CCMEO and CDPH were developed even further. Since CCMEO does not have an in-house laboratory, they relied on CDPH to help request sample testing at the GPHL, enter each sample into their testing system, and ensure that each sample was taken to the lab by the regularly scheduled CDPH courier.  

Both CDPH and CCMEO came together to jointly develop this project and write the grant application. Staff from both offices contributed to the writing, and weekly meetings were held between the two groups to continue to refine the writing and the project ideas. 

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