The first coronavirus death in the US happened several weeks earlier than initial reports believed, according to autopsies performed in California, underlining how far behind the country was in stopping the spread.

A man in Santa Clara County died with Covid-19 on 6 February, three weeks before the first recorded deaths from the virus in the US were reported on 29 February, after two people died at a hospital in Washington state. Officials later discovered that two others in the state had died with the disease caused by the virus on 26 February.

The California discovery also means the first initially reported coronavirus death in Santa Clara, on 9 March, was actually a month after the first death in the area.

Santa Clara County’s medical examiner identified two people whose deaths were linked to coronavirus on 6 February and 17 February, weeks before the first Washington state death was reported as the first coronavirus death in the US. The Centres for Disease Control and Prevention confirmed the results of lab tests.

Dr Sara Cody, the county’s chief medical examiner, said that the “significant” findings represent the “tip of an iceberg of unknown size” as similar findings from previously recorded deaths could show the depth and spread of the virus than what was previously believed. Delayed positive Covid-19 results from earlier deaths could also radically alter the nation’s death toll, which has reached more than 45,000.

The medical examiner also confirmed another person in the county who died from Covid-19 on 6 March.

In a statement, the office said that the three patients “died at home during a time when very limited testing was available only through the CDC” and underlined the strict testing criteria from the federal health agency at the onset of the outbreak.

The medical examiner said the office will “anticipate additional deaths” from the disease that were previously not identified.

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Santa Clara County’s Dr Jeffrey V Smith said the deaths “reveal that the virus was around for a long time” before reports previously had suggested. “It was probably around unrecognised for quite some time.”

Washington was the initial epicentre of the US outbreak, with the first reported case of the virus on 21 January in a patient who had recently travelled to Wuhan, China.

The state implemented stringent quarantine efforts and physical distancing measures beginning in February.