When Mount Mora was still a new cemetery in St. Joseph, the leading causes of death were pneumonia, tuberculosis and diarrhea. Cancer and heart disease are the leading killers today.

Weathered headstones and gentle hills provide a sense of tranquility inside the stone walls of Mount Mora Cemetery.

Those buried here include generals, politicians and industrialists from St. Joseph’s founding days and Gilded Age. Their accomplishments still echo today, but their deaths are shrouded in time.

More than likely, the end wasn’t pretty for anyone buried in a cemetery that opened in 1851. Pneumonia, influenza, tuberculosis and diarrhea were the most common causes of death at the dawn of the 20th century, according to statistics from the U.S. Centers for Disease Control and Prevention.

Things are different today, thanks to advances like antibiotics and modern water and sewage treatment. Someone in 2020 is most likely to die from heart disease, cancer and chronic lower respiratory disease. St. Joseph is no exception.

“We think we’re special, and we are special for other reasons, but not for how we die,” said Dr. Jane Schwabe, a cardiac surgeon at Mosaic Life Care. “Buchanan County is exactly like the rest of the United States. The number one killer is heart disease. The second most common cause of death is

cancer, and lung cancer is the most common of all cancers.”

The coronavirus pandemic places a new spotlight on how we die, with some questioning the high fatality totals attributed to COVID-19. As of Friday, the virus has caused 17 deaths in Buchanan County and more than 190,000 fatalities nationwide.

Media reports don’t reflect the reality that a person often dies from multiple causes, with room on a death certificate for an immediate factor and three others leading up to it. COVID-19 can act as a trigger that leads to the death of a patient, especially an elderly one. They might have lived five more years with a certain condition, but not after COVID.

“Usually when somebody dies, it’s not just one thing that takes their life. It’s a series of events,” Schwabe said. “COVID was sort of the ball that got things rolling and their bodies couldn’t take it anymore. Had the initial event of the virus not happened, they would not have died at this particular time.”

Dr. Adam Wineinger, Buchanan County’s medical examiner, noted a similar phenomenon with patients who died of pneumonia after getting AIDS.

“We’re probably undercounting the coronavirus deaths, to be honest with you,” said Wineinger, who is called to find a cause in suspicious and unattended deaths.

This year, Wineinger notices a trend of more overdose deaths in Buchanan County, with 16 so far in 2020 and three or four cases pending. All of last year brought 15 overdose deaths.

“Last year was a record number,” he said. “It’s a problem across the country.”

Medical professionals caution against looking at numbers as the sole measure. Buchanan County averages about 240 deaths due to heart disease a year, but that doesn’t mean those 16 or so overdose deaths don’t merit some sort of action, such as prescription drug monitoring.

The same could be said for COVID-19, especially when considering, unlike heart disease or diabetes, the virus can be transmitted to friends, co-workers and loved ones.

“It is a serious disease. It’s real,” said Schwabe, who calls wearing a mask part of “being a good citizen on the planet.”

Many people do take coronavirus precautions seriously, which makes Schwabe wonder what would happen if a similar focus was devoted to some of the leading causes of death. Buchanan County trends higher than the state average in deaths from heart disease, chronic lower respiratory disease and diabetes. All have a link to smoking or unhealthy lifestyles.

Health rankings from the Robert Wood Johnson Foundation estimate that Buchanan County residents lost a combined 8,800 years of life from premature death from 2016 to 2018. The rankings calculate that figure under the assumption that the average person lives to age 75. A newborn baby would lose 75 years, a 20-year-old who dies in a car accident loses 55 years and a 70-year-old who has a heart attack loses five years.

The sad thing is many of those deaths are preventable.

“I think preventative medicine is not very sexy,” Schwabe said. “People get more excited about a cure or a pill or a potion or something, but preventative medicine is what’s going to make us live longer. It’s harder to do: Eating right. Exercising. Not smoking. Getting eight hours of sleep. We need to do them consistently every day.”

Greg Kozol can be reached at greg.kozol@newspressnow.com. Follow him on Twitter: @NPNowKozol.