A Santa Clara County woman now believed to be the first person in the U.S. killed by the novel coronavirus died of a ruptured heart caused by her body’s struggle to defeat the virus, her autopsy shows.

Patricia Dowd, 57, of San Jose, died at home on Feb. 6 of what seemed like a heart attack while suffering from what seemed like the flu. But this news organization reported Thursday that officials now say she had the coronavirus, which they didn’t know at the time.

A report on her autopsy, posted Saturday night by the San Francisco Chronicle, shows that her body struggled so hard against the virus that a valve in her heart ruptured, a pathologist who reviewed the document told this news organization. .

Dr. Judy Melinek, a Bay Area forensic pathologist who reviewed the autopsy report, said it showed the heart “muscle was infected, that’s what caused her heart to rupture.”

Dowd’s heart was a normal size and weight, Melinek said. Heart ruptures like the one Dowd suffered typically occur in people who have bad cholesterol levels.

“There’s an indication the heart was weakened,” Melinek said. “The immune system was attacking the virus and in attacking the virus it damaged the heart and then the heart basically burst.”

Dowd’s husband, citing his wife’s strong exercise habits and overall good health before falling ill, had requested an autopsy.

The results showed the role the virus played, which wasn’t known at the time of death, and is now considered a crucial missed opportunity in the battle against the virus and COVID-19, the disease it causes. Dowd’s death, as well as two others, on Feb. 17 and March 6, show the virus was spreading on the West Coast well before the first known U.S. case was flagged in Solano County in late February.

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“If we had understood then that people were already dying … we probably would have acted earlier than we did,” said Santa Clara County Health Officer Dr. Sara Cody at a Wednesday press briefing.

What was then thought to be the first coronavirus death in Santa Clara County was publicly reported March 9. As of Saturday, the county health department had reported 99 deaths attributed to the virus.